Robot-assisted versus open radical hysterectomy: A multi-institutional experience for early-stage cervical cancer

• Published in: European journal of surgical oncology Vol. 42; no. 4; pp. 513 - 522
• Main Authors: Sert, B.M, Boggess, J.F, Ahmad, S, Jackson, A.L, Stavitzski, N.M, Dahl, A.A, Holloway, R.W
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-04-2016
• Subjects: Cervical cancer; Early-stage; Female; Hematology, Oncology and Palliative Medicine; Humans; Hysterectomy - methods; Incidence; Intra-operative complications; Middle Aged; Morbidity; Neoplasm Recurrence, Local - epidemiology; Neoplasm Staging; Norway - epidemiology; Open radical hysterectomy; Prognosis; Recurrence; Retrospective Studies; Robotic radical hysterectomy; Robotics - methods; Surgery; Survival; Survival Rate - trends; United States - epidemiology; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - surgery; Norway; United States; Recurrence; Early-stage; Intra-operative complications; Open radical hysterectomy; Robotic radical hysterectomy; Survival; Cervical cancer; Morbidity
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2015.12.014

Abstract Objective To compare perioperative and clinico-pathological outcomes of patients with early-stage cervical cancer who underwent robot-assisted radical hysterectomy (RRH) and open radical hysterectomy (ORH). Methods This retrospective multi-center study abstracted demographic, clinico-pathological and perioperative outcomes data from medical records of 491 cervical cancer patients treated with RRH (n = 259) ORH (n = 232) between 2005 and 2011 at two American and one Norwegian University Cancer Centres. Results Mean estimated blood loss (EBL) and transfusion rates were less for RRH than for ORH (97 vs. 49 mL, p  < 0.001, and 3% vs. 7%, p  = 0.018, respectively). Mean length of hospital stay (LOS) was significantly shorter in RRH versus ORH (1.8 vs. 5.1 days, p  < 0.001). Mean operative time was longer for RRH than ORH (220 vs. 156 min, p  < 0.001). Although overall complications were similar ( p  = 0.49), intra-operative complications were less common in the RRH group than ORH (4% vs. 10%, p  = 0.004). In multivariate regression analyses longer operative time, less EBL and intra-operative complications, shorter LOS, and more pre-operative cone were significantly associated with RRH versus ORH. Recurrence and death rates were not statistically different for the two groups at a mean follow-up time of 39 months ( p  = 1.00 and p  = 0.48, respectively). Conclusions RRH had improved clinical outcomes compared to ORH in the treatment of early-stage cervical cancer in terms of EBL, intra-operative complications, transfusion rates, LOS, and pre-operative cone. Disease recurrence and survival were comparable for the two procedures.