Abstract
BackgroundDespite recent advances in diagnosis and treatment, cervical cancer continues to be a significant health problem worldwide. Whereas robot-assisted surgery has advantages over the abdominal approach, and minimally invasive techniques are being used increasingly, these may be associated with a higher recurrence rate and lower overall survival than the abdominal approach. The objective of this study was to compare the surgical and survival outcomes between abdominal radical hysterectomy (ARH) and robotic radical hysterectomy (RRH).MethodsA retrospective cohort of patients undergoing radical hysterectomy for cervical cancer from 2006 to 2018 was identified. Patients with stage IA to IB cervical cancer were included and grouped: ARH vs. RRH. The RRH group was further divided into two groups based on the year of enrollment: RRH1 (2006–2012) and RRH2 (2013–2018). Tumor characteristics, recurrence rate, progression-free survival (PFS), and overall survival (OS) were compared between the groups. P-values < 0.05 (two-sided) were considered statistically significant.ResultsA total of 310 patients were identified: 142 and 168 underwent ARH and RRH, respectively. RRH1 and RRH2 had 77 and 91 patients, respectively. Interestingly, RRH2 was more likely to have a larger tumor size (1.7 ± 1.4 vs. 2.0 ± 1.1 vs. 2.4 ± 1.7 cm, P = 0.014) and higher stage (P < 0.001) than RRH1. However, RRH2 showed significantly favorable PFS in contrast to RRH1. There was no difference between ARH and RRH2 in PFS (P = 0.629), whereas overall, the RRH group showed significantly shorter PFS than the ARH group. In the multivariate analysis, the institutional learning curve represented by the operation year was one of the significant predictors for PFS (hazard ratio [HR] 0.065, P = 0.0162), along with tumor size (HR 5.651, P = 0.0241).ConclusionsThe institutional learning curve, represented by the operation year, is one of the most significant factors associated with outcomes of RRH for early-stage cervical cancer.
Highlights
Despite recent advances in diagnosis and treatment, cervical cancer continues to be a significant health problem worldwide
Only the abdominal approach has been performed, but as technology related to minimally invasive surgery (MIS) continues to develop, the mainstream approach has been shifting to laparoscopic and robotassisted surgery in radical hysterectomy [3, 4]
Recently released data from the Laparoscopic Approach to Cervical Cancer (LACC) trial (NCT00614211) indicated a higher recurrence rate and lower overall survival (OS) in patients with cervical cancer who were surgically treated with MIS than in those treated via the abdominal approach [13]
Summary
Despite recent advances in diagnosis and treatment, cervical cancer continues to be a significant health problem worldwide. Whereas robot-assisted surgery has advantages over the abdominal approach, and minimally invasive techniques are being used increasingly, these may be associated with a higher recurrence rate and lower overall survival than the abdominal approach. The recent widespread implementation of screening and prevention has decreased the incidence and mortality rates of cervical cancer, it continues to be a major public health problem [1]. Recently released data from the Laparoscopic Approach to Cervical Cancer (LACC) trial (NCT00614211) indicated a higher recurrence rate and lower overall survival (OS) in patients with cervical cancer who were surgically treated with MIS than in those treated via the abdominal approach [13]. The unfavorable outcome of the MIS arm in the LACC trial could be a result of the surgical technique or negligence of the surgeon, rather than due to the MIS itself
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