A comparison of outcomes following robotic-assisted staging and laparotomy in patients with early stage endometrioid adenocarcinoma of the uterus with uterine weight under 480 g

详细信息    查看全文

• 作者：Michael A. Ulm^a ; ^{michaelulm81@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Daniel N. Ginn^b ; Adam C. ElNaggar^c ; Todd D. Tillmanns^a ; Kevin M. Reed^d ; Jim Y. Wan^e ; Catherine H. Watson^f ; Sheetal J. Dedania^f ; Mark E. Reed^a
• 关键词：endometrial cancer ; laparotomy ; robotic surgical procedures
• 刊名：Gynecology and Minimally Invasive Therapy
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：5
• 期：1
• 页码：25-29
• 全文大小：325 K

文摘

To directly compare perioperative morbidity and hospital stay after robotic-assisted staging and laparotomy in patients with early stage endometrial endometrioid adenocarcinoma and uterine weight under 480 g.

Design

Retrospective cohort study.

Setting

The West Clinic in Memphis, TN, USA.

Patients

Patients with Stage IA and Stage IB endometrial endometrioid adenocarcinoma and uterine weight less than 480 g from June 2007 to January 2011.

Interventions

Patients underwent hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection with or without para-aortic lymph node dissection using robotic-assisted surgery or open laparotomy.

Measurements

Perioperative complications and morbidity, length of hospital stay, progression-free survival, overall survival, time to recurrence, and time do death from disease.

Main Results

A total of 160 patients who underwent laparotomy and 165 patients who received robotic-assisted staging were identified. Compared with robotic-assisted staging, laparotomy was associated with increased hospital stay (3 days vs. 1.4 days, p < 0.001), greater estimated blood loss (237 cm³ vs. 102 cm³, p < 0.001), larger uterine weight (136 g vs. 116 g, p < 0.001), as well as higher incidence of postoperative complications [29.3% vs. 6.7%, odds ratio (OR) 5.82, 95% confidence interval (CI) 2.1–11.7] including postoperative ileus (9.0% vs. 1.0%, OR 7.82, 95% CI 1.7–35.0), wound infection (6.0% vs. 1.0%, OR 5.43, 95% CI 1.2–25.2), and postoperative atelectasis (4.0% vs. 0%, p < 0.01). There were no differences in projected 5-year progression-free and overall survival rates.

Conclusion

Use of the daVinci robotic system was associated with less intraoperative blood loss, fewer postoperative complications, and shorter hospital stay compared with laparotomy for patients with uterine weight less than 480 g.