Trends and survival outcomes of robotic, laparoscopic, and open surgery for stage II uterine cancer

Abstract

IntroductionA recent randomized clinical trial showed that minimally invasive surgery led to poorer survival compared with open surgery in early stage cervical cancer. We determined the trends in adoption of minimally invasive surgery and 5-year overall survival outcomes after open, laparoscopic-assisted, and robotic-assisted hysterectomy for stage II uterine cancer with cervical stromal involvement.MethodsData for patients with stage II uterine cancer were acquired from the National Cancer Database from 2010 to 2015. χ2 testing, Kaplan–Meier methods, and Cox models were used for statistical analyses.ResultsOf 2949 patients, 44.3% underwent open hysterectomy, 13.9% underwent laparoscopic hysterectomy, and 41.8% underwent robotic hysterectomy. The proportion of robotic cases increased from 26.8% in 2010 to 48.3% in 2015 (annual percent change 10.1%), with a decrease in open hysterectomy from 63.3% to 34.3% (annual percent change –12.5%). The overall 5-year survival was 77.6% in robotic, 76.8% in laparoscopic, and 72.5% in open hysterectomy (p=0.045); however, after adjusting for known prognostic factors, robotic (HR 1.00, 95% CI 0.82 to 1.21; p=0.97) and laparoscopic hysterectomy (HR 1.09, 95% CI 0.83 to 1.44; p=0.54) did not portend for improved survival compared with open hysterectomy. Black women (HR 1.59, 95% CI 1.25 to 2.02; p<0.001) and individuals with co-morbidities (HR 1.45, 95% CI 1.21 to 1.75, p<0.001) had worse adjusted survival and the highest rates of open hysterectomy.ConclusionThe use of minimally invasive surgery for stage II uterine cancer has increased over time, with comparable adjusted 5-year survival after robotic or laparoscopic hysterectomy compared with open hysterectomy. Black women and those with co-morbidities had lowest rates of minimally invasive surgery and the poorest adjusted survival.

Comparison of Minimally Invasive Versus Abdominal Radical Hysterectomy for Early-Stage Cervical Cancer: An Updated Meta-Analysis

“…( 25 ) reported in an international European cohort observational study that early-stage cervical cancer patients undergoing MIS increased the risk of recurrence and death compared with those undergoing ARH. In addition, we observed that in many retrospective studies ( 28 , 30 , 33 , 41 , 47 , 51 , 57 , 59 ), the MIS group had a shorter follow-up time than that of the ARH group. In order to objectively evaluate the effect of MIS and ARH on the prognosis of patients with early-stage cervical cancer, more adequate follow-up time is needed.…”

“…Additionally, Abel et al. ( 33 ) revealed that stage II cervical cancer undergoing MIS or ARH revealed comparable 5-year survival rates. Nonetheless, some recent studies have demonstrated that early-stage patients undergoing MIS had poorer DFS and OS than those undergoing ARH.…”

“…Brandt et al (43) evaluated 196 cases and presented similar results that MIS had no association with a 5-year prognosis in patients with earlystage cervical cancer. Additionally, Abel et al (33) revealed that stage II cervical cancer undergoing MIS or ARH revealed comparable 5-year survival rates. Nonetheless, some recent studies have demonstrated that early-stage patients undergoing MIS had poorer DFS and OS than those undergoing ARH.…”

Uterine Neoplasms, Version 1.2023, NCCN Clinical Practice Guidelines in Oncology

“…[131][132][133][134][135] Prospective cohort and retrospective studies suggest that robotic approaches perform similarly to laparoscopy and result in comparable or improved perioperative outcomes. [135][136][137][138][139][140] Oncologic outcomes appear to be comparable to other surgical approaches, although longer-term outcomes (including quality of life) are still being investigated. [141][142][143] In heavier patients, robotic surgery may result in less frequent conversion to laparotomy when compared with laparoscopic approaches and also appears to be safe and feasible in patients at higher anesthesiologic risk.…”

Analgesic effects of intrathecal morphine and bupivacaine during robotic‐assisted surgery: A prospective randomized controlled study

“…It is also considered more ergonomic for the surgeon, as well as a more precise and, therefore, safer procedure than traditional laparoscopy. [1][2][3] At the Central Hospital Karlstad (Sweden), we perform around 100 robotic-assisted hysterectomies per year, of which the largest group, around 40, is because of uterine malignancy. Indications for the rest of the procedures are persisting premalignant conditions in the cervix, heredity of gynecological-or breast malignancy, benign fibroids in the uterus or excessive bleeding.…”