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Hwang JH, Kim B. Comparison of survival outcomes between robotic and laparoscopic radical hysterectomies for early-stage cervical cancer: a systemic review and meta-analysis. J Gynecol Oncol 2024; 35:e9. [PMID: 37857564 PMCID: PMC10792214 DOI: 10.3802/jgo.2024.35.e9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/08/2023] [Accepted: 09/04/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVE Survival outcomes of robotic radical hysterectomy (RRH) remain controversial. Therefore, we performed a meta-analysis to evaluate survival outcomes between RRH) and laparoscopic radical hysterectomy (LRH) in patients with early-stage cervical cancer. METHODS Studies comparing between RRH and LRH published up to November 2022 were systemically searched in the PubMed, Cochrane Library, Web of Science, ScienceDirect, and Google Scholar databases. Manual searches of related articles and relevant bibliographies of the published studies were also performed. Two researchers independently extracted data. Studies with information on recurrence and death after minimally invasive radical hysterectomy were also included. The extracted data were analyzed using the Stata MP software package version 17.0. RESULTS Twenty eligible clinical trials were included in the meta-analysis. When all studies were pooled, the odds ratios of RRH for recurrence and death were 1.19 (95% confidence interval [CI]=0.91-1.55; p=0.613; I²=0.0%) and 0.96 (95% CI=0.65-1.42; p=0.558; I²=0.0%), respectively. In a subgroup analysis, the quality of study methodology, study size, country where the study was conducted, and publication year were not associated with survival outcomes between RRH and LRH. CONCLUSION This meta-analysis demonstrates that the survival outcomes are comparable between RRH and LRH. TRIAL REGISTRATION International Prospective Register of Systematic Reviews Identifier: CRD42023387916.
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Affiliation(s)
- Jong Ha Hwang
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.
| | - Bitnarae Kim
- Department of Obstetrics and Gynecology, Dongwon Cancer Specialized Care Hospital, Goyang, Korea
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2
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Huang J, Tan Z, Wu W, Wu X, Liu L, Li C. Effect of robotic versus laparoscopic surgery on postoperative wound infection in patients with cervical cancer: A meta-analysis. Int Wound J 2023; 21:e14437. [PMID: 37852784 PMCID: PMC10828729 DOI: 10.1111/iwj.14437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/21/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023] Open
Abstract
The objective of this research is to evaluate the risk of postoperative infection and other risks associated with robotic radical hysterectomy (RRH) compared with laparoscopic radical hysterectomy (LRH). Recent studies on RRH versus LRH have not been conclusive for cervical carcinoma. Our group attempted to use meta-analyses to evaluate the effects of both RRH and LRH on postoperative outcomes in order to make sure that the best operative method was used to prevent wound infections. We looked up Cochrane Library and published databases for this research and found 594 findings. Articles were screened by title and abstract and then carefully examined for inclusion and exclusion criteria. Data extraction was performed independently by two researchers. Comparison studies were used to describe the incidence of wound complications after surgery. The publication bias was assessed using Egger regression correlation analysis. There were six trials eligible for inclusion, of which 491 RRH and 807 LRH. Depending on surgery for cervical carcinoma, it is true that there is a difference in the way that surgery affects the postoperative complications. Our analysis demonstrated that the use of robotic operation can decrease the amount of blood loss during operation as compared with routine laparoscopy (MD, -77.69; 95% CI, -132.08, -23.30; p = 0.005). However, there were no statistical differences in the incidence of postoperative wound infections (OR, 0.54; 95% CI, 0.25, 1.19; p = 0.13) and intraoperative operative time (MD, 13.01; 95% CI, -41.38, 67.41; p = 0.64) among the two procedures. There was no statistically significant difference between these two groups of patients with severe postoperative complications. Unlike other research, the findings of this meta-analysis are not consistent with the findings of the present study, which suggest that robotic operations cannot lower the rate of postoperative wound infections. However, because of the limitations and the retrospective character of the trials covered, these findings should be interpreted with care and more extensive research is required.
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Affiliation(s)
- Jin Huang
- Medical School of Yangtze UniversityJingzhouChina
| | - Zhe Tan
- Department of Obstetrics and GynaecologyThe National Hospital of Enshi Tujia and Miao Autonomous PrefectureEnshiChina
| | - Wenyue Wu
- Intervention Therapy DepartmentCancer Hospital of Shantou University Medical CollegeShantouChina
| | - Xiuqian Wu
- Intervention Therapy DepartmentCancer Hospital of Shantou University Medical CollegeShantouChina
| | - Lian Liu
- Medical School of Yangtze UniversityJingzhouChina
| | - Chunlin Li
- Intervention Therapy DepartmentCancer Hospital of Shantou University Medical CollegeShantouChina
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Marchand G, Taher Masoud A, Abdelsattar A, King A, Brazil G, Ulibarri H, Parise J, Arroyo A, Coriell C, Goetz S, Moir C, Baruelo G, Govindan M. Systematic Review and Meta-analysis of laparoscopic radical hysterectomy vs. Robotic assisted radical hysterectomy for early stage cervical cancer. Eur J Obstet Gynecol Reprod Biol 2023; 289:190-202. [PMID: 37690282 DOI: 10.1016/j.ejogrb.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/28/2023] [Accepted: 09/03/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE Following compelling evidence that open techniques may be related to better survival and disease free survival rates, many gynecologic oncologists in the US have turned away from performing laparoscopic radical hysterectomy (LRH) and robotic radical hysterectomy (RRH) for the treatment of early-stage cervical cancer. While this may be warranted as a safety concern, there is little high-quality data on the head-to-head comparison of LRH and RRH and therefore little evidence to answer the question of where this decrease in patient survival is originating from. In our systematic review, we aimed to compare the complications and outcomes of LRH against those of RRH. DATA SOURCES We searched PubMed, Cochrane CENTRAL, Medline, ClinicalTrials.Gov, SCOPUS, and Web of Science from database inception until February 1st, 2022. METHODS OF STUDY SELECTION A total of 676 studies were identified and screened through a manual three-step process. Ultimately 33 studies were included in our final analysis. We included all studies that compared LRH and RRH and included at least one of our selected outcomes. We included retrospective cohorts, prospective cohorts, case-control, and randomized clinical trials. TABULATION, INTEGRATION, AND RESULTS Data was independently extracted manually by multiple observers and the analysis was performed using Review Manager Software. PRISMA guidelines were followed. We analyzed homogenous data using a fixed-effects model, while a random-effects model was used for heterogeneous outcomes. We found that following RRH, women had a decreased hospital stay (MD = 0.80[0.38,1.21],(P < 0.002). We found no differences in estimated blood loss (MD = 35.24[-0.40,70.89],(P = 0.05), blood transfusion rate ((OR = 1.32[0.86,2.02],(P = 0.20), rate of post-operative complications (OR = 0.84[0.60,1.17],(P = 0.30), the operative time (MD = 6.01[-4.64,16.66],(P = 0.27), number of resected lymph node (MD = -1.22[-3.28,0.84],(P = 0.25) intraoperative complications (OR = 0.78[0.51,1.19],(P = 0.25), five-year overall survival (OR = 1.37[0.51,3.69],(P = 0.53), lifetime disease free survival (OR = 0.89[0.59,1.32],(P = 0.55), intraoperative and postoperative mortality (within 30 days) (OR = 1.30[0.66,2.54],(P = 0.44), and recurrence (OR = 1.14[0.79,1.64],(P = 0.50). CONCLUSIONS RRH seems to result in the patient leaving the hospital sooner after surgery. We were unable to find any differences in our ten other outcomes related to complications or efficacy. These findings suggest that the decreased survival seen in minimally invasive RH in previous studies could be due to factors inherent to both LRH and RRH. PROSPERO PROSPECTIVE REGISTRATION NUMBER CRD42022273727.
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Affiliation(s)
- Greg Marchand
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA.
| | - Ahmed Taher Masoud
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA; Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | | | - Alexa King
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Giovanna Brazil
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Hollie Ulibarri
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Julia Parise
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Amanda Arroyo
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | | | - Sydnee Goetz
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Carmen Moir
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Geneva Baruelo
- Midwestern University College of Osteopathic Medicine, Glendale, AZ, USA
| | - Malini Govindan
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
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Ackert KE, Bauerle W, Pellegrino AN, Stoltzfus J, Pateman S, Graves D, Graul A, Taylor N, Zighelboim I. Implementation of an enhanced recovery after surgery (ERAS) protocol for total abdominal hysterectomies in the division of gynecologic oncology: a network-wide quality improvement initiative. J Osteopath Med 2023; 123:493-498. [PMID: 37318833 DOI: 10.1515/jom-2022-0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
CONTEXT Enhanced Recovery After Surgery (ERAS) protocols have been shown to decrease length of stay and postoperative opioid usage in colorectal and bariatric surgeries performed at large academic centers. Hysterectomies are the second most common surgical procedure among women in the United States. Hysterectomies performed in an open fashion, or total abdominal hysterectomies (TAHs), account for a large portion of procedures performed by gynecologic oncologists secondary to current oncology guidelines and surgical complexity. Implementation of an ERAS protocol for gynecologic oncology TAHs is one way in which patient outcomes may be improved. OBJECTIVES An ERAS protocol for gynecologic oncology surgeries performed in a community hospital was instituted with the goal to optimize patient outcomes preoperatively. The primary outcome of interest was to reduce patient opioid usage. Secondary outcomes included compliance with the ERAS protocol, length of stay, and cost. Thirdly, this study aimed to demonstrate the unique challenges of implementing a large-scale protocol across a community network. METHODS An ERAS protocol was implemented in 2018, with multidisciplinary input from the Departments of Gynecologic Oncology, Anesthesia, Pharmacy, Nursing, Information Technology, and Quality Improvement to develop a comprehensive ERAS order set. This was implemented across a 12-site hospital system network that consisted of both urban and rural hospital settings. A retrospective review of patient charts was performed to assess measured outcomes. Parametric and nonparametric tests were utilized for statistical analysis with p<0.05 denoting statistical significance. If the p value was >0.05 and <0.09, this was considered a trend toward significant. RESULTS A total of 124 patients underwent a TAH utilizing the ERAS protocol during 2018 and 2019. The control arm consisted of 59 patients who underwent a TAH prior to the ERAS protocol intervention, which was the standard of care in 2017. After 2 years of implementation of the ERAS protocol intervention, we found that 48 % of the ERAS patients had minimal opioid requirements after surgery (oral morphine equivalent [OME] range 0-40) with decreased postoperative opioid requirements in the ERAS group (p=0.03). Although not statistically significant, utilization of the ERAS protocol for gynecologic oncology TAHs trended toward shorter hospital length of stay from 5.18 to 4.17 days (p=0.07). The median total hospital costs per patient also showed a nonsignificant decrease in cost from $13,342.00 in the non-ERAS cohort and $13,703.00 in the ERAS cohort (p=0.8). CONCLUSIONS A large-scale quality improvement (QI) initiative is feasible utilizing a multidisciplinary team to implement an ERAS protocol for TAHs in the division of Gynecologic Oncology with promising results. This large-scale QI result was comparable to studies that conducted quality-improvement ERAS initiatives at single academic institutions and should be considered within community networks.
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Affiliation(s)
- Kathleen E Ackert
- Department Obstetrics and Gynecology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Wayne Bauerle
- Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Anna Ng Pellegrino
- Department of Anesthesia, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Jill Stoltzfus
- Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Shaun Pateman
- Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Dan Graves
- Department of Anesthesia, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Ashley Graul
- Department Obstetrics and Gynecology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Nicholas Taylor
- Department Obstetrics and Gynecology, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Israel Zighelboim
- Department Obstetrics and Gynecology, St. Luke's University Health Network, Bethlehem, PA, USA
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Gitas G, Pados G, Laganà AS, Guenther V, Ackermann J, Alkatout I. Role of laparoscopic hysterectomy in cervical and endometrial cancer: a narrative review. MINIM INVASIV THER 2023; 32:1-11. [PMID: 36512487 DOI: 10.1080/13645706.2022.2154166] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Endometrial cancer is the most common carcinoma of the female genital organs and cervical cancer is the leading cause of cancer death in women worldwide. The aim of this review is to evaluate the role of laparoscopic hysterectomy in patients with endometrial and cervical cancer in this period, and analyze the outcome of hysterectomy in terms of survival. Moreover, we present the historical background, new techniques, the anatomical features, and surgical steps of radical hysterectomy. According to new evidence, minimally invasive surgery in patients with cervical cancer is associated with higher rates of recurrence and mortality compared to the open approach. Despite the numerous explanations offered for this phenomenon, the reasons for these results are unclear. Additional large trials have been launched to reevaluate the above-mentioned data. On contrary, the laparoscopic approach provides surgical outcomes and similar survival rates as open surgery in patients with early endometrial carcinoma. Furthermore, the radicality of hysterectomy does not influence local recurrence rates or overall survival in cases with complete surgical removal of the tumor. A laparoscopic radical hysterectomy is no longer an option in patients with cervical cancer. When minimally invasive surgery is offered, the patients must be counseled in detail about the current debate.
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Affiliation(s)
- Georgios Gitas
- Department of Gynecology, Breast Center, Charité University Hospital, Berlin, Germany
| | - George Pados
- First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Veronika Guenther
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Kiel, Germany
| | - Johannes Ackermann
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Kiel, Germany
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy
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Meta-analysis of laparoscopic radical hysterectomy, excluding robotic assisted versus open radical hysterectomy for early stage cervical cancer. Sci Rep 2023; 13:273. [PMID: 36609438 PMCID: PMC9822966 DOI: 10.1038/s41598-023-27430-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023] Open
Abstract
Recent evidence has shown an increase in recurrence and a decrease in overall survival in patients treated with laparoscopic radical hysterectomy (LRH) and robotic assisted radical hysterectomy (RRH) open techniques (ORH). In addition, several high quality trials were recently published regarding the laparoscopic treatment of early stage cervical cancer. We sought out to reassess the recurrence rates, overall survival, complications and outcomes associated with laparoscopic radical hysterectomy (LRH) techniques against open techniques (ORH) when robotic assisted techniques were excluded. We searched PubMed, Medline, Cochrane CENTRAL, SCOPUS, ClinicalTrials.Gov and Web of Science for relevant clinical trials and observational studies. We included all studies that compared with early stage cervical cancer receiving LRH compared with ORH. We included randomized clinical trials, prospective cohort, and retrospective cohort trials. We included studies that included LRH and RRH as long as data was available to separate the two arms. We excluded studies that combined LRH and RRH without supplying data to differentiate. Of 1244 total studies, we used a manual three step screening process. Sixty studies ultimately met our criteria. We performed this review in accordance with PRISMA guidelines. We analyzed continuous data using mean difference (MD) and a 95% confidence interval (CI), while dichotomous data were analyzed using odds ratio (OR) and a 95% CI. Review Manager and Endnote software were utilized in the synthesis. We found that when excluding RRH, the was no significant difference regarding 5-year overall Survival (OR = 1.24 [0.94, 1.64], (P = 0.12), disease free survival (OR = 1.00 [0.80, 1.26], (P = 0.98), recurrence (OR = 1.01 [0.81, 1.25], (P = 0.95), or intraoperative complications (OR = 1.38 [0.94, 2.04], (P = 0.10). LRH was statistically better than ORH in terms of estimated blood loss (MD = - 325.55 [- 386.16, - 264.94] (P < 0.001), blood transfusion rate (OR = 0.28 [0.14, 0.55], (P = 0.002), postoperative complication rate (OR = 0.70 [0.55, 0.90], (P = 0.005), and length of hospital stay (MD = - 3.64[- 4.27, - 3.01], (P < 0.001). ORH was superior in terms of operating time (MD = 20.48 [8.62, 32.35], (P = 0.007) and number of resected lymph nodes (MD = - 2.80 [- 4.35, - 1.24], (P = 0.004). The previously seen increase recurrence and decrease in survival is not seen in LRH when robotic assisted techniques are included and all new high quality is considered. LRH is also associated with a significantly shorter hospital stay, less blood loss and lower complication rate.Prospero Prospective Registration Number: CRD42022267138.
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7
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Quan C, Liang S, Feng Z, Zhu J, Zhang M, Huang Y. Surgical and oncologic outcomes between laparoscopic and radical abdominal hysterectomy for IB1-IIA2 cervical cancer. Asian J Surg 2023; 46:105-110. [PMID: 35367095 DOI: 10.1016/j.asjsur.2022.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/25/2020] [Accepted: 01/20/2022] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To compare sugrical and survival outcomes between laparoscopic radical hysterectomy (LRH) and radical abdominal hysterectomy (RAH). METHODS All the patients with IB1-IIA2 cervical cancer who performed LRH or RAH in Fudan University Shanghai Cancer Center between 1/2016 and 12/2017 were retrospectively analyzed. RESULTS There were no significant differences between LRH and RAH groups except deep stromal invasion (35.2% vs 54.4%, p = 0.000), operating time (232.3 ± 61.9 min vs. 106.7 ± 36.2 min, p = 0.000), blood loss (169.5 ± 96.2 ml vs. 219.6 ± 149.3 ml, p = 0.000), and lymph node counts (21.1 ± 7.1 vs. 23.2 ± 8.7 min, p = 0.012). The LRH group displayed poorer disease-free survival (DFS) (5-year rate, 79.4% vs. 90.0%; p = 0.046) and overall survival (OS) (5-year rate, 74.7% vs. 90.0%; p = 0.026) compared to the RAH group. On multivariate analysis, LRH was an independent risk factor for DFS (hazard ratio, 0.377; 95% confidence interval [CI], 0.227-0.625; p = 0.000) and OS (hazard ratio, 0.434; 95% CI, 0.254-0.740; p = 0.003). CONCLUSIONS LRH affected the survival of cervical cancer patients with tumor size >2 cm (p < 0.05). Adjuvant therapy could not improve the prognosis of laparoscopic patients (p < 0.05).
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Affiliation(s)
- Chenlian Quan
- Department of Oncology, Shanghai Medical College of Fudan University, 270 Dong-an Road, Shanghai, 200032, China; Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, 270 Dong-an Road, Shanghai, 200032, China.
| | - Shanhui Liang
- Department of Oncology, Shanghai Medical College of Fudan University, 270 Dong-an Road, Shanghai, 200032, China; Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, 270 Dong-an Road, Shanghai, 200032, China.
| | - Zheng Feng
- Department of Oncology, Shanghai Medical College of Fudan University, 270 Dong-an Road, Shanghai, 200032, China; Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, 270 Dong-an Road, Shanghai, 200032, China.
| | - Jun Zhu
- Department of Oncology, Shanghai Medical College of Fudan University, 270 Dong-an Road, Shanghai, 200032, China; Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, 270 Dong-an Road, Shanghai, 200032, China.
| | - Meiqin Zhang
- Department of Oncology, Shanghai Medical College of Fudan University, 270 Dong-an Road, Shanghai, 200032, China; Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, 270 Dong-an Road, Shanghai, 200032, China.
| | - Yan Huang
- Department of Oncology, Shanghai Medical College of Fudan University, 270 Dong-an Road, Shanghai, 200032, China; Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, 270 Dong-an Road, Shanghai, 200032, China.
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Chandrakar I, Pajai S, Toshniwal S. Robotic Surgery: The Future of Gynaecology. Cureus 2022; 14:e30569. [DOI: 10.7759/cureus.30569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/21/2022] [Indexed: 11/05/2022] Open
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Kohut AY, Kuhn T, Conrad LB, Chua KJ, Abuelafiya M, Gordon AN, Flowers L, Orfanelli T, Blank S, Khanna N. Thirty-day Postoperative Adverse Events in Minimally Invasive versus Open Abdominal Radical Hysterectomy for Early-stage Cervical Cancer. J Minim Invasive Gynecol 2022; 29:840-847. [PMID: 35405331 DOI: 10.1016/j.jmig.2022.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To identify the incidence, type, and grade of postoperative adverse events in minimally invasive radical hysterectomy vs abdominal radical hysterectomy (ARH) for patients with early-stage cervical cancer and determine risk factors associated with these adverse events. DESIGN The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) was queried to identify patients with early-stage cervical cancer undergoing radical hysterectomy. Multivariable logistic regression was used to assess risk factors associated with adverse postoperative outcomes among patients undergoing radical hysterectomy. SETTING ACS NSQIP participating institutions within the United States. PATIENTS Patients were collected from the ACS NSQIP databases (2014-2017) undergoing radical hysterectomy for early-stage cervical cancer. INTERVENTIONS N/A MEASUREMENTS AND MAIN RESULTS: ARH had a significantly increased incidence of any 30-day postoperative adverse event compared with minimally invasive radical hysterectomy (31.2% vs 19.9%, p <.001). There was a higher incidence of surgical site infection, both deep and superficial, and blood transfusions in ARH. On multivariable logistic regression, the abdominal surgical approach was the only risk factor significantly associated with any postoperative adverse event (odds ratio, 1.4; confidence interval, 1.1-1.9; p = .018; 95% CIs). CONCLUSIONS In this study, the abdominal surgical approach for radical hysterectomy in early-stage cervical cancer was associated with a higher incidence of postoperative adverse events than the minimally invasive approach.
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Tantitamit T, Huang KG, Lee CL. Laparoscopic versus open radical hysterectomy in women with early stage cervical cancer: A systematic review and meta-analysis. Taiwan J Obstet Gynecol 2021; 59:481-488. [PMID: 32653117 DOI: 10.1016/j.tjog.2020.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2020] [Indexed: 12/18/2022] Open
Abstract
This review aimed to evaluate the short term and long-term outcomes of laparoscopic radical hysterectomy (LRH) versus abdominal radical hysterectomy (ARH) for early-stage cervical cancer. A search of PubMed, Medline and Scopus databased from 2000 to 2018 was conducted. Thirty studies were retrieved including 22 retrospective cohort studies and 8 prospective cohort studies. LRH was comparable with ARH in 5-year overall survival (RR = 1.0. 95%CI 0.98-1.03; p = 0.33) and 5-year disease-free survival (RR = 1.02 95%CI 0.97-1.06; p = 0.98). The majority of included studies reported the negative cancer factors which drive adjuvant therapy were similar between two approaches. LRH was associated with lower blood loss and blood transfusion, less postoperative complication, shorter hospital stays and similar intraoperative complication rate compared to ARH. Our data suggested LRH for early-stage cervical cancer was as safe and effective in terms of long-term outcomes, but with lower surgical morbidities.
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Affiliation(s)
- Tanitra Tantitamit
- Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot University, Nakhonnayok, Thailand; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kweishan, Taoyuan, Taiwan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kweishan, Taoyuan, Taiwan; Chang Gung University College of Medicine, Kweishan, Taoyuan, Taiwan
| | - Chyi-Long Lee
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kweishan, Taoyuan, Taiwan; Chang Gung University College of Medicine, Kweishan, Taoyuan, Taiwan.
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11
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Hahn-Klimroth M, Loick P, Kim-Wanner SZ, Seifried E, Bonig H. Generation and validation of a formula to calculate hemoglobin loss on a cohort of healthy adults subjected to controlled blood loss. J Transl Med 2021; 19:116. [PMID: 33743699 PMCID: PMC7981850 DOI: 10.1186/s12967-021-02783-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background The ability to approximate intra-operative hemoglobin loss with reasonable precision and linearity is prerequisite for determination of a relevant surgical outcome parameter: This information enables comparison of surgical procedures between different techniques, surgeons or hospitals, and supports anticipation of transfusion needs. Different formulas have been proposed, but none of them were validated for accuracy, precision and linearity against a cohort with precisely measured hemoglobin loss and, possibly for that reason, neither has established itself as gold standard. We sought to identify the minimal dataset needed to generate reasonably precise and accurate hemoglobin loss prediction tools and to derive and validate an estimation formula. Methods Routinely available clinical and laboratory data from a cohort of 401 healthy individuals with controlled hemoglobin loss between 29 and 233 g were extracted from medical charts. Supervised learning algorithms were applied to identify a minimal data set and to generate and validate a formula for calculation of hemoglobin loss. Results Of the classical supervised learning algorithms applied, the linear and Ridge regression models performed at least as well as the more complex models. Most straightforward to analyze and check for robustness, we proceeded with linear regression. Weight, height, sex and hemoglobin concentration before and on the morning after the intervention were sufficient to generate a formula for estimation of hemoglobin loss. The resulting model yields an outstanding R2 of 53.2% with similar precision throughout the entire range of volumes or donor sizes, thereby meaningfully outperforming previously proposed medical models. Conclusions The resulting formula will allow objective benchmarking of surgical blood loss, enabling informed decision making as to the need for pre-operative type-and-cross only vs. reservation of packed red cell units, depending on a patient’s anemia tolerance, and thus contributing to resource management. Supplementary Information The online version contains supplementary material available at 10.1186/s12967-021-02783-9.
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Affiliation(s)
| | - Philipp Loick
- Goethe University Mathematics Institute, Frankfurt, Germany
| | - Soo-Zin Kim-Wanner
- German Red Cross Blood Service BaWüHe, Institute Frankfurt, Sandhofstraße 1, 60528, Frankfurt, Germany
| | - Erhard Seifried
- German Red Cross Blood Service BaWüHe, Institute Frankfurt, Sandhofstraße 1, 60528, Frankfurt, Germany.,Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt, Germany
| | - Halvard Bonig
- German Red Cross Blood Service BaWüHe, Institute Frankfurt, Sandhofstraße 1, 60528, Frankfurt, Germany. .,Institute for Transfusion Medicine and Immunohematology, Goethe University, Frankfurt, Germany. .,Department of Medicine/Hematology, University of Washington, Seattle, WA, USA.
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12
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Zanagnolo V, Baroni C, Achilarre MT, Aloisi A, Betella I, Bogliolo S, Garbi A, Maruccio M, Multinu F, Aletti G, Maggioni A. Oncologic Outcomes of Robotic Radical Hysterectomy (RRH) for Patients with Early-Stage Cervical Cancer: Experience at a Referral Cancer Center. Ann Surg Oncol 2020; 28:1819-1829. [PMID: 32860175 DOI: 10.1245/s10434-020-09016-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/26/2020] [Indexed: 01/23/2023]
Abstract
PURPOSE To evaluate oncologic outcomes of early stage cervical cancer patients who underwent robotic radical hysterectomy (RRH) in a referral center, a retrospective analysis was performed. METHODS From January 2010 to December 2018, medical records of stage IA2-IIA1 cervical cancer patients, who underwent radical hysterectomy at our institute, were retrospectively reviewed. We focused our analysis on those who underwent RRH. RESULTS A total of 198 patients were included in the final analysis. Median follow up was 52 months. At last follow-up, 188 (94.9%) women were disease-free, 9 (4.5%) had died, and 1 (0.5%) was alive with recurrent disease. At 4.5 years, PFS was 93.1% (SE ± 2.1) and OS was 95.1% (SE ± 1.8). Stratified by tumor size, PFS for tumor < 2 cm versus tumor ≥ 2 cm was statistically different (96.8% ± 2.3 and 87.9% ± 4.1 respectively, p = 0.01), as well as OS (100% and 89.8% ± 40 respectively, p = 0.01).Stratified by evidence of tumor at time of robotic surgery, PFS was statistically different in women with no residual tumor after conisation versus those with residual disease (100% ± 2.5 and 90.8% ± 2.8 respectively, p = 0.04). A recurrence occurred in 11 patients (5.6%). CONCLUSIONS Based on our results, we could speculate that robotic approach, along with some technical precautions to avoid spillage, might be safe as primary treatment of early-stage cervical cancer, especially for tumor < 2 cm and in case of no evidence of disease at time of radical hysterectomy after previous conisation.
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Affiliation(s)
- Vanna Zanagnolo
- Department of Gynecology Oncology, Robotic Gynecologic Cancer Surgery Unit, IEO, European Institute of Oncology IRCCS, Milan, 20141, Milan, Italy.
| | - Clara Baroni
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Maria Teresa Achilarre
- Department of Gynecology Oncology, Robotic Gynecologic Cancer Surgery Unit, IEO, European Institute of Oncology IRCCS, Milan, 20141, Milan, Italy
| | - Alessia Aloisi
- Department of Gynecology Oncology, Robotic Gynecologic Cancer Surgery Unit, IEO, European Institute of Oncology IRCCS, Milan, 20141, Milan, Italy
| | - Ilaria Betella
- Department of Gynecology Oncology, Robotic Gynecologic Cancer Surgery Unit, IEO, European Institute of Oncology IRCCS, Milan, 20141, Milan, Italy
| | - Stefano Bogliolo
- Department of Gynecology Oncology, Robotic Gynecologic Cancer Surgery Unit, IEO, European Institute of Oncology IRCCS, Milan, 20141, Milan, Italy
| | - Annalisa Garbi
- Department of Gynecology Oncology, Robotic Gynecologic Cancer Surgery Unit, IEO, European Institute of Oncology IRCCS, Milan, 20141, Milan, Italy
| | - Matteo Maruccio
- Department of Gynecology Oncology, Robotic Gynecologic Cancer Surgery Unit, IEO, European Institute of Oncology IRCCS, Milan, 20141, Milan, Italy
| | - Francesco Multinu
- Department of Gynecology Oncology, Robotic Gynecologic Cancer Surgery Unit, IEO, European Institute of Oncology IRCCS, Milan, 20141, Milan, Italy
| | - Giovanni Aletti
- Department of Gynecology Oncology, Robotic Gynecologic Cancer Surgery Unit, IEO, European Institute of Oncology IRCCS, Milan, 20141, Milan, Italy
| | - Angelo Maggioni
- Department of Gynecology Oncology, Robotic Gynecologic Cancer Surgery Unit, IEO, European Institute of Oncology IRCCS, Milan, 20141, Milan, Italy
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13
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Nezhat C, Roman RA, Rambhatla A, Nezhat F. Reproductive and oncologic outcomes after fertility-sparing surgery for early stage cervical cancer: a systematic review. Fertil Steril 2020; 113:685-703. [DOI: 10.1016/j.fertnstert.2020.02.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/25/2020] [Accepted: 02/03/2020] [Indexed: 12/21/2022]
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14
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Lunde S, Petersen KK, Kugathasan P, Arendt-Nielsen L, Søgaard-Andersen E. Correction to: Chronic Postoperative Pain After Robot-Assisted Laparoscopic Hysterectomy for Endometrial Cancer by Lunde S, Petersen KK, Kugathasan P, Arendt-Nielsen L and Søgaard-Andersen E. Journal of Gynecologic Surgery 2019;35(3);140-146. DOI: 10.1089/gyn.2018.0068. J Gynecol Surg 2020. [PMID: 32293603 DOI: 10.1089/gyn.2018.0068] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
[This corrects the article DOI: 10.1089/gyn.2018.0068.].
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Affiliation(s)
- Søren Lunde
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
- Center for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark
| | - Kristian Kjær Petersen
- Center for Sensory-Motor Interaction, Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Pirathiv Kugathasan
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg University, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Center for Sensory-Motor Interaction, Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Erik Søgaard-Andersen
- Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark
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15
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Survival after a nationwide adoption of robotic minimally invasive surgery for early-stage cervical cancer - A population-based study. Eur J Cancer 2020; 128:47-56. [PMID: 32109850 DOI: 10.1016/j.ejca.2019.12.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 11/10/2019] [Accepted: 12/15/2019] [Indexed: 12/21/2022]
Abstract
AIM Lately, the safety of minimally invasive surgery (MIS) in the treatment of cervical cancer (CC) has been questioned. This study aimed to evaluate the risk of recurrence and survival after a nationwide adoption of robotic MIS for the treatment of early-stage CC in Denmark. METHODS Population-based data on all Danish women with early-stage CC, who underwent radical hysterectomy January 1st 2005-June 30th 2017 were retrieved from the Danish Gynecologic Cancer Database and enriched with follow-up data on recurrence, death and cause of death. The cohort was divided into two groups according to the year of robotic MIS introduction at each cancer centre. Chi-squared or Fischer test, the Kaplan Meier method and multivariate Cox regression were used for comparison between groups. RESULTS One thousand one hundred twenty-five patients with CC were included; 530 underwent surgery before (group 1) and 595 underwent surgery after (group 2) the introduction of robotic MIS. The 5-year rate of recurrence was low: 8.2% and 6.3% (p = 0.55) in group 1 and 2, respectively. In adjusted analyses, this corresponded to a five-year disease-free survival, hazard ratio (HR) 1.23 [95% confidence interval (CI) 0.79-1.93]. No difference in site of recurrence (P = 0.19) was observed. The cumulative cancer-specific survival was 94.1% and 95.9% (P = 0.10) in group 1 and 2, respectively, corresponding to a HR 0.60 [95% CI 0.32-1.11] in adjusted analyses. CONCLUSION In this population-based cohort study, the Danish nationwide adoption of robotic MIS for early-stage CC was not associated with increased risk of recurrence or reduction in survival outcomes.
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Abstract
PURPOSE OF REVIEW This paper reviews the recent literature data on minimally invasive surgical approach to early cervical cancer compared to abdominal approach, with the aim of evaluate the oncological outcomes and the appropriateness of current indications. RECENT FINDINGS A recent multicenter randomized controlled trial and a concurrent large epidemiological study, contrary to the previous retrospective data, showed that minimally invasive surgery is associated with significantly poorer survival than the open approach. Open surgery is to be considered the standard of care for early cervical cancer as implemented in the current guidelines, and the patients must be carefully counseled if minimally invasive surgery is offered. Minimally invasive surgery can be considered safe only for sentinel lymph node mapping in a fertility-sparing setting and could be considered after preoperative conization and for small tumors, adopting preventive surgical maneuvers and in reference centers. However, prospective evidences about the suggested indications are not yet available.
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17
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Marra AR, Puig-Asensio M, Edmond MB, Schweizer ML, Bender D. Infectious complications of laparoscopic and robotic hysterectomy: a systematic literature review and meta-analysis. Int J Gynecol Cancer 2020; 29:518-530. [PMID: 30833440 DOI: 10.1136/ijgc-2018-000098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/07/2018] [Accepted: 12/11/2018] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE We performed a systematic review of the literature and meta-analysis of the infectious complications of hysterectomy, comparing robotic-assisted hysterectomy to conventional laparoscopic-assisted hysterectomy. METHODS We searched PubMed, CINAHL, CDSR, and EMBASE through July 2018 for studies evaluating robotic-assisted hysterectomy, laparoscopic-assisted hysterectomy, and infectious complications. We employed random-effect models to obtain pooled OR estimates. Heterogeneity was evaluated with I2 estimation and the Cochran Q statistic. Pooled ORs were calculated separately based on the reason for hysterectomy (eg, benign uterine diseases, endometrial cancer, and cervical cancer). RESULTS Fifty studies were included in the final review for the meta-analysis with 176 016 patients undergoing hysterectomy. There was no statistically significant difference in the number of infectious complication events between robotic-assisted hysterectomy and laparoscopic-assisted hysterectomy (pooled OR 0.97; 95 % CI 0.74 to 1.28). When we performed a stratified analysis, similar results were found with no statistically significant difference in infectious complications comparing robotic-assisted hysterectomy to laparoscopic-assisted hysterectomy among patients with benign uterine disease (pooled OR 1.10; 95 % CI 0.70 to 1.73), endometrial cancer (pooled OR 0.97; 95 % CI 0.55 to 1.73), or cervical cancer (pooled OR 1.09; 95 % CI 0.60 to 1.97). CONCLUSION In our meta-analysis the rate of infectious complications associated with robotic-assisted hysterectomy was no different than that associated with conventional laparoscopic-assisted hysterectomy.
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Affiliation(s)
- Alexandre R Marra
- Office of Clinical Quality, Safety and Performance Improvement University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
- Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Mireia Puig-Asensio
- Office of Clinical Quality, Safety and Performance Improvement University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
| | - Michael B Edmond
- Office of Clinical Quality, Safety and Performance Improvement University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Marin L Schweizer
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
- The Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
| | - David Bender
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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18
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Laparoscopic radical hysterectomy has higher risk of perioperative urologic complication than abdominal radical hysterectomy: a meta-analysis of 38 studies. Surg Endosc 2020; 34:1509-1521. [PMID: 31953731 DOI: 10.1007/s00464-020-07366-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 01/03/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE A meta-analysis was performed to assess risks of intraoperative and postoperative urologic complications in laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH). METHODS We searched Pubmed, EMBASE, and Cochrane library for studies published up to December, 2018. Manual searches of related articles and relevant bibliographies of published studies were also performed. Two researchers independently performed data extraction. Inclusion criteria of studies were: (1) had information of perioperative complications, and (2) had at least ten patients per group. RESULTS A total of 38 eligible clinical trials were collected. Intraoperative and postoperative urologic complications were reported by 34 studies and 35 studies, respectively. When all studies were pooled, odd ratios (OR) of LRH for the risk of intraoperative urologic complications compared to abdominal radical hysterectomy (ARH) was 1.40 [95% confidence interval (CI) 1.05-1.87]. The OR of LRH for postoperative complication risk compared to ARH was 1.35 [95% CI 1.01-1.80]. However, significant adverse effects of intraoperative urologic complications in LRH were not observed among articles published after 2012 (OR 1.12, 95% CI 0.77-1.62) in cumulative meta-analysis or subgroup analysis. The incidence of bladder injury was statistically higher than that of ureter injury (p = 0.001). In subgroup analysis, obesity and laparoscopic type (laparoscopic assisted vaginal radical hysterectomy) were associated with intraoperative urologic complications. CONCLUSION LRH is associated with significantly higher risk of intraoperative and postoperative urologic complications than abdominal radical hysterectomy.
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19
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Bogani G, Maggiore ULR, Rossetti D, Ditto A, Martinelli F, Chiappa V, Ferla S, Indini A, Sabatucci I, Lorusso D, Raspagliesi F. Advances in laparoscopic surgery for cervical cancer. Crit Rev Oncol Hematol 2019; 143:76-80. [DOI: 10.1016/j.critrevonc.2019.07.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/02/2018] [Accepted: 07/29/2019] [Indexed: 01/01/2023] Open
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20
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Hu TWY, Ming X, Yan HZ, Li ZY. Adverse effect of laparoscopic radical hysterectomy depends on tumor size in patients with cervical cancer. Cancer Manag Res 2019; 11:8249-8255. [PMID: 31571982 PMCID: PMC6748160 DOI: 10.2147/cmar.s216929] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/05/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose The study aimed to explore the survival outcomes of early-stage cervical cancer (CC) patients treated with laparoscopic/abdominal radical hysterectomy (LRH/ARH). Patients and Methods We performed a retrospective analysis involving women who had undergone LRH/ARH for CC in early stage during the 2013–2015 period in West China Second University Hospital. The survival outcomes and potential prognostic factors were evaluated using Kaplan–Meier method and Cox regression analysis, respectively. Results A total of 678 patients were included in our analysis. The overall survival (OS) and progression-free survival (PFS) between the ARH (n=423) and LRH (n=255) groups achieved no significant differences (p=0.122, 0.285, respectively). However, in patients with a tumor diameter >4 cm, the OS of the LRH group was significantly shorter than that of the ARH group (p=0.017). Conversely, in patients with a tumor diameter ≤4 cm, the LRH group had a significantly longer OS than the ARH group (p=0.013). The multivariate Cox analysis revealed that International Federation of Gynecology and Obstetrics stage, histology, parametrial invasion, and pelvic lymph node invasion were independent prognostic factors for OS and PFS, whereas surgical method was not a statistically significant predictor of OS (p=0.806) or PFS (p=0.236) in CC patients. Conclusion LRH was an alternative to ARH for surgical treatment of CC patients with a tumor diameter ≤4 cm. However, for the patients with a tumor diameter >4 cm, priority should be given to ARH.
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Affiliation(s)
- Ting Wen Yi Hu
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Xiu Ming
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Hao Zheng Yan
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Zheng Yu Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Obstetrics and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
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21
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Nezhat FR, Ananth CV, Vintzileos AM. The two Achilles heels of surgical randomized controlled trials: differences in surgical skills and reporting of average performance. Am J Obstet Gynecol 2019; 221:230-232. [PMID: 31121141 DOI: 10.1016/j.ajog.2019.05.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
Abstract
Randomized controlled trials of surgery are fundamentally different from randomized controlled trials of medications because it is difficult to blind or mask a surgical procedure or perform "sham" operations. An additional challenge is the variation in skills and surgical proficiency of participating centers and surgeons. Addressing heterogeneity in surgical proficiency remains of paramount importance, especially when randomized controlled trials involve a new or complex procedure such as minimally invasive radical surgery. In the presence of such heterogeneity, it is very cumbersome to evaluate objectively and monitor surgical skills so that most trials simply report associations that are averaged across surgeons and hospitals/centers. Such reporting is not transparent because the rates of complications and adverse outcomes are reported only as averages, and these averages may not apply to the individual participating surgeons or centers. These factors, coupled with the inherent nongeneralizability of findings from such randomized controlled trials, because of the strict inclusion and exclusion criteria for enrollment, may lead to conclusions that no longer apply to real life for individual surgeons or centers. Case in point is a recently published noninferiority randomized controlled trial that reported that minimally invasive radical hysterectomy was associated with lower rates of disease-free survival (86% vs 96.5% at 4.5 years) and overall survival (93.8% vs 99% at 3 years) than open abdominal radical hysterectomy in patients with cervical cancer. However, randomized controlled trials that involve 2 competing complex or new procedures may be affected by tremendous confounding because of variations in surgical proficiency and also nonstandardization for other confounding factors such as patient selection categories (ie, stage of cancer) and adjuvant postoperative therapies that may affect long-term survival. The purpose of this Viewpoint is not to provide an exhaustive review of the trial's shortcomings but to use it as an illustration to focus on 2 challenging areas that most randomized controlled trials of a new complex surgical procedure suffer from: (1) unadjusting or not correcting for surgical skill variability and (2) nontransparent reporting of averaged results. We provide suggestions to overcome these deficiencies through robust methods and statistical approaches.
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Lee CL, Huang KG, Nam JH, Lim PC, Shun FWW, Lee KW, Kanao H, Aoki Y, Takeshima N, Hadisaputra W, Liang Z, Supakarapongkul W, Wang KL. The Statement of the Asia-Pacific Association for Gynecologic Endoscopy and Minimally Invasive Therapy for LACC Study. Gynecol Minim Invasive Ther 2019; 8:91-93. [PMID: 31544017 PMCID: PMC6743232 DOI: 10.4103/gmit.gmit_75_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 12/21/2022] Open
Affiliation(s)
- Chyi-Long Lee
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Kweishan, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Kweishan, Taoyuan, Taiwan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Kweishan, Taoyuan, Taiwan
| | - Joo-Hyun Nam
- Department of Obsteterics and Gynecology, College of Medicine, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Peter C Lim
- Department of Gynecology Oncology and Robotic Surgery, Center of Hope, University of Nevada, Reno School of Medicine, Reno, Nevada, USA
| | - Felix Wong Wu Shun
- Division of Women and Child Health, The University of New South Wales, Sydney, Australia
| | | | - Hiroyuki Kanao
- Department of Gynecologic Oncology, Cancer Institute Hospital, Tokyo, Japan
| | - Yoichi Aoki
- Department of Gynecologic Oncology, Cancer Institute Hospital, Tokyo, Japan
| | - Nobuhiro Takeshima
- Department of Gynecologic Oncology, Cancer Institute Hospital, Tokyo, Japan
| | - Wachyu Hadisaputra
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Indonesia, West Java, Indonesia
| | - Zhiqing Liang
- Department of Obstetrics and Gynecology, Southwestern Hospital, Third Military Medical University, Chongqing, China
| | | | - Kung-Liahng Wang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
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Hwang JH, Kim BW, Kim SR, Kim JH. Robotic Radical Hysterectomy Is Not Superior to Laparoscopic Radical Hysterectomy in Perioperative Urologic Complications: A Meta-Analysis of 23 Studies. J Minim Invasive Gynecol 2019; 27:38-47. [PMID: 31315060 DOI: 10.1016/j.jmig.2019.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/05/2019] [Accepted: 07/11/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aimed to compare the risks of intraoperative and postoperative urologic complications after robotic radical hysterectomy (RRH) compared with laparoscopic radical hysterectomy (LRH). DATA SOURCES We searched Pubmed, EMBASE, and the Cochrane Library for studies published up to March 2019. Related articles and relevant bibliographies of published studies were also checked. METHODS OF STUDY SELECTION Two researchers independently performed data extraction. We selected comparative studies that reported perioperative urologic complications. TABULATION, INTEGRATION, AND RESULTS Twenty-three eligible clinical trials were included in this analysis. When all studies were pooled, the odds ratio for the risk of any urologic complication after RRH compared with LRH was .91 (95% confidence interval [CI], .64-1.28; p = .585). The odds ratios for intraoperative and postoperative complications after RRH versus LRH were .86 (95% CI, .48-1.55; p = .637) and .94 (95% CI, .64-1.38; p = .767), respectively. In a secondary analysis study quality, study location, and the publication year were not associated with intraoperative or postoperative urologic complications. CONCLUSION Current evidence suggests that RRH is not superior to LRH in terms of perioperative urologic complications.
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Affiliation(s)
- Jong Ha Hwang
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (all authors).
| | - Bo Wook Kim
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (all authors)
| | - Soo Rim Kim
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (all authors)
| | - Jang Heub Kim
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea (all authors)
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24
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Gil-Moreno A, Carbonell-Socias M, Salicrú S, Bradbury M, García Á, Vergés R, Puig OP, Sánchez-Iglesias JL, Cabrera-Díaz S, de la Torre J, Gómez-Hidalgo NR, Pérez-Benavente A, Díaz-Feijoo B. Nerve-sparing versus non-nerve-sparing radical hysterectomy: surgical and long-term oncological outcomes. Oncotarget 2019; 10:4598-4608. [PMID: 31360307 PMCID: PMC6642047 DOI: 10.18632/oncotarget.27078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/29/2019] [Indexed: 02/01/2023] Open
Abstract
Objectives There are controversies regarding the long-term oncological safety of preservation of pelvic innervation during radical hysterectomy (RH). This study aimed to analyze the feasibility and safety of nerve-sparing radical hysterectomy (NSRH) for cervical cancer compared with non-NSRH following 17 years of experience in a tertiary cancer referral center. Materials and Methods Between May 1999 and June 2016, all patients who underwent RH for cervical cancer were followed-up prospectively. Comparison analyses regarding surgical outcomes, complications, overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS) were performed between patients treated with NSRH and non-NSRH. Results A total of 188 patients were included (113 non-NSRH and 75 NSRH). The median follow-up was 112 months. Estimated blood loss and hospital stay were all significantly lower in the NSRH group. Overall intraoperative complication rate (p = 0.02) and need for transfusion (p = 0.016) were lower in the NSRH group. There were no differences in the median operation time, OS, DFS, CSS, or recurrence rates between the NSRH and non-NSRH group. Conclusions Our study provides a wide perspective on the developments of nerve-sparing procedures for the management of women with early-stage cervical cancer. Our results suggest that NSRH is a feasible and safe procedure, with reduced morbidity outcomes.
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Affiliation(s)
- Antonio Gil-Moreno
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Melchor Carbonell-Socias
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sabina Salicrú
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Melissa Bradbury
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ángel García
- Department of Pathology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ramona Vergés
- Radiotherapy Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oriol Puig Puig
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Luís Sánchez-Iglesias
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Silvia Cabrera-Díaz
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier de la Torre
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Natalia R Gómez-Hidalgo
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Assumpció Pérez-Benavente
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Berta Díaz-Feijoo
- Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
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Comparison of Different Surgical Approaches for Stage IB1 Cervical Cancer Patients: A Multi-institution Study and a Review of the Literature. Int J Gynecol Cancer 2019; 28:1020-1028. [PMID: 29727351 DOI: 10.1097/igc.0000000000001254] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The aim of this retrospective study was to assess the surgical and oncological outcome of 3 different surgical approaches (laparotomy, laparoscopy, and robotic surgery) in the treatment of early-stage cervical cancer International Federation of Gynecology and Obstetrics (FIGO) stage IB1. METHODS All patients with a histologically confirmed diagnosis of early-stage cervical cancer, FIGO stage IB1, who underwent abdominal radical hysterectomy (ARH), laparoscopic radical hysterectomy, or robotic radical hysterectomy with or without pelvic and aortic lymphadenectomy were included in the study. A review of the literature was conducted. RESULTS Three hundred forty-one patients, between January 2001 and December 2016, were included in this study: 101 patients were submitted to ARH, 152 to laparoscopic radical hysterectomy, and 88 to robotic radical hysterectomy. In 97% and 11.5% of cases, bilateral pelvic and aortic lymph node dissections were performed, respectively. The 3 groups were similar in regard to clinical characteristics. Compared with ARH, the minimally invasive surgery group was safer in terms of estimated blood loss, transfusion rates, and hospital stay. Above all, robotic surgery was equivalent to laparoscopy in terms of intraoperative and postoperative complications, hospital stay, conversions, and reintervention. On the other hand, robotic surgery had better outcomes compared with laparoscopy in terms of transfusion rates and was equivalent to abdominal surgery and laparoscopy in regard to oncological outcomes. CONCLUSIONS Our study confirmed that minimally invasive surgery (laparoscopy or robotics) was as adequate and effective as abdominal surgery in terms of surgical and oncological outcomes in the surgical treatment of EEC FIGO stage IB1.
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Lee CL, Huang KG. Clinical trial should be more rigorous. Taiwan J Obstet Gynecol 2019; 58:306-307. [DOI: 10.1016/j.tjog.2019.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2019] [Indexed: 10/27/2022] Open
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Lee CL. Minimally Invasive Therapy for Cancer: It is Time to Take Actions for Training System in Minimally Invasive Therapy After LACC Report. Gynecol Minim Invasive Ther 2019; 8:1-3. [PMID: 30783581 PMCID: PMC6367915 DOI: 10.4103/gmit.gmit_132_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 12/27/2018] [Accepted: 12/27/2018] [Indexed: 11/04/2022] Open
Affiliation(s)
- Chyi-Long Lee
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University, 5, Fu-Hsin Street, Kweishan Taoyuan, Taiwan
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Zhang SS, Ding T, Cui ZH, Lv Y, Jiang RA. Efficacy of robotic radical hysterectomy for cervical cancer compared with that of open and laparoscopic surgery: A separate meta-analysis of high-quality studies. Medicine (Baltimore) 2019; 98:e14171. [PMID: 30681582 PMCID: PMC6358398 DOI: 10.1097/md.0000000000014171] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND To perform a meta-analysis of high-quality studies comparing robotic radical hysterectomy (RRH) vs laparoscopic radical hysterectomy (LRH), and open radical hysterectomy (ORH) for the treatment of cervical cancer. METHODS A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was performed to identify studies that compared RRH with LRH or ORH. The selection of high-quality, nonrandomized comparative studies was based on a validated tool (methodologic index for nonrandomized studies) since no randomized controlled trials have been published. Outcomes of interest included conversion rate, operation time, intraoperative estimated blood loss (EBL), length of hospital stay (LOS), morbidity, mortality, number of retrieved lymph nodes (RLNs), and long-term oncologic outcomes. RESULTS Twelve studies assessing RRH vs LRH or ORH were included for this meta-analysis. In comparison with LRH, there was no difference in operation time, EBL, conversion rate, intraoperative or postoperative complications, LOS, and tumor recurrence (P > .05). Compared with ORH, patients underwent RRH had less EBL (weighted mean difference [WMD] = -322.59 mL; 95% confidence interval [CI]: -502.75 to -142.43, P < .01), a lower transfusion rate (odds ratio [OR] = 0.14, 95% CI: 0.06-0.34, P < .01), and shorter LOS (WMD = -2.71 days; 95% CI: -3.74 to -1.68, P < .01). There was no significant difference between RRH and LRH with respect to the operation time, intraoperative or postoperative complications, RLN, and tumor recurrence (P > .05). CONCLUSION Our results indicate that RRH is safe and effective compared to its laparoscopic and open counterpart and provides favorable outcomes in postoperative recovery.
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Affiliation(s)
- Youn-Jee Chung
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
- Seoul St. Mary's Fibroid Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Mee-Ran Kim
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
- Seoul St. Mary's Fibroid Center, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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Lee B, Kim K, Park Y, Lim MC, Bristow RE. Impact of hospital care volume on clinical outcomes of laparoscopic radical hysterectomy for cervical cancer: A systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e13445. [PMID: 30544427 PMCID: PMC6310549 DOI: 10.1097/md.0000000000013445] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In cervical cancer, the impact of hospital volume of laparoscopic radical hysterectomy (LRH) has not been investigated systematically as in ovarian cancer.The aim of this study was to investigate the impact of hospital care volume of LRH on treatment outcomes of patients with cervical cancer. METHODS The PubMed, Embase, and Cochrane Library databases were searched with the terms "cervical cancer," "radical hysterectomy," and "laparoscopy." The selection criteria included studies presenting operative outcomes and/or perioperative complications of LRH from high-volume hospitals (HVHs) (≥15 cases/year) and low-volume hospitals (LVHs) (<15 cases/year). Fifty-nine studies including 4367 cases were selected. Linear regression analysis weighted by the average annual case number in each study was performed to evaluate differences between the groups. RESULTS In HVH, a higher number of lymph nodes (24.5 vs 21.1; P = .037) were retrieved by LRH in older women (48.4 vs 44.5 years; P = .010) with tendencies of shorter operation time (224.4 vs 256.4 minutes; P = .096) and less blood loss (253.1 vs 322.2 mL; P = .080). Compared with LVH, HVH had fewer patients with stage IA disease (13.8 vs 24.4%; P = .003) and more patients with stage IIA disease (15.3 vs 7.1%; P = .052) with comparable 5-year overall survival (93.1 vs 88.6%; P = .112). CONCLUSION HVH is a prognostic factor for operative outcome and perioperative complications in patients with cervical cancer undergoing LRH. The exact effect of hospital volume on survival outcome needs to be evaluated.
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Affiliation(s)
- Banghyun Lee
- Department of Obstetrics and Gynecology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul
| | - Kidong Kim
- Department of Obstetrics and Gynecology Gyeonggi-do
| | - Youngmi Park
- Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam-Si
| | - Myong Cheol Lim
- Cancer Healthcare Research Branch, Center for Uterine Cancer, and Center for Clinical Trials, Research Institute and Hospital, Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si Gyeonggi-do, Republic of Korea
| | - Robert E. Bristow
- Division of Gynecologic Oncology, Obstetrics and Gynecology, Irvine Medical Center, University of California, Orange, CA
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Ramirez PT, Frumovitz M, Pareja R, Lopez A, Vieira M, Ribeiro R, Buda A, Yan X, Shuzhong Y, Chetty N, Isla D, Tamura M, Zhu T, Robledo KP, Gebski V, Asher R, Behan V, Nicklin JL, Coleman RL, Obermair A. Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer. N Engl J Med 2018; 379:1895-1904. [PMID: 30380365 DOI: 10.1056/nejmoa1806395] [Citation(s) in RCA: 1102] [Impact Index Per Article: 183.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND There are limited data from retrospective studies regarding whether survival outcomes after laparoscopic or robot-assisted radical hysterectomy (minimally invasive surgery) are equivalent to those after open abdominal radical hysterectomy (open surgery) among women with early-stage cervical cancer. METHODS In this trial involving patients with stage IA1 (lymphovascular invasion), IA2, or IB1 cervical cancer and a histologic subtype of squamous-cell carcinoma, adenocarcinoma, or adenosquamous carcinoma, we randomly assigned patients to undergo minimally invasive surgery or open surgery. The primary outcome was the rate of disease-free survival at 4.5 years, with noninferiority claimed if the lower boundary of the two-sided 95% confidence interval of the between-group difference (minimally invasive surgery minus open surgery) was greater than -7.2 percentage points (i.e., closer to zero). RESULTS A total of 319 patients were assigned to minimally invasive surgery and 312 to open surgery. Of the patients who were assigned to and underwent minimally invasive surgery, 84.4% underwent laparoscopy and 15.6% robot-assisted surgery. Overall, the mean age of the patients was 46.0 years. Most patients (91.9%) had stage IB1 disease. The two groups were similar with respect to histologic subtypes, the rate of lymphovascular invasion, rates of parametrial and lymph-node involvement, tumor size, tumor grade, and the rate of use of adjuvant therapy. The rate of disease-free survival at 4.5 years was 86.0% with minimally invasive surgery and 96.5% with open surgery, a difference of -10.6 percentage points (95% confidence interval [CI], -16.4 to -4.7). Minimally invasive surgery was associated with a lower rate of disease-free survival than open surgery (3-year rate, 91.2% vs. 97.1%; hazard ratio for disease recurrence or death from cervical cancer, 3.74; 95% CI, 1.63 to 8.58), a difference that remained after adjustment for age, body-mass index, stage of disease, lymphovascular invasion, and lymph-node involvement; minimally invasive surgery was also associated with a lower rate of overall survival (3-year rate, 93.8% vs. 99.0%; hazard ratio for death from any cause, 6.00; 95% CI, 1.77 to 20.30). CONCLUSIONS In this trial, minimally invasive radical hysterectomy was associated with lower rates of disease-free survival and overall survival than open abdominal radical hysterectomy among women with early-stage cervical cancer. (Funded by the University of Texas M.D. Anderson Cancer Center and Medtronic; LACC ClinicalTrials.gov number, NCT00614211 .).
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Affiliation(s)
- Pedro T Ramirez
- From the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center, Houston (P.T.R., M.F., R.L.C.); the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, and Clínica de Oncología Astorga, Medellin - both in Colombia (R.P.); the Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (A.L.); the Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos (M.V.), the Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba (R.R.), and the Department of Gynecologic Oncology, Albert Einstein Hospital, São Paulo (M.T.) - all in Brazil; the Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy (A.B.); the Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou (X.Y.), the Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (Y.S.), and the Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou (T.Z.) - all in China; the Department of Gynecologic Oncology, Mater Health Services Brisbane, South Brisbane (N.C.), the National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney (K.P.R., V.G., R.A.), and the Queensland Centre for Gynaecological Cancer Research and the Faculty of Medicine, University of Queensland (V.B., A.O.), and the Department of Gynaecologic Oncology, Royal Brisbane and Women's Hospital (J.L.N.), Herston - all in Australia; and the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City (D.I.)
| | - Michael Frumovitz
- From the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center, Houston (P.T.R., M.F., R.L.C.); the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, and Clínica de Oncología Astorga, Medellin - both in Colombia (R.P.); the Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (A.L.); the Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos (M.V.), the Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba (R.R.), and the Department of Gynecologic Oncology, Albert Einstein Hospital, São Paulo (M.T.) - all in Brazil; the Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy (A.B.); the Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou (X.Y.), the Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (Y.S.), and the Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou (T.Z.) - all in China; the Department of Gynecologic Oncology, Mater Health Services Brisbane, South Brisbane (N.C.), the National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney (K.P.R., V.G., R.A.), and the Queensland Centre for Gynaecological Cancer Research and the Faculty of Medicine, University of Queensland (V.B., A.O.), and the Department of Gynaecologic Oncology, Royal Brisbane and Women's Hospital (J.L.N.), Herston - all in Australia; and the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City (D.I.)
| | - Rene Pareja
- From the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center, Houston (P.T.R., M.F., R.L.C.); the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, and Clínica de Oncología Astorga, Medellin - both in Colombia (R.P.); the Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (A.L.); the Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos (M.V.), the Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba (R.R.), and the Department of Gynecologic Oncology, Albert Einstein Hospital, São Paulo (M.T.) - all in Brazil; the Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy (A.B.); the Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou (X.Y.), the Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (Y.S.), and the Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou (T.Z.) - all in China; the Department of Gynecologic Oncology, Mater Health Services Brisbane, South Brisbane (N.C.), the National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney (K.P.R., V.G., R.A.), and the Queensland Centre for Gynaecological Cancer Research and the Faculty of Medicine, University of Queensland (V.B., A.O.), and the Department of Gynaecologic Oncology, Royal Brisbane and Women's Hospital (J.L.N.), Herston - all in Australia; and the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City (D.I.)
| | - Aldo Lopez
- From the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center, Houston (P.T.R., M.F., R.L.C.); the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, and Clínica de Oncología Astorga, Medellin - both in Colombia (R.P.); the Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (A.L.); the Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos (M.V.), the Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba (R.R.), and the Department of Gynecologic Oncology, Albert Einstein Hospital, São Paulo (M.T.) - all in Brazil; the Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy (A.B.); the Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou (X.Y.), the Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (Y.S.), and the Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou (T.Z.) - all in China; the Department of Gynecologic Oncology, Mater Health Services Brisbane, South Brisbane (N.C.), the National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney (K.P.R., V.G., R.A.), and the Queensland Centre for Gynaecological Cancer Research and the Faculty of Medicine, University of Queensland (V.B., A.O.), and the Department of Gynaecologic Oncology, Royal Brisbane and Women's Hospital (J.L.N.), Herston - all in Australia; and the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City (D.I.)
| | - Marcelo Vieira
- From the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center, Houston (P.T.R., M.F., R.L.C.); the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, and Clínica de Oncología Astorga, Medellin - both in Colombia (R.P.); the Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (A.L.); the Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos (M.V.), the Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba (R.R.), and the Department of Gynecologic Oncology, Albert Einstein Hospital, São Paulo (M.T.) - all in Brazil; the Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy (A.B.); the Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou (X.Y.), the Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (Y.S.), and the Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou (T.Z.) - all in China; the Department of Gynecologic Oncology, Mater Health Services Brisbane, South Brisbane (N.C.), the National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney (K.P.R., V.G., R.A.), and the Queensland Centre for Gynaecological Cancer Research and the Faculty of Medicine, University of Queensland (V.B., A.O.), and the Department of Gynaecologic Oncology, Royal Brisbane and Women's Hospital (J.L.N.), Herston - all in Australia; and the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City (D.I.)
| | - Reitan Ribeiro
- From the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center, Houston (P.T.R., M.F., R.L.C.); the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, and Clínica de Oncología Astorga, Medellin - both in Colombia (R.P.); the Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (A.L.); the Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos (M.V.), the Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba (R.R.), and the Department of Gynecologic Oncology, Albert Einstein Hospital, São Paulo (M.T.) - all in Brazil; the Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy (A.B.); the Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou (X.Y.), the Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (Y.S.), and the Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou (T.Z.) - all in China; the Department of Gynecologic Oncology, Mater Health Services Brisbane, South Brisbane (N.C.), the National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney (K.P.R., V.G., R.A.), and the Queensland Centre for Gynaecological Cancer Research and the Faculty of Medicine, University of Queensland (V.B., A.O.), and the Department of Gynaecologic Oncology, Royal Brisbane and Women's Hospital (J.L.N.), Herston - all in Australia; and the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City (D.I.)
| | - Alessandro Buda
- From the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center, Houston (P.T.R., M.F., R.L.C.); the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, and Clínica de Oncología Astorga, Medellin - both in Colombia (R.P.); the Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (A.L.); the Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos (M.V.), the Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba (R.R.), and the Department of Gynecologic Oncology, Albert Einstein Hospital, São Paulo (M.T.) - all in Brazil; the Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy (A.B.); the Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou (X.Y.), the Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (Y.S.), and the Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou (T.Z.) - all in China; the Department of Gynecologic Oncology, Mater Health Services Brisbane, South Brisbane (N.C.), the National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney (K.P.R., V.G., R.A.), and the Queensland Centre for Gynaecological Cancer Research and the Faculty of Medicine, University of Queensland (V.B., A.O.), and the Department of Gynaecologic Oncology, Royal Brisbane and Women's Hospital (J.L.N.), Herston - all in Australia; and the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City (D.I.)
| | - Xiaojian Yan
- From the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center, Houston (P.T.R., M.F., R.L.C.); the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, and Clínica de Oncología Astorga, Medellin - both in Colombia (R.P.); the Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (A.L.); the Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos (M.V.), the Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba (R.R.), and the Department of Gynecologic Oncology, Albert Einstein Hospital, São Paulo (M.T.) - all in Brazil; the Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy (A.B.); the Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou (X.Y.), the Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (Y.S.), and the Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou (T.Z.) - all in China; the Department of Gynecologic Oncology, Mater Health Services Brisbane, South Brisbane (N.C.), the National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney (K.P.R., V.G., R.A.), and the Queensland Centre for Gynaecological Cancer Research and the Faculty of Medicine, University of Queensland (V.B., A.O.), and the Department of Gynaecologic Oncology, Royal Brisbane and Women's Hospital (J.L.N.), Herston - all in Australia; and the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City (D.I.)
| | - Yao Shuzhong
- From the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center, Houston (P.T.R., M.F., R.L.C.); the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, and Clínica de Oncología Astorga, Medellin - both in Colombia (R.P.); the Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (A.L.); the Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos (M.V.), the Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba (R.R.), and the Department of Gynecologic Oncology, Albert Einstein Hospital, São Paulo (M.T.) - all in Brazil; the Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy (A.B.); the Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou (X.Y.), the Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (Y.S.), and the Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou (T.Z.) - all in China; the Department of Gynecologic Oncology, Mater Health Services Brisbane, South Brisbane (N.C.), the National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney (K.P.R., V.G., R.A.), and the Queensland Centre for Gynaecological Cancer Research and the Faculty of Medicine, University of Queensland (V.B., A.O.), and the Department of Gynaecologic Oncology, Royal Brisbane and Women's Hospital (J.L.N.), Herston - all in Australia; and the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City (D.I.)
| | - Naven Chetty
- From the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center, Houston (P.T.R., M.F., R.L.C.); the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, and Clínica de Oncología Astorga, Medellin - both in Colombia (R.P.); the Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (A.L.); the Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos (M.V.), the Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba (R.R.), and the Department of Gynecologic Oncology, Albert Einstein Hospital, São Paulo (M.T.) - all in Brazil; the Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy (A.B.); the Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou (X.Y.), the Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (Y.S.), and the Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou (T.Z.) - all in China; the Department of Gynecologic Oncology, Mater Health Services Brisbane, South Brisbane (N.C.), the National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney (K.P.R., V.G., R.A.), and the Queensland Centre for Gynaecological Cancer Research and the Faculty of Medicine, University of Queensland (V.B., A.O.), and the Department of Gynaecologic Oncology, Royal Brisbane and Women's Hospital (J.L.N.), Herston - all in Australia; and the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City (D.I.)
| | - David Isla
- From the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center, Houston (P.T.R., M.F., R.L.C.); the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, and Clínica de Oncología Astorga, Medellin - both in Colombia (R.P.); the Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (A.L.); the Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos (M.V.), the Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba (R.R.), and the Department of Gynecologic Oncology, Albert Einstein Hospital, São Paulo (M.T.) - all in Brazil; the Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy (A.B.); the Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou (X.Y.), the Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (Y.S.), and the Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou (T.Z.) - all in China; the Department of Gynecologic Oncology, Mater Health Services Brisbane, South Brisbane (N.C.), the National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney (K.P.R., V.G., R.A.), and the Queensland Centre for Gynaecological Cancer Research and the Faculty of Medicine, University of Queensland (V.B., A.O.), and the Department of Gynaecologic Oncology, Royal Brisbane and Women's Hospital (J.L.N.), Herston - all in Australia; and the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City (D.I.)
| | - Mariano Tamura
- From the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center, Houston (P.T.R., M.F., R.L.C.); the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, and Clínica de Oncología Astorga, Medellin - both in Colombia (R.P.); the Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (A.L.); the Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos (M.V.), the Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba (R.R.), and the Department of Gynecologic Oncology, Albert Einstein Hospital, São Paulo (M.T.) - all in Brazil; the Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy (A.B.); the Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou (X.Y.), the Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (Y.S.), and the Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou (T.Z.) - all in China; the Department of Gynecologic Oncology, Mater Health Services Brisbane, South Brisbane (N.C.), the National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney (K.P.R., V.G., R.A.), and the Queensland Centre for Gynaecological Cancer Research and the Faculty of Medicine, University of Queensland (V.B., A.O.), and the Department of Gynaecologic Oncology, Royal Brisbane and Women's Hospital (J.L.N.), Herston - all in Australia; and the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City (D.I.)
| | - Tao Zhu
- From the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center, Houston (P.T.R., M.F., R.L.C.); the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, and Clínica de Oncología Astorga, Medellin - both in Colombia (R.P.); the Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (A.L.); the Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos (M.V.), the Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba (R.R.), and the Department of Gynecologic Oncology, Albert Einstein Hospital, São Paulo (M.T.) - all in Brazil; the Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy (A.B.); the Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou (X.Y.), the Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (Y.S.), and the Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou (T.Z.) - all in China; the Department of Gynecologic Oncology, Mater Health Services Brisbane, South Brisbane (N.C.), the National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney (K.P.R., V.G., R.A.), and the Queensland Centre for Gynaecological Cancer Research and the Faculty of Medicine, University of Queensland (V.B., A.O.), and the Department of Gynaecologic Oncology, Royal Brisbane and Women's Hospital (J.L.N.), Herston - all in Australia; and the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City (D.I.)
| | - Kristy P Robledo
- From the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center, Houston (P.T.R., M.F., R.L.C.); the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, and Clínica de Oncología Astorga, Medellin - both in Colombia (R.P.); the Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (A.L.); the Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos (M.V.), the Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba (R.R.), and the Department of Gynecologic Oncology, Albert Einstein Hospital, São Paulo (M.T.) - all in Brazil; the Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy (A.B.); the Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou (X.Y.), the Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (Y.S.), and the Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou (T.Z.) - all in China; the Department of Gynecologic Oncology, Mater Health Services Brisbane, South Brisbane (N.C.), the National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney (K.P.R., V.G., R.A.), and the Queensland Centre for Gynaecological Cancer Research and the Faculty of Medicine, University of Queensland (V.B., A.O.), and the Department of Gynaecologic Oncology, Royal Brisbane and Women's Hospital (J.L.N.), Herston - all in Australia; and the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City (D.I.)
| | - Val Gebski
- From the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center, Houston (P.T.R., M.F., R.L.C.); the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, and Clínica de Oncología Astorga, Medellin - both in Colombia (R.P.); the Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (A.L.); the Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos (M.V.), the Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba (R.R.), and the Department of Gynecologic Oncology, Albert Einstein Hospital, São Paulo (M.T.) - all in Brazil; the Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy (A.B.); the Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou (X.Y.), the Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (Y.S.), and the Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou (T.Z.) - all in China; the Department of Gynecologic Oncology, Mater Health Services Brisbane, South Brisbane (N.C.), the National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney (K.P.R., V.G., R.A.), and the Queensland Centre for Gynaecological Cancer Research and the Faculty of Medicine, University of Queensland (V.B., A.O.), and the Department of Gynaecologic Oncology, Royal Brisbane and Women's Hospital (J.L.N.), Herston - all in Australia; and the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City (D.I.)
| | - Rebecca Asher
- From the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center, Houston (P.T.R., M.F., R.L.C.); the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, and Clínica de Oncología Astorga, Medellin - both in Colombia (R.P.); the Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (A.L.); the Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos (M.V.), the Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba (R.R.), and the Department of Gynecologic Oncology, Albert Einstein Hospital, São Paulo (M.T.) - all in Brazil; the Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy (A.B.); the Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou (X.Y.), the Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (Y.S.), and the Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou (T.Z.) - all in China; the Department of Gynecologic Oncology, Mater Health Services Brisbane, South Brisbane (N.C.), the National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney (K.P.R., V.G., R.A.), and the Queensland Centre for Gynaecological Cancer Research and the Faculty of Medicine, University of Queensland (V.B., A.O.), and the Department of Gynaecologic Oncology, Royal Brisbane and Women's Hospital (J.L.N.), Herston - all in Australia; and the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City (D.I.)
| | - Vanessa Behan
- From the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center, Houston (P.T.R., M.F., R.L.C.); the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, and Clínica de Oncología Astorga, Medellin - both in Colombia (R.P.); the Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (A.L.); the Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos (M.V.), the Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba (R.R.), and the Department of Gynecologic Oncology, Albert Einstein Hospital, São Paulo (M.T.) - all in Brazil; the Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy (A.B.); the Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou (X.Y.), the Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (Y.S.), and the Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou (T.Z.) - all in China; the Department of Gynecologic Oncology, Mater Health Services Brisbane, South Brisbane (N.C.), the National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney (K.P.R., V.G., R.A.), and the Queensland Centre for Gynaecological Cancer Research and the Faculty of Medicine, University of Queensland (V.B., A.O.), and the Department of Gynaecologic Oncology, Royal Brisbane and Women's Hospital (J.L.N.), Herston - all in Australia; and the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City (D.I.)
| | - James L Nicklin
- From the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center, Houston (P.T.R., M.F., R.L.C.); the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, and Clínica de Oncología Astorga, Medellin - both in Colombia (R.P.); the Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (A.L.); the Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos (M.V.), the Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba (R.R.), and the Department of Gynecologic Oncology, Albert Einstein Hospital, São Paulo (M.T.) - all in Brazil; the Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy (A.B.); the Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou (X.Y.), the Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (Y.S.), and the Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou (T.Z.) - all in China; the Department of Gynecologic Oncology, Mater Health Services Brisbane, South Brisbane (N.C.), the National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney (K.P.R., V.G., R.A.), and the Queensland Centre for Gynaecological Cancer Research and the Faculty of Medicine, University of Queensland (V.B., A.O.), and the Department of Gynaecologic Oncology, Royal Brisbane and Women's Hospital (J.L.N.), Herston - all in Australia; and the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City (D.I.)
| | - Robert L Coleman
- From the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center, Houston (P.T.R., M.F., R.L.C.); the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, and Clínica de Oncología Astorga, Medellin - both in Colombia (R.P.); the Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (A.L.); the Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos (M.V.), the Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba (R.R.), and the Department of Gynecologic Oncology, Albert Einstein Hospital, São Paulo (M.T.) - all in Brazil; the Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy (A.B.); the Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou (X.Y.), the Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (Y.S.), and the Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou (T.Z.) - all in China; the Department of Gynecologic Oncology, Mater Health Services Brisbane, South Brisbane (N.C.), the National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney (K.P.R., V.G., R.A.), and the Queensland Centre for Gynaecological Cancer Research and the Faculty of Medicine, University of Queensland (V.B., A.O.), and the Department of Gynaecologic Oncology, Royal Brisbane and Women's Hospital (J.L.N.), Herston - all in Australia; and the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City (D.I.)
| | - Andreas Obermair
- From the Department of Gynecologic Oncology and Reproductive Medicine, University of Texas M.D. Anderson Cancer Center, Houston (P.T.R., M.F., R.L.C.); the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, and Clínica de Oncología Astorga, Medellin - both in Colombia (R.P.); the Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru (A.L.); the Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos (M.V.), the Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba (R.R.), and the Department of Gynecologic Oncology, Albert Einstein Hospital, São Paulo (M.T.) - all in Brazil; the Unit of Gynecologic Oncology Surgery, Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy (A.B.); the Department of Gynecology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou (X.Y.), the Department of Obstetrics and Gynecology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou (Y.S.), and the Department of Gynecologic Oncology, Zhejiang Cancer Hospital, Hangzhou (T.Z.) - all in China; the Department of Gynecologic Oncology, Mater Health Services Brisbane, South Brisbane (N.C.), the National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney (K.P.R., V.G., R.A.), and the Queensland Centre for Gynaecological Cancer Research and the Faculty of Medicine, University of Queensland (V.B., A.O.), and the Department of Gynaecologic Oncology, Royal Brisbane and Women's Hospital (J.L.N.), Herston - all in Australia; and the Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Mexico City (D.I.)
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Oyama K, Kanno K, Kojima R, Shirane A, Yanai S, Ota Y, Andou M. Short-term outcomes of robotic-assisted versus conventional laparoscopic radical hysterectomy for early-stage cervical cancer: A single-center study. J Obstet Gynaecol Res 2018; 45:405-411. [DOI: 10.1111/jog.13858] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/13/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Keisuke Oyama
- Department of Obstetrics and Gynecology; Kurashiki Medical Center; Okayama Japan
| | - Kiyoshi Kanno
- Department of Obstetrics and Gynecology; Kurashiki Medical Center; Okayama Japan
| | - Ryuji Kojima
- Department of Obstetrics and Gynecology; Kurashiki Medical Center; Okayama Japan
| | - Akira Shirane
- Department of Obstetrics and Gynecology; Kurashiki Medical Center; Okayama Japan
| | - Shiori Yanai
- Department of Obstetrics and Gynecology; Kurashiki Medical Center; Okayama Japan
| | - Yoshiaki Ota
- Department of Obstetrics and Gynecology; Kurashiki Medical Center; Okayama Japan
| | - Masaaki Andou
- Department of Obstetrics and Gynecology; Kurashiki Medical Center; Okayama Japan
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Ind TEJ, Marshall C, Kasius J, Butler J, Barton D, Nobbenhuis M. Introducing robotic radical hysterectomy for stage 1bi cervical cancer-A prospective evaluation of clinical and economic outcomes in a single UK institution. Int J Med Robot 2018; 15:e1970. [PMID: 30408324 DOI: 10.1002/rcs.1970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 07/31/2018] [Accepted: 09/09/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND We have assessed the impact of introducing robotics for a stage 1b cervical cancer service on laparotomy rates, complications, and costs. METHODS Data were collected prospectively from 90 consecutive patients who had a radical hysterectomy between 1 April 2010 and 31 December 2017. RESULTS There were 37 women before the first robotic procedure and 53 after. The laparotomy rate reduced from 75% (9/12) in 2010 to 0% (0/18) in 2017. The length of stay reduced from 6 days (range 3-39) to 3 days (range 1-15) (P < 0.0001). The complication rate before robotics was 68% (25/37) compared with 45% (24/53) afterwards (P = 0.0493). The blood transfusion rate reduced from 43% (16/37) to 11% (6/53) (P = 0.0007). There were no differences between the total costs before and after the introduction of robotics or between each route. CONCLUSIONS In this series, introducing robotics for cervical carcinoma reduced hospital stay and complications. No cost differences were demonstrated.
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Affiliation(s)
- Thomas E J Ind
- Department of Gynaecological Oncology, Royal Marsden Hospital, London, UK.,St George's University of London, London, UK
| | | | - Jenneke Kasius
- Department of Gynaecological Oncology, Royal Marsden Hospital, London, UK
| | - John Butler
- Department of Gynaecological Oncology, Royal Marsden Hospital, London, UK
| | - Desmond Barton
- Department of Gynaecological Oncology, Royal Marsden Hospital, London, UK.,St George's University of London, London, UK
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Kim JH, Kim K, Park SJ, Lee JY, Kim K, Lim MC, Kim JW. Comparative Effectiveness of Abdominal versus Laparoscopic Radical Hysterectomy for Cervical Cancer in the Postdissemination Era. Cancer Res Treat 2018; 51:788-796. [PMID: 30205416 PMCID: PMC6473278 DOI: 10.4143/crt.2018.120] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 09/10/2018] [Indexed: 01/15/2023] Open
Abstract
Purpose Despite the benefits of minimally invasive surgery for cervical cancer, there are a lack of randomized trials comparing laparoscopic radical hysterectomy and abdominal radical hysterectomy. We compared morbidity, cost of care, and survival between abdominal radical hysterectomy and laparoscopic radical hysterectomy for cervical cancer. Materials and Methods We used the Korean nationwide database to identify women with cervical cancer who underwent radical hysterectomy from January 1, 2011 to December 31, 2014. Patients who underwent abdominal radical hysterectomy were compared to those who underwent laparoscopic radical hysterectomy. Perioperative morbidity, the use of adjuvant therapy, and survival were evaluated after propensity score balancing. Results We identified 6,335 patients, including 3,235 who underwent abdominal radical hysterectomy and 3,100 who underwent laparoscopic radical hysterectomy. The use of laparoscopic radical hysterectomy increased from 46.1% in 2011 to 51.8% in 2014. Patients who were younger, had a more recent year of diagnosis, and were treated in the metropolitan area were more likely to undergo a laparoscopic procedure (p < 0.001). Compared to abdominal radical hysterectomy, laparoscopic radical hysterectomy was associated with lower rates of complication, fewertransfusions, a shorter hospital stay, less adjuvant therapy, and reduced total medical costs (p < 0.001). Laparoscopic surgery was associated with a better overall survival than abdominal operation (hazard ratio, 0.74; 95% confidence interval, 0.64 to 0.85). Conclusion In the postdissemination era, laparoscopic radical hysterectomy was associated with more favorable morbidity profiles, a lower cost of care, and comparable survival than abdominal radical hysterectomy.
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Affiliation(s)
- Jin Hee Kim
- Department of Nursing, Chosun University College of Medicine, Gwangju, Korea
| | - Kyungjoo Kim
- Department of Public Health, Korea University, Seoul, Korea
| | - Seo Jin Park
- Department of Nursing, Chosun University College of Medicine, Gwangju, Korea
| | - Jung-Yun Lee
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Myong Cheol Lim
- Division of Gynecologic Oncology, Obstetrics and Gynecology, Irvine Medical Center, University of California, Orange, CA, USA.,Center for Uterine Cancer and Center for Clinical Trials, Hospital, National Cancer Center, Goyang, Korea.,Cancer Healthcare Research Branch, Precision Medicine Branch, and Common Cancer Branch, Research Institute, National Cancer Center, Goyang, Korea.,Department of Cancer Control & Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Jae Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Dioun SM, Fleming ND, Munsell MF, Lee J, Ramirez PT, Soliman PT. Setting Benchmarks for the New User: Training on the Robotic Simulator. JSLS 2018; 21:JSLS.2017.00059. [PMID: 29279661 PMCID: PMC5737239 DOI: 10.4293/jsls.2017.00059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background and Objectives: Data showing the impact of the robotic simulator on fellowship training are limited. This study was conducted to determine whether simulator scores reflect the experience of the robotic gynecologic surgeon and to develop a simulator curriculum for trainees in gynecologic oncology. Methods: All faculty and fellows in the Department of Gynecologic Oncology and Reproductive Medicine were asked to participate. For phase 1, all participants were divided into 2 groups based on robotic surgical experience: beginner (0–50 cases) and experienced (>50 cases). Each participant completed 9 modules 3 times each to establish baseline data. Median module scores for the experienced group defined the benchmarks scores. In phase 2, all trainees who did not meet the benchmark score on a module were asked to repeat the module until they reached the score twice. Results: Twenty-four participants were included: 18 beginners and 6 experienced surgeons. For all modules, experienced surgeons received higher median scores than beginners. There was a significant difference between the scores of the 2 groups in the Energy Switching 1 (87.5 vs 92.5; P = .002) and Suture Sponge 2 (75.0 vs 87.3; P = .011) modules. Thirteen trainees participated in phase 2. For 8 of 9 of the modules, >75% of trainees met proficiency, with a median of 3 to 6 attempts (range, 2–24). Conclusion: Based on the findings, scores reflected each surgeon's experience. With repetition, most of the trainees were able to reach the benchmark scores. Further study is needed to determine the impact of surgical simulation on true intraoperative performance.
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Affiliation(s)
- Shayan M Dioun
- Department of Gynecologic Oncology and Reproductive Medicine
| | | | - Mark F Munsell
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joseph Lee
- Department of Gynecologic Oncology and Reproductive Medicine
| | - Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine
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Gil-Moreno A, Carbonell-Socias M, Salicrú S, Centeno-Mediavilla C, Franco-Camps S, Colas E, Oaknin A, Pérez-Benavente A, Díaz-Feijoo B. Radical Hysterectomy: Efficacy and Safety in the Dawn of Minimally Invasive Techniques. J Minim Invasive Gynecol 2018; 26:492-500. [PMID: 29908339 DOI: 10.1016/j.jmig.2018.06.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/02/2018] [Accepted: 06/05/2018] [Indexed: 12/27/2022]
Abstract
STUDY OBJECTIVE To analyze the effect that the introduction of minimally invasive procedures has had on surgical and oncologic outcomes when compared with conventional open radical hysterectomy (ORH) in a national reference cancer after 17 years of experience in radical hysterectomy. DESIGN A prospective controlled study (Canadian Task Force classification II-2). SETTING A university teaching hospital. PATIENTS All patients who underwent radical hysterectomy as primary treatment for cervical cancer in our institution between May 1999 and June 2016, with a total of 188 patients. INTERVENTIONS Patients underwent ORH or minimally invasive surgery (MIS) (i.e., laparoscopic or robotically assisted radical hysterectomy). MEASUREMENTS AND MAIN RESULTS Seventy-six patients underwent ORH, 90 laparoscopic radical hysterectomy, and 22 robotically assisted radical hysterectomy. Blood loss and hospital stay were inferior in the MIS group (p <.0001). The laparotomic group presented shorter operation times (p = .0001). With a median follow-up of 112.4 months, a total of 156 patients (83%) were alive and free of disease at the time of the data analysis. Overall survival was higher in the MIS group when compared with the ORH group (91 vs 78.9, p = .026). There were no differences regarding recurrence rates between the surgical approaches. CONCLUSION With 1 of the largest follow-up periods in the literature, this study provides added evidence that MIS could become the preferable surgical approach for early-stage cervical cancer since it appears to reduce morbidity without affecting oncologic results.
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Affiliation(s)
- Antonio Gil-Moreno
- Department of Obstetrics and Gynecology (Drs. Gil-Moreno, Carbonell-Socias, Salicrú, Centeno-Mediavilla, Franco-Camps, Pérez-Benavente, and Díaz-Feijoo), Biomedical Research Group in Gynecology (Dr. Colas), and Department of Medical Oncology (Dr. Oaknin), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Melchor Carbonell-Socias
- Department of Obstetrics and Gynecology (Drs. Gil-Moreno, Carbonell-Socias, Salicrú, Centeno-Mediavilla, Franco-Camps, Pérez-Benavente, and Díaz-Feijoo), Biomedical Research Group in Gynecology (Dr. Colas), and Department of Medical Oncology (Dr. Oaknin), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sabina Salicrú
- Department of Obstetrics and Gynecology (Drs. Gil-Moreno, Carbonell-Socias, Salicrú, Centeno-Mediavilla, Franco-Camps, Pérez-Benavente, and Díaz-Feijoo), Biomedical Research Group in Gynecology (Dr. Colas), and Department of Medical Oncology (Dr. Oaknin), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Centeno-Mediavilla
- Department of Obstetrics and Gynecology (Drs. Gil-Moreno, Carbonell-Socias, Salicrú, Centeno-Mediavilla, Franco-Camps, Pérez-Benavente, and Díaz-Feijoo), Biomedical Research Group in Gynecology (Dr. Colas), and Department of Medical Oncology (Dr. Oaknin), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Silvia Franco-Camps
- Department of Obstetrics and Gynecology (Drs. Gil-Moreno, Carbonell-Socias, Salicrú, Centeno-Mediavilla, Franco-Camps, Pérez-Benavente, and Díaz-Feijoo), Biomedical Research Group in Gynecology (Dr. Colas), and Department of Medical Oncology (Dr. Oaknin), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eva Colas
- Department of Obstetrics and Gynecology (Drs. Gil-Moreno, Carbonell-Socias, Salicrú, Centeno-Mediavilla, Franco-Camps, Pérez-Benavente, and Díaz-Feijoo), Biomedical Research Group in Gynecology (Dr. Colas), and Department of Medical Oncology (Dr. Oaknin), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Oaknin
- Department of Obstetrics and Gynecology (Drs. Gil-Moreno, Carbonell-Socias, Salicrú, Centeno-Mediavilla, Franco-Camps, Pérez-Benavente, and Díaz-Feijoo), Biomedical Research Group in Gynecology (Dr. Colas), and Department of Medical Oncology (Dr. Oaknin), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Assumpció Pérez-Benavente
- Department of Obstetrics and Gynecology (Drs. Gil-Moreno, Carbonell-Socias, Salicrú, Centeno-Mediavilla, Franco-Camps, Pérez-Benavente, and Díaz-Feijoo), Biomedical Research Group in Gynecology (Dr. Colas), and Department of Medical Oncology (Dr. Oaknin), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Berta Díaz-Feijoo
- Department of Obstetrics and Gynecology (Drs. Gil-Moreno, Carbonell-Socias, Salicrú, Centeno-Mediavilla, Franco-Camps, Pérez-Benavente, and Díaz-Feijoo), Biomedical Research Group in Gynecology (Dr. Colas), and Department of Medical Oncology (Dr. Oaknin), Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
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Luo C, Liu M, Li X. Efficacy and safety outcomes of robotic radical hysterectomy in Chinese older women with cervical cancer compared with laparoscopic radical hysterectomy. BMC WOMENS HEALTH 2018; 18:61. [PMID: 29716555 PMCID: PMC5930733 DOI: 10.1186/s12905-018-0544-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 03/16/2018] [Indexed: 12/02/2022]
Abstract
Background Recently, as a complex integrating a number of modern high-tech means, robotic surgery system is a well-deserved revolutionary tool in globally minimally invasive surgical field. For the first time in China, the objective of this study was to evaluate the efficacy and safety outcomes of robotic radical hysterectomy (RRH) in Chinese older women with cervical cancer compared with laparoscopic radical hysterectomy (LRH). Methods In this prospective, randomized and double-blinded study, 60 Chinese older women with cervical cancer were evenly divided to accept the RRH or LRH. Follow-up period lasted for 24 months. Results Median age for the entire cohort was 65 (range: 61-69) years. There was no difference in International Federation of Gynecology and Obstetrics (FIGO) stages and cell types between two groups (p > 0.05 for all). Uterine size, tumor size, vaginal length and numbers of left and right pelvic lymph nodes did not differ between two groups (p > 0.05 for all). No difference was observed in numbers of left and right lymph node metastasis (p > 0.05 for all). All patients had negative margins without conversion to laparotomy. There were significantly less postoperative complications in the RRH group than in the LRH group (p < 0.05). Shorter indwelling time of bladder and drain catheters was observed in the RRH group than in the LRH group (p < 0.05 for all). Length of postoperative hospital stay in the RRH group was significantly shorter compared with that in the LRH group (p < 0.05). Patients in two groups similarly experienced the recurrence and death (p > 0.05 for all). Conclusions This study demonstrated that RRH provided additional benefits for Chinese older women with cervical cancer because of less complications and faster recovery compared with LRH. Meanwhile, this study supported an equivalence of surgical qualities and survival outcomes of RRH to LRH. Robotics-assisted surgical method is effective, safe and feasible for Chinese older women with cervical cancer.
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Affiliation(s)
- Cheng Luo
- Department of Gynecology, Chinese People's Liberation Army General Hospital and Hainan Branch, Haitang Bay, Sanya, China
| | - Mei Liu
- Department of Oncology, Chinese People's Liberation Army General Hospital and Hainan Branch, Sanya, China
| | - Xiuli Li
- Department of Gynecology, Chinese People's Liberation Army General Hospital and Hainan Branch, Haitang Bay, Sanya, China.
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Abstract
Minimally invasive surgery continues to transform the field of gynecologic oncology and has now become the standard of care for many early-stage malignancies. The proven benefits of minimally invasive surgery are driving the rapid introduction and dissemination of novel technologies and the increasing ability to perform even the most complex procedures less invasively. In this article, we will review the current literature on traditional multiport laparoscopy, robotic-assisted laparoscopy, laparoendoscopic single-site surgery as well as robotic-assisted laparoendoscopic single-site surgery, with a specific focus on their role in the treatment of gynecologic malignancies.
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Jin YM, Liu SS, Chen J, Chen YN, Ren CC. Robotic radical hysterectomy is superior to laparoscopic radical hysterectomy and open radical hysterectomy in the treatment of cervical cancer. PLoS One 2018; 13:e0193033. [PMID: 29554090 PMCID: PMC5858845 DOI: 10.1371/journal.pone.0193033] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 01/19/2018] [Indexed: 12/27/2022] Open
Abstract
Objective Cervical cancer (CC) continues to be a global burden for women, with higher incidence and mortality rates reported annually. Many countries have witnessed a dramatic reduction in the prevalence of CC due to widely accessed robotic radical hysterectomy (RRH). This network meta-analysis aims to compare intraoperative and postoperative outcomes in way of RRH, laparoscopic radical hysterectomy (LTH) and open radical hysterectomy (ORH) in the treatment of early-stage CC. Methods A comprehensive search of PubMed, Cochrane Library and EMBASE databases was performed from inception to June 2016. Clinical controlled trials (CCTs) of above three hysterectomies in the treatment of early-stage CC were included in this study. Direct and indirect evidence were incorporated for calculating values of weighted mean difference (WMD) or odds ratio (OR), and drawing the surface under the cumulative ranking curve (SUCRA). Results Seventeen 17 CCTs were ultimately enrolled in this network meta-analysis. The network meta-analysis showed that patients treated by RRH and LRH had lower estimated blood loss compared to patients treated by ORH (WMD = -399.52, 95% CI = -600.64~-204.78; WMD = -277.86, 95%CI = -430.84 ~ -126.07, respectively). Patients treated by RRH and LRH had less hospital stay (days) than those by ORH (WMD = -3.49, 95% CI = -5.79~-1.24; WMD = -3.26, 95% CI = -5.04~-1.44, respectively). Compared with ORH, patients treated with RRH had lower postoperative complications (OR = 0.21, 95%CI = 0.08~0.65). Furthermore, the SUCRA value of three radical hysterectomies showed that patients receiving RRH illustrated better conditions on intraoperative blood loss, operation time, the number of resected lymph nodes, length of hospital stay and intraoperative and postoperative complications, while patients receiving ORH demonstrated relatively poorer conditions. Conclusion The results of this meta-analysis confirmed that early-stage CC patients treated by RRH were superior to patients treated by LRH and ORH in intraoperative blood loss, length of hospital stay and intraoperative and postoperative complications, and RRH might be regarded as a safe and effective therapeutic procedure for the management of CC.
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Affiliation(s)
- Yue-Mei Jin
- Department of Gynecology and Obstetrics, the Second Hospital of Jilin University, Changchun, P.R. China
| | - Shan-Shan Liu
- Department of Gynecology and Obstetrics, the Second Hospital of Jilin University, Changchun, P.R. China
| | - Jun Chen
- Department of Gynecology and Obstetrics, the Second Hospital of Jilin University, Changchun, P.R. China
- * E-mail:
| | - Yan-Nan Chen
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Chen-Chen Ren
- Department of Gynecology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
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Robotic-Assisted Radical Hysterectomy Results in Better Surgical Outcomes Compared With the Traditional Laparoscopic Radical Hysterectomy for the Treatment of Cervical Cancer. Int J Gynecol Cancer 2018; 27:1990-1999. [PMID: 28858908 PMCID: PMC5671798 DOI: 10.1097/igc.0000000000001101] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objective The aim of this study was to compare the surgical outcomes of robotic-assisted radical hysterectomy (RRH) with traditional laparoscopic radical hysterectomy (TLRH) for the treatment of early-stage cervical cancer in a large retrospective cohort of a total of 933 patients. Methods We have enrolled 100 patients into the RRH and 833 patients into the TLRH group. The surgical outcomes include operating time, blood loss, transfusion rate, pelvic lymph node yield, hospitalization days, duration of bowel function recovery, catheter removal before and after 3 weeks, conversion to laparotomy, and intraoperative and postoperative complications. Follow-up results were also analyzed for all patients. Results Both groups have similar patient and tumor characteristics but patients with a larger lesion size were preferably enrolled in the TLRH treatment group. The treatment with RRH was generally superior to TLRH with respect to operating time, blood loss, length of hospitalization, duration of bowel function recovery, and postoperative complications. On follow-up of patients, there were no relapses reported in the RRH group compared with 4% of relapse cases and 2.9% of deaths because of metastasis in the TLRH group. No conversion of laparotomy occurred in the RRH group. No significant difference was found with respect to intraoperative complications and blood transfusion between both groups. Conclusions The results from this study suggest that RRH is superior to TLRH with regard to surgical outcome and may pose a safe and feasible alternative to TLRH. The operating time and lymph node yield is acceptable. Our study is one of the largest single-center studies of surgical outcomes comparing RRH with TLRH during cervical cancer treatment and will significantly contribute to the safety of alternative treatment options for patients. Furthermore, the difference detected between TLRH and RRH group is further strengthened by the great expertise of the surgeon performing laparoscopic surgeries.
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Gallotta V, Conte C, Federico A, Vizzielli G, Gueli Alletti S, Tortorella L, Pedone Anchora L, Cosentino F, Chiantera V, Fagotti A, D'Indinosante M, Pelligra S, Scambia G, Ferrandina G. Robotic versus laparoscopic radical hysterectomy in early cervical cancer: A case matched control study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2018; 44:754-759. [PMID: 29422253 DOI: 10.1016/j.ejso.2018.01.092] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/06/2018] [Accepted: 01/16/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study aims at evaluating the feasibility, surgical outcome and oncological results observed after robotic radical hysterectomy (RH) compared to laparoscopy for patients with early stage cervical cancer (ECC) patients. METHODS Between January 2010 and October 2016, 210 patients underwent RH for treatment of ECC: 70 underwent robotic approach (Cases), and 140 underwent laparoscopic approach (Controls). RESULTS There was no statistically significant difference between the two approaches with regard to clinical patient characteristics and in terms of extent of RH and rate of pelvic and aortic lymphadenectomy. Operative time was significantly longer in the robotic versus laparoscopic group (median = 243 min, range 90-612 versus median = 210 min, range 80-660; p value = 0.008). Conversion to laparotomy was necessary in 4 patients (1.9%) in the whole series. No difference was found in terms of intraoperative and postoperative complications between the two groups. Overall, during the observation period, 34 (16.2%) patients experienced any grade postoperative complications, and 21 (10.0%) had >G2 complications. The 3-yr DFS was 88.0% versus 84.0% in robotic and laparoscopic group, respectively (p value = 0.866). Central and/or lateral pelvic disease represented the most common site of relapse. The 3-yr OS was 90.8% in patients underwent robotic RH versus 94.0% in patients underwent laparoscopic RH (p value = 0.924). CONCLUSIONS The present study shows the equivalence of robotic and laparoscopic approaches to radical surgery of ECC patients, in terms of perioperative and postoperative outcomes with equivalent survival figures, and thus the choice of approach can be tailored to the choice of patient and surgeon.
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Affiliation(s)
- Valerio Gallotta
- Division of Gynecologic Oncology, Fondazione "Policlinico Universitario A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy.
| | - Carmine Conte
- Division of Gynecologic Oncology, Fondazione "Policlinico Universitario A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Alex Federico
- Division of Gynecologic Oncology, Fondazione "Policlinico Universitario A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Vizzielli
- Division of Gynecologic Oncology, Fondazione "Policlinico Universitario A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Salvatore Gueli Alletti
- Division of Gynecologic Oncology, Fondazione "Policlinico Universitario A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Lucia Tortorella
- Division of Gynecologic Oncology, Fondazione "Policlinico Universitario A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Luigi Pedone Anchora
- Division of Gynecologic Oncology, Fondazione "Policlinico Universitario A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Cosentino
- Division of Gynecologic Oncology, Fondazione "Policlinico Universitario A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Vito Chiantera
- Division of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione "Policlinico Universitario A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Marco D'Indinosante
- Division of Gynecologic Oncology, Fondazione "Policlinico Universitario A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Silvia Pelligra
- Division of Gynecologic Oncology, Fondazione "Policlinico Universitario A. Gemelli", Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Department of Women's and Children's Health, Catholic University of the Sacred Heart, Rome, Italy
| | - Gabriella Ferrandina
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
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Minimally Invasive Surgery to Treat Gynecological Cancer: Conventional Laparoscopy and/or Robot-Assisted Surgery. Int J Gynecol Cancer 2018; 27:562-574. [PMID: 28187093 DOI: 10.1097/igc.0000000000000925] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Robotic-assisted surgery is a technological advancement derived from conventional laparoscopy, which facilitates the application of minimally invasive techniques for complex operations in the field of gynecological oncology. However, its introduction in gynecological cancer has been scarce in most hospitals worldwide. Most publications on robotic surgery are still retrospective or descriptive in nature. Some studies compare robotic-assisted laparoscopy with open procedures, which is a questionable analysis, because the advantages of minimally invasive surgery have been already well established. Robotic surgery should be directly compared with conventional laparoscopy to determine whether its additional direct and indirect costs are in accordance with some improvements within patient clinical outcomes. On the other hand, the role of robotic-assisted surgery in allowing more patients to receive the benefits of the minimally invasive approach should also be considered. The objective of this article was, therefore, to review the literature regarding the role of conventional and robotic-assisted laparoscopy to treat women with gynecologic cancer.
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Pellegrino A, Damiani GR, Loverro M, Pirovano C, Fachechi G, Corso S, Trojano G. Comparison of Robotic and laparoscopic Radical type-B and C hysterectomy for cervical cancer: Long term-outcomes. ACTA BIO-MEDICA : ATENEI PARMENSIS 2017; 88:289-296. [PMID: 29083333 DOI: 10.23750/abm.v88i3.6100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 01/23/2017] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To compare the clinical and oncologic outcomes of Robotic radical hysterectomy (RRH) vs Laparoscopic radical hysterectomy (TLRH) in patients with cervical carcinoma. DESIGN Long term follow-up in a prospective study between March 2010 to March 2016. SETTING Oncological referral center, department of gynecology and obstetrics of Alessandro Manzoni Hospital, department of gynecology, University of San Gerardo Monza, Milan. PATIENTS 52 patients with cervical carcinoma, matched by age, body mass index, tumor size, International Federation of Gynecology and Obstetrics (FIGO) stage, comorbidity, previous neoadjuvant chemotherapy, histology type, and tumor grade to obtain homogeneous samples. INTERVENTIONS Patients with FIGO stage IA2 or IB1 with a tumor size less than or equal to 2 cm underwent RR type B. RR-Type C1 was performed in stage IB1, with a tumor size larger than 2 cm, or in patients previously treated with NACT (IB2). In all cases Pelvic lymphadenectomy was performed for the treatment of cervical cancer. MEASUREMENTS AND MAIN RESULTS Surgical time was similar for both the 2 groups. RRH was associated with significantly less (EBL) estimated blood loss (P=0,000). Median number pelvic lymph nodes was similar, but a major number of nodes was observed in RRH group (35.58 vs 24.23; P=0,050). The overall median length of follow-up was 59 months (range: 9-92) and 30 months (range: 90-6) for RRH and TLRH group respectively. Overall survival rate (OSR) was 100% for RRH group and 83.4% for LTRH group. The DFS (disease free survival rate) was of 97% and 89% in RRH and LTRH group respectively. No significant difference was reported in HS (hospital stay). CONCLUSIONS RRH is safe and feasible and is associated with an improved intraoperative results and clinical oncological outcomes. The present study showed that robotic surgery, in comparison to laparoscopic approach, was associated with better perioperative outcomes because of a decrease of EBL, and similar operative time, HS and complication rate, without neglecting the long-term optimal oncologic outcomes.
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The robotic approach significantly reduces length of stay after colectomy: a propensity score-matched analysis. Int J Colorectal Dis 2017; 32:1415-1421. [PMID: 28685223 DOI: 10.1007/s00384-017-2845-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Robotic surgery has helped overcome several of the inherent limitations of conventional laparoscopy. The aim of this study is to identify any short-term advantage of robotic-assisted (RC) over laparoscopic colectomy (LC) using standardized nationwide data. METHODS Patients from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) 2012-2014 datasets who underwent elective LC or RC were compared for patient demographics, comorbidity, diagnosis, extent of colon resection, operative duration, and conversion rates. Thirty-day postoperative complications and post-discharge utilization of resources, readmission, and discharge to another facility were also evaluated. Propensity score matching was used to balance the sample size in the two groups. RESULTS Of 35,839 LC and RC procedures, 2482 cases were eligible for propensity score matching for the statistically significant variables (standardized difference > 0.10) and 1241 colectomy procedures were assigned to each group. Most of the major, minor surgical, and medical postoperative complications were comparable between the two groups. However, RC was associated with reduced 30-day postoperative septic complications (2.3 vs. 4%, p = 0.02), hospital stay (mean: 4.8 vs. 6.3 days, p = 0.001), and discharge to another facility (3.5 vs. 5.8%, p = 0.01). RC was, however, associated with readmission within 30 days after surgery (9.4 vs. 9.1%, p = 0.049). Postoperative ileus, anastomotic leak, reoperation, reintubation, and mortality were equivalent between RC and LC. CONCLUSION This propensity score-matched analysis suggests that RC is associated with some recovery benefits over LC. Greater experience with the technique may allow these advantages to counter some of the cost-related concerns that have deterred the more widespread utilization of robotic technology for colectomy.
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Park JY, Nam JH. Role of robotic surgery in cervical malignancy. Best Pract Res Clin Obstet Gynaecol 2017; 45:60-73. [PMID: 28533153 DOI: 10.1016/j.bpobgyn.2017.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 03/24/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
Abstract
Surgical treatment is the mainstay of the management of early-stage cervical cancer. Abdominal radical hysterectomy and trachelectomy have long been the standard surgical approach to early-stage cervical cancer, achieving excellent survival outcomes. Recently, laparoscopic radical hysterectomy and trachelectomy have become the preferred alternative to abdominal surgery because laparoscopic approaches lead to better surgical outcomes without compromising survival outcomes. Since the robotic surgery platform was approved for the use of gynaecologic surgery in 2005, robotic radical hysterectomy and trachelectomy have been increasingly used in the surgical management of early-stage cervical cancer. However, the role of robotic surgery is poorly defined. This review examines the role of robotic surgery in the surgical management of cervical cancer by comparing the published data on its use with those of abdominal and laparoscopic surgeries.
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Affiliation(s)
- Jeong-Yeol Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Joo-Hyun Nam
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
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Lauterbach R, Matanes E, Lowenstein L. Review of Robotic Surgery in Gynecology-The Future Is Here. Rambam Maimonides Med J 2017; 8:RMMJ.10296. [PMID: 28467761 PMCID: PMC5415365 DOI: 10.5041/rmmj.10296] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The authors present a systematic review of randomized and observational, retrospective and prospective studies to compare between robotic surgery as opposed to laparoscopic, abdominal, and vaginal surgery for the treatment of both benign and malignant gynecologic indications. The comparison focuses on operative times, surgical outcomes, and surgical complications associated with the various surgical techniques. PubMed was the main search engine utilized in search of study data. The review included studies of various designs that included at least 25 women who had undergone robotic gynecologic surgery. Fifty-five studies (42 comparative and 13 non-comparative) met eligibility criteria. After careful analysis, we found that robotic surgery was consistently connected to shorter post-surgical hospitalization when compared to open surgery, a difference less significant when compared to laparoscopic surgery. Also, it seems that robotic surgery is highly feasible in gynecology. There are quite a few inconsistencies regarding operative times and estimated blood loss between the different approaches, though in the majority of studies estimated blood loss was lower in the robotic surgery group. The high variance in operative times resulted from the difference in surgeon's experience. The decision whether robotic surgery should become mainstream in gynecological surgery or remain another surgical technique in the gynecological surgeon's toolbox requires quite a few more randomized controlled clinical trials. In any case, in order to bring robotic surgery down to the front row of surgery, training surgeons is by far the most important goal for the next few years.
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Affiliation(s)
- Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; and Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Emad Matanes
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; and Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; and Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Zhao Y, Hang B, Xiong GW, Zhang XW. Laparoscopic Radical Hysterectomy in Early Stage Cervical Cancer: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2017; 27:1132-1144. [PMID: 28300465 DOI: 10.1089/lap.2017.0022] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE To investigate the value of laparoscopic radical hysterectomy (LRH) in the treatment of early stage cervical cancer by comparing intraoperative and postoperative outcomes with abdominal radical hysterectomy (ARH). MATERIALS AND METHODS We searched the Medline, Web of Knowledge, Cochrane Library, and Chinese National Knowledge Infrastructure, through February 2, 2016 with keywords of "laparoscopic OR laparoscopy" AND "radical hysterectomy OR early cervical cancer OR stage IB, stage IB1, stage IB2, stage IIA, stage IIA1, stage IIA2, stage IIA cervical cancer" to identify all relevant studies that compared LRH with ARH in treating early cervical cancer. Two reviewers evaluated the quality of literature independently. Standardized tables were used to extract data (study or participant details and results) from the texts, tables, figures, or any other attachments of eligible publications. Weighted mean differences (MDs) and odds ratios (ORs) were pooled with the random effects model. Then we conducted meta-analysis using the RevMan5.3 software. RESULTS A total of 615 studies were initially identified. After screening, 23 studies, including 4205 patients were recruited. LRH was associated with lower estimated blood loss (mL) (MD = -178.41, 95% confidence interval [CI] = -214.89 to -141.94, P < .00001), longer operation time (minutes) (MD = 43.68, 95% CI = 29.42-57.95, P < .00001), fewer retrieved lymph nodes (MD = -3.44, 95% CI = -5.96 to -0.92, P = .007), shorter hospital stay (day) (MD = -3.17, 95% CI = -4.06 to -2.29, P < .00001), quicker return to normal bowel activity (day) (MD = -0.7, 95% CI = -0.96 to -0.45, P < .00001), and shorter duration of bladder catheterization (day) (MD = -1.69, 95% CI = -2.83 to -0.55, P < .004) than ARH. LRH also demonstrated lower odds of transfusion (OR = 0.47, 95% CI = 0.30-0.73, P = .0007), and ileus (OR = 0.34, 95% CI = 0.12-0.91, P = .03) than ARH. CONCLUSION LRH outweighs ARH in treating early stage cervical cancer in most essential aspects, which should arouse sufficient attention.
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Affiliation(s)
- Yue Zhao
- 1 Department of Obstetrics and Gynecology, Peking University Third Hospital , Beijing, China .,2 Biological Sciences & Engineering Division, Lawrence Berkeley National Laboratory, University of California , Berkeley, California
| | - Bo Hang
- 2 Biological Sciences & Engineering Division, Lawrence Berkeley National Laboratory, University of California , Berkeley, California
| | - Guang-Wu Xiong
- 3 Department of Obstetrics and Gynecology, Third Affiliated Hospital of Chongqing Medical University , Chongqing, China
| | - Xiao-Wei Zhang
- 1 Department of Obstetrics and Gynecology, Peking University Third Hospital , Beijing, China
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Diver E, Hinchcliff E, Gockley A, Melamed A, Contrino L, Feldman S, Growdon W. Minimally Invasive Radical Hysterectomy for Cervical Cancer Is Associated With Reduced Morbidity and Similar Survival Outcomes Compared With Laparotomy. J Minim Invasive Gynecol 2017; 24:402-406. [DOI: 10.1016/j.jmig.2016.12.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/06/2016] [Accepted: 12/07/2016] [Indexed: 01/05/2023]
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Zanagnolo V, Garbi A, Achilarre MT, Minig L. Robot-assisted Surgery in Gynecologic Cancers. J Minim Invasive Gynecol 2017; 24:379-396. [PMID: 28104497 DOI: 10.1016/j.jmig.2017.01.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/09/2017] [Accepted: 01/09/2017] [Indexed: 11/30/2022]
Abstract
Robotic-assisted surgery is a technological advancement that facilitates the application of minimally invasive techniques for complex operations in gynecologic oncology. The objective of this article was to review the literature regarding the role of robotic-assisted surgery to treat women with gynecologic cancers. The majority of publications on robotic surgery are still retrospective or descriptive in nature; however, the data for managing patients with a robotic-assisted approach show comparable, and at times improved, outcomes compared with both laparoscopy (2-dimensional) and laparotomy approaches. Robotic-assisted surgery has been used for patients with endometrial cancer and resulted in the increased use of minimally invasive surgery with improved outcomes compared with laparotomy and partially with laparoscopy. This has been shown in large cohorts of patients as well as in obese patients in whom the complication rates have significantly decreased. For early cervical cancer, robotic radical hysterectomy seems to be safe and feasible and to be preferable to laparotomy with seemingly comparable oncologic outcomes. Robotic-assisted surgery and conventional laparoscopy to stage women with early-stage ovarian cancer seem to have similar surgical and oncologic outcomes, with a shorter learning curve for robotic-assisted surgery. However, robotic-assisted surgery appears to be more expensive than laparotomy and traditional laparoscopy. In conclusion, robotic-assisted surgery appears to facilitate the surgical approach for complex operations to treat women with gynecologic cancers. Although randomized controlled trials are lacking to further elucidate the equivalence of robot-assisted surgery with conventional methods in terms of oncologic outcome and patients' quality of life, the technology appears to be safe and effective and could offer a minimally invasive approach to a much larger group of patients.
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Affiliation(s)
- Vanna Zanagnolo
- Gynecology Department, European Institute of Oncology, Milan, Italy.
| | - Annalisa Garbi
- Gynecology Department, European Institute of Oncology, Milan, Italy
| | | | - Lucas Minig
- Gynecology Department, Instituto Valenciano de Oncología, Valencia, Spain
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Teoh D, Halloway RN, Heim J, Vogel RI, Rivard C. Evaluation of the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator in Gynecologic Oncology Patients Undergoing Minimally Invasive Surgery. J Minim Invasive Gynecol 2017; 24:48-54. [PMID: 27789387 PMCID: PMC6614862 DOI: 10.1016/j.jmig.2016.10.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/14/2016] [Accepted: 10/14/2016] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE To evaluate the ability of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) surgical risk calculator to predict discharge to postacute care and perioperative complications in gynecologic oncology patients undergoing minimally invasive surgery (MIS). DESIGN A retrospective chart review (Canadian Task Force classification II-1). SETTING A university hospital. PATIENTS All patients undergoing MIS on the gynecologic oncology service from January 1, 2009, to December 30, 2013. INTERVENTIONS Surgical procedures were reviewed, and appropriate Common Procedural Terminology codes were assigned. Twenty-one preoperative risk factors were abstracted from the chart and entered into the ACS NSQIP surgical risk calculator. The predicted risk of discharge to postacute care and 8 additional postoperative complications were calculated and recorded. Actual postoperative complications were abstracted from the medical record. The association between the calculated risk and the actual outcome was determined using logistic regression. The ability of the calculator to accurately predict a particular event was assessed using the c-statistic and Brier score. MEASUREMENTS AND MAIN RESULTS Of the 876 patients reviewed, a majority underwent hysterectomy (71.6%), with almost half of those patients undergoing additional cancer staging procedures (34.8%). Although the calculator was a poor predictor of postoperative complications, it was a strong predictor for discharge to postacute care (c-statistic = 0.91, Brier score = 0.02) with an odds ratio of 2.31 (95% confidence interval, 1.65-3.25; p < .0001). CONCLUSION The ACS NSQIP surgical risk calculator does not accurately predict postoperative complications or length of stay in gynecologic oncology patients undergoing MIS. Although it was a strong predictor of need for discharge to postacute care, it vastly overestimated the number of patients requiring this service. Therefore, the calculator's risk score for discharge to postacute care may be considered during preoperative counseling but should not be a predictor of whether or not the patient should proceed with surgery.
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Affiliation(s)
- Deanna Teoh
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, Minnesota.
| | | | - Jennifer Heim
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, Minnesota
| | - Rachel Isaksson Vogel
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, Minnesota; Biostatistics and Bioinformatics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Colleen Rivard
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Minnesota, Minneapolis, Minnesota
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