Classification of Postoperative Complications in Robotic-assisted Compared With Laparoscopic Hysterectomy for Endometrial Cancer

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• 作者：Allison Barrie ; MD^a ; Alexandra H. Freeman ; MD^a ; Liisa Lyon ; MS^b ; Christine Garcia ; MD^c ; Carol Conell ; PhD^b ; Laura H. Abbott ; MD^a ; Ramey D. Littell ; MD^d ; C. Bethan Powell ; MD^b ; ^d ; ^{Bethan.Powell@kp.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Endometrial cancer ; Minimally invasive hysterectomy ; Robotic surgery ; Surgical complications
• 刊名：Journal of Minimally Invasive Gynecology
• 出版年：2016
• 出版时间：November-December 2016
• 年：2016
• 卷：23
• 期：7
• 页码：1181-1188
• 全文大小：339 K

文摘

To compare intraoperative and postoperative surgical complications and outcomes between robotic-assisted and laparoscopic surgical management of endometrial cancer using a standardized classification system.

d="absSec_2">Design

d="abspara0015">A retrospective cohort study (Canadian Task Force classification II-2).

d="absSec_3">Setting

d="abspara0020">An integrated health care system in Northern California.

d="absSec_4">Patients

d="abspara0025">One thousand four hundred thirty-three women with a diagnosis of complex atypical hyperplasia and endometrial cancer managed by minimally invasive hysterectomy and surgical staging from January 2009 to January 2014.

d="absSec_5">Interventions

d="abspara0030">Seven hundred forty-five robotic-assisted and 688 laparoscopic hysterectomies were evaluated.

d="absSec_6">Measurements and Main Results

d="abspara0035">The primary outcome was intraoperative and postoperative complications within 30 days. All complications were categorized using the Clavien-Dindo classification system. Secondary outcomes included total operative time, estimated blood loss, transfusion rates, length of stay, conversion to laparotomy, and number of pelvic and para-aortic lymph nodes retrieved. The modality of hysterectomy was not associated with either overall intraoperative complications or major postoperative complications (p > .1). However, there were significantly fewer minor postoperative complications with robotic surgery (16.6% vs 25.6%, p < .01). Statistically significant differences were also noted in the following outcomes: decreased median operative time, length of stay, estimated blood loss, conversion to laparotomy, and median number of lymph nodes retrieved in the robotic group when compared with the laparoscopic group.

d="absSec_7">Conclusion

d="abspara0040">There was no difference in the rate of major complication between robotic and laparoscopic surgery using the Clavien-Dindo system of categorizing surgical complications; however, there were clinically significant differences favoring the robotic approach, including a lower rate of minor complications and conversion rate to laparotomy.