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Durdağ GD, Alemdaroğlu S, Baran ŞY, Şimşek SY, Yetkinel S, Çelik H. Safety of laparoscopic surgery in the management of endometrioid endometrial cancer. Indian J Cancer 2023; 60:366-372. [PMID: 36861713 DOI: 10.4103/ijc.ijc_206_21] [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] [Indexed: 12/02/2022]
Abstract
Background Laparoscopic surgery has increasingly been preferred in recent years. However, data regarding the safety of laparoscopy in endometrial cancer are not sufficient. The aim of this study was to compare perioperative and oncologic outcomes of laparoscopic and laparotomic staging surgery in patients with endometrioid endometrial cancer and to evaluate the safety and efficacy of laparoscopic surgery in this population. Methods Data of 278 patients, who underwent surgical staging for endometrioid endometrial cancer at the gynecologic oncology department of a university hospital between 2012 and 2019, were analyzed retrospectively. Demographic, histopathologic, perioperative, and oncologic characteristics were compared between laparoscopy and laparotomy groups. A subgroup of patients with a body mass index (BMI) >30 was further evaluated. Results Demographic and histopathologic characteristics were similar between the two groups, while laparoscopic surgery was seen to be significantly superior in terms of perioperative outcomes. The number of removed and metastatic lymph nodes was significantly higher in the laparotomy group; however, this difference did not affect the oncologic outcomes, including recurrence and survival rates, and the two groups had similar results in this aspect. The outcomes of the subgroup with BMI >30 were also in accordance with the whole population. Intraoperative complications in laparoscopy were managed successfully. Conclusions Laparoscopic surgery appears to be advantageous over laparotomy, and depending on the surgical experience, it may be performed safely for surgical staging of endometrioid endometrial cancer.
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Affiliation(s)
- Gülşen Doğan Durdağ
- Department of Gynecology and Obstetrics, Baskent University Faculty of Medicine, Adana Application and Research Hospital, Adana, Turkey
| | - Songül Alemdaroğlu
- Department of Gynecology and Obstetrics, Baskent University Faculty of Medicine, Adana Application and Research Hospital, Adana, Turkey
| | - Şafak Yilmaz Baran
- Department of Gynecology and Obstetrics, Baskent University Faculty of Medicine, Adana Application and Research Hospital, Adana, Turkey
| | - Seda Yüksel Şimşek
- Department of Gynecology and Obstetrics, Baskent University Faculty of Medicine, Adana Application and Research Hospital, Adana, Turkey
| | - Selçuk Yetkinel
- Department of Gynecology and Obstetrics, Baskent University Faculty of Medicine, Adana Application and Research Hospital, Adana, Turkey
| | - Hüsnü Çelik
- Department of Gynecology and Obstetrics, Baskent University Faculty of Medicine, Adana Application and Research Hospital, Adana, Turkey
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Gruhl SL, Yusoff MA, Chin HMS, Nadarajah R. Robotic surgery in morbidly obese women with endometrial cancer in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:161-163. [PMID: 38904495 DOI: 10.47102/annals-acadmedsg.20234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Affiliation(s)
| | | | - Hui Men Selina Chin
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
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Tomov ST, Gorchev GA, Kiprova DK, Lyubenov AD, Hinkova NH, Tomova VD, Gorcheva ZV, Ahmad S. Peri-operative and survival outcomes analysis of patients with endometrial cancer managed by three surgical approaches: a long-term Bulgarian experience. J Robot Surg 2022; 16:1367-1382. [PMID: 35142980 DOI: 10.1007/s11701-022-01374-0] [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: 09/28/2021] [Accepted: 01/21/2022] [Indexed: 12/24/2022]
Abstract
The study aim was to assess the peri-operative, oncologic, and survival outcomes for patients with endometrial cancer (EC) managed by abdominal hysterectomy (AH), laparoscopic hysterectomy (LH), or robotic hysterectomy (RH) approaches at premier centers in Bulgaria. We analyzed histologically diagnosed EC cases operated via any of the three surgical methods during 2008-2019. Data analyses included patients and tumor characteristics, peri-operative outcomes, and disease status. We grouped FIGO stages I and II to represent early-stage EC and to investigate their survival. Kaplan-Meier and Cox regression analyses were performed to determine disease-free survival (DFS) and overall survival (OS). Consecutive 917 patients (AH = 466; LH = 60, RH = 391) formed the basis of study analyses. Most of demographics and tumor characteristics of the patients were comparable across the groups except few minor variations (e.g., LH/RH cases were younger, heavier, more stage IA, endometrioid, G1, low-risk group). LH and RH group cases had significantly lower operative time than AH (p < 0.001), shorter hospital length-of-stay (p < 0.001), higher post-operative Hgb (p < 0.001). RH cases had fewer blood transfusions than AH or LH (p < 0.001). Cox multivariate analyses indicate that OS was not influenced by the type of surgical approach. Despite the fact that the DFS in "early-stage" EC is significantly better in AH group than RH, the type of surgery (i.e., AH, LH, or RH) for "all stages" is insignificant factor for DFS. With our long-term experience, minimally invasive surgical approach resulted in superior peri-operative, oncologic, and survival outcomes. Specifically, RH is not only safe in terms of post-operative results, but also for mortality and oncologic rates.
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Affiliation(s)
- Slavcho T Tomov
- Medical University Pleven, University Hospital "Saint Marina", Pleven, 5800, Bulgaria.
| | - Grigor A Gorchev
- Medical University Pleven, University Hospital "Saint Marina", Pleven, 5800, Bulgaria
| | - Desislava K Kiprova
- Medical University Pleven, University Hospital "Saint Marina", Pleven, 5800, Bulgaria
| | - Aleksandar D Lyubenov
- Medical University Pleven, University Hospital "Saint Marina", Pleven, 5800, Bulgaria
| | - Nadezhda H Hinkova
- Medical University Pleven, University Hospital "Saint Marina", Pleven, 5800, Bulgaria
| | - Vesela D Tomova
- Medical University Pleven, University Hospital "Saint Marina", Pleven, 5800, Bulgaria
| | - Zornitsa V Gorcheva
- Medical University Pleven, University Hospital "Saint Marina", Pleven, 5800, Bulgaria
| | - Sarfraz Ahmad
- Gynecologic Oncology Program, AdventHealth Cancer Institute, 2501 N. Orange Ave., Suite 786, Orlando, FL, 32804, USA. .,FSU and UCF Colleges of Medicine, Orlando, FL 32804, USA.
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Liu H, Cao Y, Li L, Bai Y, Liu J. Effectiveness of robotic surgery for endometrial cancer: a systematic review and meta-analysis. Arch Gynecol Obstet 2021; 305:837-850. [PMID: 34498124 DOI: 10.1007/s00404-021-06229-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/31/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Our current study was performed aimed at determining the efficacy and safety profile of robotic surgery (RS) compared to laparoscopic surgery (LPS) and laparotomy (LT) in the treatment of endometrial cancer on the basis of relevant studies. PATIENTS AND METHODS A systematic literature search was conducted based on appropriate keywords, using the Embase, Cochrane library, as well as PubMed. Our studiers also reviewed the key pertinent sources among the publications and included associated literatures published by June 2021. Odds ratios (ORs), mean difference (MD), as well as 95% confidence interval (95% CI) for each study were measured for further assessment and synthesis of outcomes. RESULTS Thirty studies involving a total of 12,025 patients were eventually included in the current meta-analysis. Compared with LPS, RS could significantly decrease the estimated blood loss, the incidence of intraoperative complications, the length of hospital stay, and the rate of conversion, and increased the rate of readmission. Compared with LT, RS significantly decreased the estimated blood loss, blood transfusion volume, the length of hospital stay, the rate of total, intraoperative and postoperative complications, and the rate of readmission and re-operation, and increased the operative time. CONCLUSION Considering the effects and safety profile of RS in terms of treating endometrial cancer, our study suggest that RS exerts superior outcomes than that of LPS and LT.
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Affiliation(s)
- Huafang Liu
- Department of Gynecology, Beijing Ditan Hospital, Capital Medical University, No.8 Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Yanjun Cao
- Department of Gynecology, Beijing Ditan Hospital, Capital Medical University, No.8 Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Li Li
- Department of Gynecology, Beijing Ditan Hospital, Capital Medical University, No.8 Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Yuqing Bai
- Department of Gynecology, Beijing Ditan Hospital, Capital Medical University, No.8 Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Jun Liu
- Department of Gynecology, Beijing Ditan Hospital, Capital Medical University, No.8 Jingshun East Street, Chaoyang District, Beijing, 100015, China.
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Renaud MC, Sebastianelli A, Grégoire J, Plante M. Five-Year Experience in the Surgical Treatment of Endometrial Cancer: Comparing Laparotomy With Robotic and Minimally Invasive Hysterectomy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 44:21-27. [PMID: 34474173 DOI: 10.1016/j.jogc.2021.07.021] [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: 04/09/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To compare surgical and oncological outcomes in the treatment of endometrial cancer between laparotomy and minimally invasive surgery. The secondary objective was to determine which MIS approach was the most beneficial. METHODS This was a single-centre retrospective review of all endometrial cancer surgeries performed between November 1, 2012 and October 31, 2017 in a gynaecologic oncology unit of a university hospital. Descriptive statistics were used to compare histopathologic results and oncological outcomes, and Kaplan-Meier estimates were used to compare survival. RESULTS A total of 735 cases were reviewed. The majority of patients (77%) underwent either laparotomy (35%) or robotic-assisted hysterectomy (42%); the remaining patients underwent total laparoscopic hysterectomy (12%) or a laparoscopic-assisted vaginal hysterectomy (8.7%). There was a statistically significant overall survival benefit (P = 0.02), a shorter hospital stay (P < 0.0001), and fewer early surgical complications (<30 d; P = 0.0002), as well as a survival benefit in elderly patients (>70 y) in the robotic-assisted hysterectomy group (P = 0.043) than the laparotomy group. Operating time was shorter in the laparotomy group (P < 0.0001). Recurrence rates in stage 1 low-risk disease were similar between groups. CONCLUSION Minimally invasive surgical approaches, particularly robotic surgery, do not compromise oncologic outcomes, especially for early-stage low-risk disease. In addition, these approaches are associated with fewer early surgical complications and shorter hospital stay, with significantly more same-day discharges. Overall survival and survival in a subgroup of elderly patients were significantly better in the robotic-assisted hysterectomy group.
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Affiliation(s)
- Marie Claude Renaud
- Department of Obstetrics and Gynecology-CHU de Québec-Gynecologic Oncology Service, Québec, QC.
| | - Alexandra Sebastianelli
- Department of Obstetrics and Gynecology-CHU de Québec-Gynecologic Oncology Service, Québec, QC
| | - Jean Grégoire
- Department of Obstetrics and Gynecology-CHU de Québec-Gynecologic Oncology Service, Québec, QC
| | - Marie Plante
- Department of Obstetrics and Gynecology-CHU de Québec-Gynecologic Oncology Service, Québec, QC
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Slaager C, Hofhuis W, Hoogduin K, Ewing-Graham P, van Beekhuizen H. Serous endometrial intraepithelial carcinoma (SEIC): Current clinical practice in The Netherlands. Eur J Obstet Gynecol Reprod Biol 2021; 265:25-29. [PMID: 34416579 DOI: 10.1016/j.ejogrb.2021.08.012] [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: 05/18/2021] [Revised: 07/27/2021] [Accepted: 08/08/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Serous endometrial intraepithelial carcinoma (SEIC) is a rare diagnosis, defined as an intraepithelial lesion with cells identical to serous type endometrial carcinoma. SEIC is considered to be potentially metastatic, however clear and robust data on prognosis are lacking, potentially leading to variability in clinical management. OBJECTIVE The aim is to establish the opinion of gynecologists on the optimal management of patients with SEIC. METHODS An online questionnaire with 15 multiple choice questions was sent to all gynecologists with expertise in gynecological oncology in 19 expert centers in The Netherlands. RESULTS A total of 24 gynecologists participated. The majority of respondents (n = 18/24, 75%) do not consult a guideline regarding the treatment of SEIC. In current practice, 14 of the 24 respondents perform surgical staging in women with SEIC (58.3%) while seven choose hysterectomy with bilateral salpingo-oophorectomy (29.2%), and three (12.5%) have no firm preference. Eleven of the 14 respondents who perform a surgical staging procedure believe that this is certainly the optimal treatment. The majority of respondents have no firm opinion on whether lymph node sampling or lymph node dissection is preferable during surgical staging (n = 15/23, 65.2%). Most respondents do not give adjuvant therapy (n = 15/24, 62.5%), 25.0% recommend brachytherapy (n = 6/24). Follow-up is for 5 years in almost all cases (n = 23/24). CONCLUSION There is no consensus on the optimal surgical treatment and the use of adjuvant therapy for patients with SEIC. Our research team is therefore conducting a nationwide cohort study in which treatment modality, morbidity and survival will be evaluated.
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Affiliation(s)
- Ciska Slaager
- Franciscus Gasthuis en Vlietland, Department of Obstetrics and Gynecology. Kleiweg 400, Rotterdam, The Netherlands.
| | - Ward Hofhuis
- Franciscus Gasthuis en Vlietland, Department of Obstetrics and Gynecology. Kleiweg 400, Rotterdam, The Netherlands.
| | | | - Patricia Ewing-Graham
- Erasmus Medical Center, Department of Pathology. Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
| | - Heleen van Beekhuizen
- Erasmus MC Cancer Institute, Department of Gynecological Oncology. Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
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Opławski M, Smoczyńska M, Grabarek BO, Boroń D. Assessment of Dysfunction in the Urinary System as Well as Comfort in the Life of Women during and after Combination Therapy Due to Ovarian and Endometrial Cancer Based on the SWL, II-Q7 and UDI-6 Scales. J Clin Med 2021; 10:jcm10061228. [PMID: 33809612 PMCID: PMC8000855 DOI: 10.3390/jcm10061228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/24/2021] [Accepted: 03/04/2021] [Indexed: 01/22/2023] Open
Abstract
This work aimed to assess the influence of oncological combination therapy that was done on endometrial or ovarian cancer and how the urinary system is influenced as well as the quality of life in comparison to a group of female patients after the removal of the uterus with appendages due to endometrial cancer, which did not require the supplementation of therapy after operative treatment. The study included 87 patients with endometrial cancer, where, after the removal of the uterus, there was no need for conducting adjuvant therapy (C), as well as 92 female patients with endometrial cancer or 38 patients with ovarian cancer in whom combination therapy was conducted (group A, B). The assessment of the quality of life was conducted using the questionnaires: Satisfaction Life Scale (SWLS), Incontinence Impact Questionnaire, Short Form (IIQ-7), and Urogenital Distress Inventory (UDI-6) for three, six, nine, and 12 months after the conclusion of oncological treatment. It was observed that there was a statistically significant decrease in the quality of life in female patients who underwent combination therapy in comparison to a group in whose treatment only included surgery (p < 0.05). The risk of developing urinary incontinence increases alongside an increase in the scope of the operation and in the case of supplementing treatment with brachytherapy in comparison to chemotherapy.
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Affiliation(s)
- Marcin Opławski
- Department of Gynecology and Obstetrics with Gynecologic Oncology, Ludwik Rydygier Memorial Specialized Hospital, 31-826 Kraków, Poland; (B.O.G.); (D.B.)
- Correspondence:
| | - Magdalena Smoczyńska
- Department of Rehabilitation Psychology, Ludwik Rydygier Collegium Medium, Mikołaj Kopernik’s University CM UMK, 30-835 Bydgoszcz, Poland;
| | - Beniamin Oskar Grabarek
- Department of Gynecology and Obstetrics with Gynecologic Oncology, Ludwik Rydygier Memorial Specialized Hospital, 31-826 Kraków, Poland; (B.O.G.); (D.B.)
- Department of Histology, Cytophysiology and Embryology in Zabrze, Faculty of Medicine in Zabrze, University of Technology in Katowice, 41-800 Zabrze, Poland
- District Hospital in Chrzanów, 32-500 Chrzanów, Poland
- Department of Nursing and Maternity, High School of Strategic Planning in Dąbrowa Górnicza, 41-300 Dąbrowa Górnicza, Poland
| | - Dariusz Boroń
- Department of Gynecology and Obstetrics with Gynecologic Oncology, Ludwik Rydygier Memorial Specialized Hospital, 31-826 Kraków, Poland; (B.O.G.); (D.B.)
- Department of Histology, Cytophysiology and Embryology in Zabrze, Faculty of Medicine in Zabrze, University of Technology in Katowice, 41-800 Zabrze, Poland
- District Hospital in Chrzanów, 32-500 Chrzanów, Poland
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Han Z, Zheng Z, Tao K, Yu Y, Wu J, Tian X. The effect of surgical approach on the outcomes and prognosis of high-risk histologic endometrioid carcinomas. Gland Surg 2021; 10:355-363. [PMID: 33633992 DOI: 10.21037/gs-20-887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background High-risk histologic endometrioid carcinomas include poorly differentiated endometrial carcinoma (PDEC), uterine clear cell carcinoma (UCCC), uterine carcinosarcoma (UCS), and uterine papillary serous carcinomas (UPCS). The purpose of this study was to investigate and compare the effect of open surgery and minimally invasive surgery on the prognosis of patients with high-risk endometrial cancer tissue types. Methods A retrospective analysis was conducted to investigate 57 UCS or UPCS, 53 UCCC, and 110 PDEC patients receiving initial treatment at the Department of Gynecology in Shaanxi Provincial Tumor hospital and the Affiliated Hospital of Medical College of Xi'an Jiaotong University between February 2010 and January 2015. Prognostic factors were determined using univariate/multivariate analysis, and survival rates were assessed using the Kaplan-Meier method. The Cox regression model was adopted to assess the independent prognostic factors. Results Two hundred and twenty patients who met the criteria were included in this study. At the end of follow-up period, 94 patients were still alive. Univariate analysis found that the survival time of the patients was related to staging, adjuvant therapy, and surgical approach. Multivariate analysis revealed that surgical approach, staging, pathology, and adjuvant therapy were independent prognostic factors. Conclusions Minimally invasive surgery has a shorter survival time compared to open surgery in women with PDEC, UCCC, UCS, and UPCS. Multivariate analysis confirmed that staging, pathological type, surgical approach, and postoperative adjuvant therapy are independent risk factors for prognosis and affect the survival of women with PDEC, UCCC, UCS, and UPCS.
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Affiliation(s)
- Zhihong Han
- Department of Gynecologic Oncology, Shaanxi Provincial Tumor Hospital, Xi'an, China
| | - Zhong Zheng
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Kai Tao
- Department of Gynecologic Oncology, Shaanxi Provincial Tumor Hospital, Xi'an, China
| | - Yanping Yu
- Department of Gynecologic Oncology, Shaanxi Provincial Tumor Hospital, Xi'an, China
| | - Jinping Wu
- Department of Gynecology and Obstetrics, 521 Hospital of Norinco Group Xi'an, Xi'an, China
| | - Xiaofei Tian
- Department of Gynecologic Oncology, Shaanxi Provincial Tumor Hospital, Xi'an, China
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Doğan Durdağ G, Alemdaroğlu S, Yılmaz Baran Ş, Alkaş Yağınç D, Yüksel Şimşek S, Çelik H. Laparoscopic para-aortic lymphadenectomy: Technique and surgical outcomes. J Gynecol Obstet Hum Reprod 2020; 50:101917. [PMID: 32961327 DOI: 10.1016/j.jogoh.2020.101917] [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: 08/29/2020] [Accepted: 09/16/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Pelvic and para-aortic lymph node dissection is an important part of staging surgery. Aim of this study is to evaluate perioperative outcomes of patients, who underwent laparoscopic para-aortic lymphadenectomy for gynecological cancer in a single center over a period of 7 years, based on body mass index (BMI), and to present the surgical technique in steps. METHODS Data of patients who underwent para-aortic lymphadenectomy at gynecological oncology department of a tertiary center in between March 2013 and July 2020 were analyzed retrospectively. Patients were evaluated in two groups according to their BMI (< 30 kg/m2 as non-obese and ≥ 30 kg/m2 as obese groups). Surgical technique is described in steps. Perioperative outcomes of the two groups were evaluated. RESULTS A total of 230 patients were included in the study. BMI was ≥30 at 58.46 % of the patients. Peri-operative features were not significantly affected by the patient's BMI with the presented surgical technique, however, collected para-aortic lymph node numbers were higher in the group with BMI < 30, though sufficient number of lymph nodes were achieved in both groups. CONCLUSION Although some technical difficulties may be encountered, laparoscopic para-aortic lymphadenectomy is feasable in gynecologic oncological surgery independent of BMI. However, surgical experience is important.
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Affiliation(s)
- Gülşen Doğan Durdağ
- Başkent University Faculty of Medicine, Adana Application and Research Hospital, Department of Gynecology and Obstetrics, Adana, Turkey.
| | - Songül Alemdaroğlu
- Başkent University Faculty of Medicine, Adana Application and Research Hospital, Department of Gynecology and Obstetrics, Adana, Turkey
| | - Şafak Yılmaz Baran
- Başkent University Faculty of Medicine, Adana Application and Research Hospital, Department of Gynecology and Obstetrics, Adana, Turkey
| | - Didem Alkaş Yağınç
- Başkent University Faculty of Medicine, Adana Application and Research Hospital, Department of Gynecology and Obstetrics, Adana, Turkey
| | - Seda Yüksel Şimşek
- Başkent University Faculty of Medicine, Adana Application and Research Hospital, Department of Gynecology and Obstetrics, Adana, Turkey
| | - Hüsnü Çelik
- Başkent University Faculty of Medicine, Adana Application and Research Hospital, Department of Gynecology and Obstetrics, Adana, Turkey
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Ziętek-Strobl A, Futyma K, Kuna-Broniowska I, Wojtaś M, Rechberger T. Urogynaecological Symptoms among Oncological Survivors and Impact of Oncological Treatment on Pelvic Floor Disorders and Lower Urinary Tract Symptoms. A Six-Month Follow-Up Study. J Clin Med 2020; 9:E2804. [PMID: 32872660 PMCID: PMC7563446 DOI: 10.3390/jcm9092804] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/29/2020] [Accepted: 08/25/2020] [Indexed: 11/25/2022] Open
Abstract
It has been widely underlined that both gynaecological malignancies and urogynaecological disorders are often associated with high stress and have a negative impact on the quality of life and psychological well-being of women affected. Knowledge of the pelvic anatomy is crucial in recommending and carrying out the least harmful although successful treatment. Subsequent chemoradiation may also induce or exaggerate troublesome symptoms. The aim of the study was to establish the frequency of urogynaecological symptoms (stress urinary incontinence, urgency, pelvic organ prolapse) and to assess the impact of surgical treatment and additional oncological therapy: pelvic radiation, chemoradiation, chemotherapy, on the prevalence of pelvic floor dysfunctions (PFD) and lower urinary tract symptoms (LUTS) in patients suffering from gynecological malignancies. The study group consisted of 160 women, diagnosed with gynaecological malignancy, who underwent surgical treatment and additional adjuvant treatment as necessary. To establish the QoL and prevalence of PFD Urinary Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire 7 (II-Q7), King's Health Questionnaire (KHQ) and the SF-36 Questionnaire were used. Herein, 69 patients reported urinary incontinence (UI) and 67 reported symptoms of pelvic organ prolapse (POP). After the six months follow-up UI was found in 78 patients, 25 patients showed de novo symptoms, 65 patients reported POP and 10 patients demonstrated de novo POP. Our data show that urogynaecological symptoms are not correlated with the type of malignancy, but with the extensiveness of surgery.
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Affiliation(s)
- Alicja Ziętek-Strobl
- 2nd Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (K.F.); (M.W.); (T.R.)
| | - Konrad Futyma
- 2nd Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (K.F.); (M.W.); (T.R.)
| | - Izabela Kuna-Broniowska
- Department of Applied Mathematics and Computer Science, University of Life Science, Akademicka 13, 20-950 Lublin, Poland;
| | - Małgorzata Wojtaś
- 2nd Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (K.F.); (M.W.); (T.R.)
| | - Tomasz Rechberger
- 2nd Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland; (K.F.); (M.W.); (T.R.)
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Gracia M, García-Santos J, Ramirez M, Bellón M, Herraiz MA, Coronado PJ. Value of robotic surgery in endometrial cancer by body mass index. Int J Gynaecol Obstet 2020; 150:398-405. [PMID: 32506474 DOI: 10.1002/ijgo.13258] [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: 11/11/2019] [Revised: 04/07/2020] [Accepted: 06/02/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To compare perioperative outcomes and complications in robotically assisted laparoscopy (RAL) and standard laparoscopy (SLP) approaches in the treatment of endometrial cancer by body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters). METHODS A comparative study was carried out of women treated for endometrial cancer at the Hospital Clinico San Carlos from January 2012 to December 2016: 133 patients were operated by RAL and 101 by SLP. Demographic characteristics of the patients, perioperative outcomes and complications were compared in both approaches. RESULTS Hospital stay was significantly lower in patients with BMI ≤30 operated with RAL (2 days RAL vs 4 days SLP; P=0.002). Estimated blood loss was significantly lower in the group with BMI<25 (60 mL RAL vs 100 mL SLP; P=0.004) and in the group with BMI ≥30 (87.5 mL RAL vs 180 SLP; P=0.003) operated with RAL. RAL significantly reduced the conversion rate in patients with BMI ≥30 (2 [3.4%] patients RAL vs 6 [27.3%] patients SLP; P=0.004). CONCLUSIONS RAL has demonstrated advantages in treating obese women with endometrial cancer by reducing blood loss and conversion to laparotomy.
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Affiliation(s)
- Myriam Gracia
- José Botella Llusiá Institute of Women's Health, Sanitary Research Institute of the San Carlos Clinical Hospital (IdISSC), Complutense University of Madrid, Madrid, Spain
| | - Javier García-Santos
- José Botella Llusiá Institute of Women's Health, Sanitary Research Institute of the San Carlos Clinical Hospital (IdISSC), Complutense University of Madrid, Madrid, Spain
| | - Mar Ramirez
- José Botella Llusiá Institute of Women's Health, Sanitary Research Institute of the San Carlos Clinical Hospital (IdISSC), Complutense University of Madrid, Madrid, Spain
| | - Mónica Bellón
- José Botella Llusiá Institute of Women's Health, Sanitary Research Institute of the San Carlos Clinical Hospital (IdISSC), Complutense University of Madrid, Madrid, Spain
| | - Miguel A Herraiz
- José Botella Llusiá Institute of Women's Health, Sanitary Research Institute of the San Carlos Clinical Hospital (IdISSC), Complutense University of Madrid, Madrid, Spain
| | - Pluvio J Coronado
- José Botella Llusiá Institute of Women's Health, Sanitary Research Institute of the San Carlos Clinical Hospital (IdISSC), Complutense University of Madrid, Madrid, Spain
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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: 5] [Impact Index Per Article: 1.3] [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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A Meta-Analysis of Robotic Surgery in Endometrial Cancer: Comparison with Laparoscopy and Laparotomy. DISEASE MARKERS 2020; 2020:2503753. [PMID: 32454902 PMCID: PMC7212337 DOI: 10.1155/2020/2503753] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 10/23/2019] [Indexed: 12/26/2022]
Abstract
Background The safety and effectiveness of robotic surgery are evaluated by comparing perioperative outcomes with laparoscopy and laparotomy in endometrial cancer. Method PubMed, MEDLINE, Embase, Cochrane, and other databases were searched for eligible studies up to April 2019. Studies that compared robotic surgery with laparoscopy or laparotomy in surgical staging of endometrial cancer were included. The pooled odds ratio and weighted mean difference were calculated using a random-effects or a fixed-effects model to summarize the results. Results Twenty-seven articles were ultimately included, with one randomized controlled trial and 26 observational studies. A total of 6568 patients were included. Meta-analysis showed that robotic surgery had less estimated blood loss (P < 0.001), blood transfusion (P = 0.04), intraoperative complications (P = 0.001), and conversion to open surgery (P = 0.001), and a shorter hospital stay (P = 0.001), but had a longer operation time (P = 0.04) in surgical staging of endometrial cancer compared with laparoscopy. There were no significant differences in postoperative complications, the total number of lymph nodes harvested, the number of pelvic lymph nodes harvested, and the number of para-aortic lymph nodes harvested between techniques. Robotic surgery had a longer operation time (P = 0.008), less estimated blood loss (P < 0.001), blood transfusion (P < 0.001), and postoperative complications (P < 0.001), and a shorter hospital stay (P < 0.001) compared with laparotomy. There were no significant differences in other variables between techniques. Conclusion Robotic surgery is a safer surgical approach than laparoscopy and laparotomy in surgical staging of endometrial cancer, with less estimated blood loss, blood transfusion, and conversion, and the same number of lymph nodes harvested.
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Mortality Rates in Laparoscopic and Robotic Gynecologic Oncology Surgery: A Systemic Review and Meta-analysis. J Minim Invasive Gynecol 2019; 26:1253-1267.e4. [DOI: 10.1016/j.jmig.2019.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 11/18/2022]
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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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Ind T, Laios A, Hacking M, Nobbenhuis M. A comparison of operative outcomes between standard and robotic laparoscopic surgery for endometrial cancer: A systematic review and meta-analysis. Int J Med Robot 2017; 13:e1851. [PMID: 28762635 PMCID: PMC5724687 DOI: 10.1002/rcs.1851] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/19/2017] [Accepted: 06/09/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Evidence has been systematically assessed comparing robotic with standard laparoscopy for treatment of endometrial cancer. METHODS A search of Medline, Embase and Cochrane databases was performed until 30th October 2016. RESULTS Thirty-six papers including 33 retrospective studies, two matched case-control studies and one randomized controlled study were used in a meta-analysis. Information from a further seven registry/database studies were assessed descriptively. There were no differences in the duration of surgery but days stay in hospital were shorter in the robotic arm (0.46 days, 95%CI 0.26 to 0.66). A robotic approach had less blood loss (57.74 mL, 95%CI 38.29 to 77.20), less conversions to laparotomy (RR = 0.41, 95%CI 0.29 to 0.59), and less overall complications (RR = 0.82, 95%CI 0.72 to 0.93). A robotic approach had higher costs ($1746.20, 95%CI $63.37 to $3429.03). CONCLUSION A robotic approach has favourable clinical outcomes but is more expensive.
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Affiliation(s)
- Thomas Ind
- Department of Gynaecological OncologyRoyal Marsden HospitalLondonUK
- St George's University of LondonLondonUK
| | - Alex Laios
- Department of Gynaecological OncologyRoyal Marsden HospitalLondonUK
| | - Matthew Hacking
- Department of Gynaecological OncologyRoyal Marsden HospitalLondonUK
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A Comparison of Outcomes Between Open Hysterectomy and Robotic-Assisted Hysterectomy for Endometrial Cancer Using the National Cancer Database. Int J Gynecol Cancer 2017; 27:1508-1516. [DOI: 10.1097/igc.0000000000001034] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PurposeThe purpose of this study is to evaluate usage patterns and outcomes of women who underwent open hysterectomy (OH) versus robotic assisted-hysterectomy (RAH) for the treatment of endometrial cancer.MethodsWomen with nonmetastatic endometrial adenocarcinoma diagnosed between 2010 and 2012, who either underwent an OH or RAH, were selected from the National Cancer Database. The χ2, Fisher exact, or Mann-Whitney U tests were used where appropriate to compare outcomes between groups. Multivariable logistic regression was used to analyze for predictors for RAH and other outcome variables.ResultsA total of 43,985 women were included in this study with a median age of 61 years. Of these, 23,872 (54.3%) underwent RAH and 20,113 (45.7%) underwent OH. The usage of RAH increased from 43.0% in 2010 to 63.8% in 2012 (P < 0.001). Women receiving RAH were more commonly found to have a Charlson comorbidity score of 0 to 1, lower pathologic stage, nonblack race, treatment at a comprehensive center, and had insurance other than Medicaid. Robotic-assisted hysterectomy was associated with a shorter inpatient stay, lower readmission rates, and lower 30- and 90-day mortality rates (P < 0.001 for all comparisons). There was a significant improvement in overall survival favoring RAH, 96.1% versus 94.0%, which persisted on multivariable logistic regression (P < 0.001).ConclusionsIn this large, hospital-based analysis, RAH was associated with decreased length of stay, lower readmission rates, and less perioperative mortality. However, socioeconomic status continues to remain a barrier to equal treatment allocation. Overall survival was improved with RAH, but the follow-up is limited, and this finding must be interpreted with caution.
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Abstract
PURPOSE OF REVIEW Robotically assisted laparoscopy has been introduced in the armamentarium of gynaecologic oncology surgeons. A lot of studies compared robotic surgery and laparotomy when the real issue is to demonstrate the interest and added value of robotically assisted laparoscopy versus standard laparoscopy. In this review, we will describe the most meaningful indications and advantages of robotically assisted laparoscopy in gynaecologic oncology. RECENT FINDINGS The learning curve for advanced procedures in robot-assisted laparoscopy is shorter and easier than with the standard laparoscopy, especially for beginners. In most of the series, operating time is longer with robot, but complication rates are often decreased, especially in obese patients with a conversion rate to laparotomy that is decreased compared with standard laparoscopy. Robot-assisted laparoscopy can be used for surgery of high-risk endometrial cancer, staging of early-ovarian cancer, and pelvic exenteration in case of recurrent malignancies. Furthermore, more recent robots allow performing sentinel node biopsy in endometrial or cervical cancer using fluorescence detection with indocyanine green. SUMMARY The spreading of robotic surgery led to an enhancement of minimal invasive surgical approach in general, and to the development of new indications in gynaecologic oncology. The superiority of robot-assisted laparoscopy still has to be demonstrated with properly designed trials.
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Vásquez-Ciriaco S, Isla-Ortiz D, Palomeque-Lopez A, García-Espinoza JA, Jarquín-Arremilla A, Lechuga-García NA. [Initial experience in the laparoscopic treatment of benign and malignant gynaecological diseases in the Hospital Regional de Alta Especialidad in Oaxaca]. CIR CIR 2016; 85:12-20. [PMID: 27320647 DOI: 10.1016/j.circir.2016.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 05/06/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The history of laparoscopic surgery in gynaecological diseases progressed with the advances of Semm, as well as with the development of tools, equipment, and energy that led to its development in all surgical areas, including oncology. OBJECTIVE To present the initial experience in the laparoscopic treatment of benign and malignant gynaecological disease in the Hospital Regional de Alta Especialidad in Oaxaca. MATERIAL AND METHODS An analysis was performed on a total of 44 cases, distributed into: type III radical hysterectomy for invasive cervical cancer, hysterectomy type I cervical cancer in situ, extrafascial hysterectomy for benign disease, routine endometrium, ovary and routine salpingo-oophorectomy. The variables included age, BMI, surgical time, bleeding, intraoperative and postoperative complications, conversion, hospital stay, and pathology report. RESULTS Hysterectomy type III; age 40.2 years, BMI 25.8kg/m2, 238ml bleeding, operative time 228min, 2.6-day hospital stay, intraoperative or postoperative complications, tumour size 1.1cm, 14 lymph nodes dissected, vaginal and negative parametrical edge. Type I hysterectomy cervical cancer in situ: 51 years, BMI 23.8kg/m2, 80ml bleeding, operative time 127minutes, uterus of 9cm, length of stay of 2 days, a conversion by external iliac artery injury, with bleeding of 1500ml. Routine endometrium: 50.3 years, BMI 30.3kg/m2, 83ml bleeding, operative time 180minutes, uterus 12.6cm, length of stay 2.3 days, no complications. CONCLUSION The management of benign and malignant pelvic diseases using laparoscopy is feasible and safe, with shorter hospital stays and a prompt recovery to daily activities.
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Affiliation(s)
- Sergio Vásquez-Ciriaco
- Servicio de Oncología Quirúrgica, Hospital Regional de Alta Especialidad de Oaxaca, Oaxaca, México
| | - David Isla-Ortiz
- Servicio de Ginecología Oncológica, Instituto Nacional de Cancerología, Ciudad de México, México
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Robot-assisted surgery versus conventional laparoscopic surgery for endometrial cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol 2016; 142:2173-83. [PMID: 27217038 DOI: 10.1007/s00432-016-2180-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 05/09/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE To compare perioperative outcomes between robot-assisted surgery (RAS) and conventional laparoscopic surgery (CLS) for the treatment of endometrial cancer by conducting a meta-analysis. METHODS We searched the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE up to January 8, 2016. Studies clearly documenting a comparison between RAS and CLS for patients with endometrial cancer were included. The perioperative outcomes of interest included intraoperative visceral injuries, postoperative complications, operation time, estimated blood loss (EBL), blood transfusion, total lymph nodes harvested (TLNH), conversion to laparotomy, and length of hospital stay. The weighted mean difference (WMD) and odds ratio (OR) were pooled with either a fixed-effects or a random-effects model. RESULTS A total of 19 studies were included in the analysis, involving 3056 patients. The pooled analysis showed that RAS was associated with lower EBL (WMD -77.65; 95 % confidence interval [CI] -105.58 to -49.72), lower conversion rate (OR 0.29; 95 % CI 0.18-0.46), and shorter hospital stay (WMD -0.48; 95 % CI -0.70 to -0.26) compared to CLS. The incidence of intraoperative visceral injuries, operation time, transfusion rate, and TLNH showed no significant differences between RAS and CLS. CONCLUSIONS RAS is a feasible and effective surgical approach that may be superior to CLS for the treatment of endometrial cancer, with lower EBL and lower conversion rate. Further prospective randomized trials are required to validate our findings.
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