Robotics Versus Laparoscopic Radical Hysterectomy with Lymphadenectomy in Patients with Early Cervical Cancer: A Multicenter Study

Abstract

The aim of this study was to retrospectively compare the safety, morbidity, and recurrence rate of total laparoscopic radical hysterectomy (TLRH) with lymphadenectomy and total robotic radical hysterectomy (RRH) with lymphadenectomy for early cervical carcinoma in a series of 99 consecutive women. We studied 99 consecutive patients with FIGO stage Ia1 (LVSI), Ia2, Ib1, Ib2, and IIa cervical cancer, 76 of whom underwent TLRH and 23 underwent RRH with pelvic lymph node dissection. Para-aortic lymphadenectomy, with the superior border of the dissection being the inferior mesenteric artery, was performed in all cases with positive pelvic lymph nodes discovered at frozen section evaluation. The mean blood loss was 157ml in the RRH group (95% confidence interval [95% CI] 50-400) and 95ml in the TLRH group (95% CI 30-500) (not significant [NS]). The median length of hospital stay was 3days in the RRH group (95% CI 2-7) and 4days in the TLRH group (95% CI 3-7) (NS). The mean operating time was 255min for the TLRH group (95% CI 182-415) compared with 323min in the RRH group (95% CI 161-433) (P<0.05). No significant difference was found between the 2groups when comparing the recurrence rate. Robotic radical hysterectomy can be considered a safe and effective therapeutic procedure for managing early-stage cervical cancer without significant differences, if compared with laparoscopic radical hysterectomy, in terms of the recurrence rate and intraoperative and postoperative complications, although multicenter randomized clinical trials with longer follow-up are necessary to evaluate the overall oncologic outcomes of this procedure.