Abstract
Objective
In view of the recent controversy concerning the use of minimally invasive radical
hysterectomy as primary treatment for early stage cervical cancer, this study compared
the survival and perioperative outcomes in a cohort of patients who underwent radical
hysterectomy either by laparotomy or by robotics.
Methods
This retrospective study compared all consecutive patients with early stage cervical
cancer since the beginning of the Division of Gynecologic Oncology at the Jewish General
Hospital in 2003, who underwent robotic radical hysterectomy (n = 74) with a cohort
of all consecutive patients from the immediate past who underwent open radical hysterectomy
(n = 24) for early stage cervical cancer. All patients were treated at the Jewish
General Hospital in Montréal (Canadian Task Force Classification II-2).
Results
The median follow-up time for the robotic group was 46 months. During that time, 7%
and 17% of patients in the robotic group and the laparotomy group had disease recurrence,
respectively (P = 0.12). Cox multivariate regression showed no statistically significant effect of
surgical approach on overall survival (hazard ratio 1.50, P = 0.63) or on progression-free survival (hazard ratio 0.29, P = 0.07). Patients in the robotic cohort had significantly shorter median hospital
stays (1 day vs. 7 days, P < 0.001), and their overall incidence of postoperative complications was lower (13%
vs. 50%, P < 0.001). Median estimated blood loss for robotics was also significantly lower (82
mL vs. 528 mL, P < 0.001).
Conclusion
Based on the data on a limited number of patients in a Canadian context, robotic radical
hysterectomy did not lead to worse oncologic outcomes and was associated with improved
short-term surgical outcomes. One might consider the evaluation of more personalized
surgical decision making.
Résumé
Objectif
À la lumière de la récente controverse entourant le recours à une hystérectomie radicale
à effraction minimale comme traitement de première intention dans les cas de cancer
du col de l'utérus de stade précoce, cette étude compare la survie et les issues périopératoires
au sein d'une cohorte de patientes ayant subi une hystérectomie radicale par laparotomie
ou par chirurgie robotique.
Méthodologie
Cette éude rétrospective a comparé toutes les patientes consécutives présentant un
cancer du col de l'ut'rus de stade précoce depuis la mise sur pied du programme de
gynéco-oncologie de l'Hôpital général juif en 2003. Une cohorte de toutes les patientes
consécutives ayant subi une hystérectomie radicale par chirurgie robotique (n = 74)
à été comparée à une cohorte de toutes les patientes consécutives ayant subi une hystérectomie
radicale par laparotomie (n = 24) pour la même maladie durant la période précédant
immédiatement le début des chirurgies robotiques. Toutes les patientes ont été traitées
à l'Hôpital général juif de Montréal (classification II-2 du Groupe d'étude canadien).
Résultats
La durée médiane du suivi pour le groupe de chirurgie robotique était de 46 mois.
Durant cette période, 7% des patientes de ce groupe et 17% des patientes du groupe
de laparotomie ont présenté une récidive (P = 0,12). Une régression de Cox multivariée n'a montré aucun effet significatif de
l'approche chirurgicale sur la survie globale (rapport de risque 1,50; P = 0,63) et sur la survie sans progression (rapport de risque 0,29; P = 0,07). Le séjour à l'hôpital médian des patientes ayant subi une chirurgie robotique
était significativement inférieur (un jour contre sept jours, P < 0,001), et l'incidence globale de complications postopératoires dans cette cohorte
était plus faible (13 % contre 50 %, P < 0,001). La perte sanguine estimée médiane était aussi significativement plus faible
pour la chirurgie robotique (82 ml contre 528 ml, P < 0,001).
Conclusion
D'après des données issues d'un nombre limité de patientes traitées au Canada, on
peut conclure que l'hystérectomie radicale par chirurgie robotique ne serait pas associée
à des issues oncologiques comparativement défavorables et serait associée à de meilleures
issues chirurgicales à court terme. On pourrait envisager l'évaluation d'une prise
de décision chirurgicale plus personnalisée.
Key Words
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Article info
Publication history
Published online: December 07, 2018
Received:
July 31,
2018
Footnotes
Competing interests: See Acknowledgements.
Identification
Copyright
© 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
