Abstract
The aim of this study was to analyse the dynamics of tissue damage and inflammatory response markers perioperatively and whether these differ between women operated with robotic and abdominal hysterectomy in treating early-stage endometrial cancer. At a Swedish university hospital fifty women with early-stage low-risk endometrial cancer were allocated to robotic or abdominal hysterectomy in a randomiszed controlled trial. Blood samples reflecting inflammatory responses (high sensitivity CRP, white blood cells (WBC), thrombocytes, IL-6, cortisol) and tissue damage (creatine kinase (CK), high-mobility group box 1 protein (HMGB1)) were collected one week preoperatively, just before surgery, postoperatively at two, 24 and 48 hours, and one and six weeks postoperatively. High sensitivity CRP (p = 0.03), WBC (p < 0.01), IL-6 (p = 0.03) and CK (p = 0.03) were significantly lower in the robotic group, but fast transitory. Cortisol returned to baseline two hours after robotic hysterectomy but remained elevated in the abdominal group comparable to the preoperative high levels for both groups just before surgery (p < 0.0001). Thrombocytes and HMGB1 were not affected by the mode of surgery. Postoperative inflammatory response and tissue damage were lower after robotic hysterectomy compared to abdominal hysterectomy. A significant remaining cortisol elevation two hours after surgery may reflect a higher stress response in the abdominal group.
Highlights
The aim of this study was to analyse the dynamics of tissue damage and inflammatory response markers perioperatively and whether these differ between women operated with robotic and abdominal hysterectomy in treating early-stage endometrial cancer
Women admitted for surgical treatment of endometrial cancer, assessed by the gynaecological oncologist as International Federation of Gynaecology and Obstetrics (FIGO) stage I, low-risk endometrial cancer and scheduled for hysterectomy and bilateral salpingo-oophorectomy with peritoneal washings between February 2012 and May 2016 were asked to participate in the study
The repeated measures analysis of variance (ANOVA) (Table 2) demonstrated that high sensitivity C-reactive protein (hs-CRP) was significantly lower in the robotic group (Fig. 2)
Summary
The aim of this study was to analyse the dynamics of tissue damage and inflammatory response markers perioperatively and whether these differ between women operated with robotic and abdominal hysterectomy in treating early-stage endometrial cancer. Studies have shown significant effects on immunological response depending on the mode of hysterectomy and anaesthesia with a reduced activation of the inflammatory response and only a slight effect on cellular immunity in favour of www.nature.com/scientificreports laparoscopic hysterectomy compared with abdominal hysterectomy[8,9,10]. None of these studies were carried out using ERAS programs and lacked efforts to reduce surgical stress response. There are few randomised controlled trials published on robotic surgery in gynaecologic oncology, and only one recently published randomised trial has compared the inflammatory response and clinical recovery in robotic and abdominal hysterectomy[12]
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