Robotic Versus Open Radical Hysterectomy in Women With Locally Advanced Cervical Cancer After Neoadjuvant Chemotherapy: A Single-institution Experience of Surgical and Oncologic Outcomes

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• 作者：Vanna Zanagnolo ; MD^a ; ^{vanna.zanagnolo@ieo.it" class="auth_mail" title="E-mail the corresponding author} ; Lucas Minig ; MD ; PhD^b ; Jose Miguel Cá ; rdenas-Rebollo ; PhD^c ; Maria Teresa Achilarre ; MD^a ; Annalisa Garbi ; MD^a ; Maria Guadalupe Patrono ; MD^d ; Nicoletta Colombo ; MD ; PhD^a ; Angelo Maggioni ; MD^a
• 关键词：Abdominal radical hysterectomy ; Complications ; Locally advanced cervical cancer ; Neoadjuvant chemotherapy ; Robotic radical hysterectomy
• 刊名：Journal of Minimally Invasive Gynecology
• 出版年：2016
• 出版时间：September-October 2016
• 年：2016
• 卷：23
• 期：6
• 页码：909-916
• 全文大小：601 K

文摘

To compare the surgical and oncologic outcomes of robotic radical hysterectomy (RRH) versus laparotomy in women with locally advanced cervical cancer (LACC) after neoadjuvant chemotherapy (NACT).

Setting

Oncology referral center.

Design

A retrospective comparative observational study was performed in 30 patients with LACC Fédération Internationale de Gynécologie et d'Obstétrique stage IB2-IIB who underwent RRH after NACT between February 2008 and December 2014. This group was compared with a cohort of 44 patients with similar characteristics who underwent abdominal radical hysterectomy after NACT (Canadian Task Force classification II2).

Patients

Patients with LACC FIGO stage IB2-IIB.

Interventions

A retrospective comparative observational study.

Measurements and Main Results

The mean (standard deviation [SD]) operative time was significantly longer in the robotic group (307.8 minutes [40.2] vs 233.7 minutes [61.9], p ≤ .001). On the contrary, the mean (SD) estimated blood loss was significantly lower in the robotic group (111.0 mL [69.6] vs 286.9 mL [159.1], p ≤ .001), and length of stay was significantly shorter (4.1 [2.4] days vs 5.8 days [3.3], p = .015). The incidence of intraoperative and early and late complications was not statistically significantly different between the 2 groups. The mean (SD) follow-up of patients was 35.6 months (28.4) and 43.7 months (23.2) in the open and robotic groups, respectively (p = .137). The disease recurrence rate (27.2% vs 20%) was similar between the 2 groups; sites and types of recurrences were also similar. Kaplan-Meier survival analysis for median progression-free survival and median overall survival were not statistically different comparing cohorts by surgery type.

Conclusions

RRH after NACT in women with LACC is associated with similar perioperative and oncologic outcomes to open procedure. These results require further investigation to establish a more robust conclusion.