The RECOURSE study: Long-term oncologic outcomes associated with robotically-assisted minimally invasive hsyterectomy performed in patients with endometrial cancer: A meta-analysis (540)

Abstract

Objectives: To compare long-term oncologic outcomes of robotic- assisted (ROBOT) procedures with laparoscopy (LAP) and laparo- tomic (OPEN) hysterectomy based on comparative studies in the published literature. Methods: A systematic literature review and meta-analysis for timedependent oncologic outcomes were conducted in accordance with the PRISMA statement, the Cochrane guidelines and registered with PROSPERO. PubMed, Scopus, and Embase databases were searched. Studies included those comparing robotic to non-robotic hysterectomy with 20 or more cases for each comparator from January 1, 2010, to September 1, 2020. Additionally, studies needed to report on hysterectomy for cancer, distinguish robotic from non-robotic cases, with a minimum follow-up of 12 months or more, and report at least one outcome of interest; disease-free/recurrence-free (DFS) or overall survival (OS). A hierarchical decision tree was developed to calculate and combine hazard ratios (HR) based on information available in each paper, maximizing the number of studies for consideration. Comparisons of long-term oncologic results for ROBOT versus OPEN and LAP were reported. Results: There were 6,477 unique references identified from initial search from which 19 studies were included based on an adjusted analysis of HRs with heterogeneity tests. The weighted HR for DFS for ROBOT (n=1152) versus LAP (n=1029) was 0.94 (95% CI: 0.71-1.26; p=0.68; I2=0%), and ROBOT (n=887) versus OPEN (n=1035) was 0.84 (95% CI: 0.64-1.11; p=0.22; I2=0%). The weighted HR for OS for ROBOT (n=4675) versus LAP (n=2643) was 0.98 (95% CI: 0.82-1.16; p=0.78; I2=0%) and ROBOT (n=27,647) versus OPEN (n=23,923) was 0.77 (95% CI: 0.71-0.83; p<0.0001; I2=18%). Conclusions: When compared with OPEN and LAP hysterectomy, ROBOT hysterectomy does not result in worse oncologic outcomes with respect to DFS and shows improved OS results compared to OPEN. The noted improved outcomes with ROBOT need further validation and investigation. Objectives: To compare long-term oncologic outcomes of robotic- assisted (ROBOT) procedures with laparoscopy (LAP) and laparo- tomic (OPEN) hysterectomy based on comparative studies in the published literature. Methods: A systematic literature review and meta-analysis for timedependent oncologic outcomes were conducted in accordance with the PRISMA statement, the Cochrane guidelines and registered with PROSPERO. PubMed, Scopus, and Embase databases were searched. Studies included those comparing robotic to non-robotic hysterectomy with 20 or more cases for each comparator from January 1, 2010, to September 1, 2020. Additionally, studies needed to report on hysterectomy for cancer, distinguish robotic from non-robotic cases, with a minimum follow-up of 12 months or more, and report at least one outcome of interest; disease-free/recurrence-free (DFS) or overall survival (OS). A hierarchical decision tree was developed to calculate and combine hazard ratios (HR) based on information available in each paper, maximizing the number of studies for consideration. Comparisons of long-term oncologic results for ROBOT versus OPEN and LAP were reported. Results: There were 6,477 unique references identified from initial search from which 19 studies were included based on an adjusted analysis of HRs with heterogeneity tests. The weighted HR for DFS for ROBOT (n=1152) versus LAP (n=1029) was 0.94 (95% CI: 0.71-1.26; p=0.68; I2=0%), and ROBOT (n=887) versus OPEN (n=1035) was 0.84 (95% CI: 0.64-1.11; p=0.22; I2=0%). The weighted HR for OS for ROBOT (n=4675) versus LAP (n=2643) was 0.98 (95% CI: 0.82-1.16; p=0.78; I2=0%) and ROBOT (n=27,647) versus OPEN (n=23,923) was 0.77 (95% CI: 0.71-0.83; p<0.0001; I2=18%). Conclusions: When compared with OPEN and LAP hysterectomy, ROBOT hysterectomy does not result in worse oncologic outcomes with respect to DFS and shows improved OS results compared to OPEN. The noted improved outcomes with ROBOT need further validation and investigation.