Robot assisted endometrial cancer staging – evaluation the first 100 operations and comparing the first andthe last 30 operations
Authors:
R. Marek 1; P. Dzvinčuk 1; Milan Kudela 1
; P. Hambálek 1; M. Maděrka 1
; J. Zapletalová 2; R. Pilka 1
Authors place of work:
Gynekologicko-porodnická klinika LF UP a FN, Olomouc, přednosta prof. MUDr. R. Pilka, Ph. D.
1; Ústav lékařské statistiky a biofyziky LF UP, Olomouc, přednostka prof. MUDr. H. Kolářová, CSc.
2
Published in the journal:
Ceska Gynekol 2015; 80(5): 324-332
Summary
Objective:
To describe and evaluate our experience with robotically assisted laparoscopic staging of endometrial cancer in first hundred cases as compared with the first and last 30 cases of patients staged by this method.
Design:
Comparative retrospective study.
Setting:
Department of Obstetrics and Gynaecology, Faculty of Medicine and Dentistry, Palacky University in Olomouc, Czech Republic. Institute of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University in Olomouc, Czech Republic.
Methods:
The robotic centre at the Faculty Hospital in Olomouc was opened in August 2009 which enabled to perform robotically assisted laparoscopic staging of endometrial cancer. Retrospectively we evaluated the first hundred patients with the early stage of endometrial cancer who underwent hysterectomy, bilateral salpingo-oophorectomy, and pelvic/paraaortic lymphadenectomy using four-armed da Vinci S HD surgical robotic system. In the second stage of the evaluation we compared the first and the last 30 cases operated by the above mentioned minimally invasive approach. All cases were performed by two surgeons (P.R., D.P.), within the same institution in the course of learning this technique. Age, body mass index (BMI), clinical stage of disease, length of operation, nodal yield, blood loss, the pre-operative and post-operative hemoglobin concentration difference and operating complications were documented and compared.
Results:
The first hundred patients were operated by the above mentioned minimally invasive method between September 2009 nad June 2014. All patients were between 33 and 85 years of age. The average age of the entire group of patients was 65 years of age, the average BMI reached 31.0 (ranging from 18.0 to 49.0), the operating times median was 206 minutes. The estimated median of blood loss was 100 ml. The conversion of robotic surgery to a laparotomy was recordedin 6 cases. When comparing the first and the last30 operated patients there was observed a statistically significant increase in BMI in the group of the last30 operations (29.5 vs. 33.0, p = 0.004) and there was a decrease in the number of conversions from 4 to 1.In particular, however, there was a statistically significant increase in the total number of the obtained lymph nodes in the group of the last 30 vs. the first30 patients (27 vs. 17), and the increase in the number of removed pelvic lymph nodes (21 vs. 17) and the paraaortic nodes (4 vs. 0).
Conclusion:
The robotically assisted laparoscopic staging is one of several possible surgical approaches in the treatment of patients with endometrial cancer and it can be performed adequately in this way. According to the results from our patients group it is a surgical modality with significantly low blood loss, safe even for patients with high BMI and age. The increasing erudition of the surgeon is linked to the shortening of the operating time, reducing the number of conversions and the higher yield of lymph nodes and a reduction in blood loss which was reflected in particular in the comparison of the pre-operative and post-operative hemoglobin difference.
Keywords:
laparoscopy, endometrial cancer, staging, robotic surgery
Zdroje
1. Advincula, AP. Surgical techniques: robot-assisted laparoscopic hysterectomy with the da Vinci surgical system. Int J Med Robot, 2006, 2(4), p. 305–311.
2. Aly, E. Robotic colorectal surgery: summary of the current evidence. Int J Colorectal Dis, 2013.
3. Antoniou, SA., Antoniou, GA., Koch, OO., et al. Robot-assisted laparoscopic surgery of the colon and rectum. Surg Endosc, 2012, 26(1), p. 1–11.
4. Ben-Shachar, I., Pavelka, J., Cohn, DE., et al. Surgical staging for patients presenting with grade 1 endometrial carcinoma. Obstet Gynecol, 2005, 105(3), p. 487–493.
5. Beste, TM., Nelson, KH., Daucher, JA. Total laparoscopic hysterectomy utilizing a robotic surgical system. Jsls, 2005, 9(1), p. 13–15.
6. Boggess, JF. Robotic surgery in gynecologic oncology: evolution of a new surgical paradigm. J Robot Surg, 2007, 1(1), p. 31–37.
7. Cohn, DE., Huh, WK., Fowler, JM., et al. Cost-effectiveness analysis of strategies for the surgical management of grade 1 endometrial adenocarcinoma. Obstet Gynecol, 2007, 109(6), p. 1388–1395.
8. Cragun, JM., Havrilesky, LJ., Calingaert, B., et al. Retrospective analysis of selective lymphadenectomy in apparent early-stage endometrial cancer. J Clin Oncol, 2005, 23(16), p. 3668–3675.
9. DeNardis, SA., Holloway, RW., Bigsby, GE., et al. Robotically assisted laparoscopic hysterectomy versus total abdominal hysterectomy and lymphadenectomy for endometrial cancer. Gynecol Oncol, 2008, 111(3), p. 412–417.
10. duPont, NC., Chandrasekhar, R., Wilding, G., et al. Current trends in robot assisted surgery: a survey of gynecologic oncologists. Int J Med Robot, 2010, 6(4), p. 468–472.
11. Eklind, S., Lindfors, A., Sjoli, P., et al. A prospective, comparative study on robotic versus open-surgery hysterectomy and pelvic lymphadenectomy for endometrial carcinoma. Int J Gynecol Cancer, 2015, 25(2), p. 250–256.
12. Eltabbakh, GH., Shamonki, MI., Moody, JM., et al. Laparoscopy as the primary modality for the treatment of women with endometrial carcinoma. Cancer, 2001, 91(2), p. 378–387.
13. Fiorentino, RP. Pilot study assessing robotic laparoscopic hysterectomy and patient outcomes. J Minim Invasive Gynecol, 2006, 13, p. 60–63.
14. Fowler, JM. The role of laparoscopic staging in the management of patients with early endometrial cancer. Gynecol Oncol, 1999, 73(1), p. 1–3.
15. Gerhig, PCL., Shafer, A. What is the optimal minimally invasive surgical procedure for endometrial cancer staging in the obese and morbidly obese woman? Gynecol Oncol, 2008, 111, p. 41–45.
16. Holloway, RW., Ahmad, S., DeNardis, SA., et al. Robotic--assisted laparoscopic hysterectomy and lymphadenectomy for endometrial cancer: Analysis of surgical performance. Gynecol Oncol, 2009, 115(3), p. 447–452.
17. Kho, RM., Hilger, WS., Hentz, JG., et al. Robotic hysterectomy: technique and initial outcomes. Am J Obstet Gynecol, 2007, 197(1), p. 113 e1–4.
18. Kilgore, LC., Partridge, EE., Alvarez, RD., et al. Adenocarcinoma of the endometrium: survival comparisons of patients with and without pelvic node sampling. Gynecol Oncol, 1995, 56(1), p. 29–33.
19. Kuek, A. Laparoscopic technology for the treatment of endometrial cancer. Int J Gynaecol Obstet, 2006, 93, p. 176–181.
20. Leiserowitz, G. Survival of endometrial cancer patients after laparoscopically assisted vaginal hysterectomy or total abdominal hysterectomy: analysis of risk factors. Gynecol Oncol, 2007, 104(1).
21. Lenihan, JP., Jr., Kovanda, C., Seshadri-Kreaden, U. What is the learning curve for robotic assisted gynecologic surgery? J Minim Invasive Gynecol, 2008, 15(5), p. 589–594.
22. Lowe, MP., Chamberlain, DH., Kamelle, SA., et al. A multi-institutional experience with robotic-assisted radical hysterectomy for early stage cervical cancer. Gynecol Oncol, 2009, 113(2), p. 191–194.
23. Lutman, CV., Havrilesky, LJ., Cragun, JM., et al. Pelvic lymph node count is an important prognostic variable for FIGO stage I and II endometrial carcinoma with high-risk histology. Gynecol Oncol, 2006, 102(1), p. 92–97.
24. Magrina, JF., Mutone, NF., Weaver, AL., et al. Laparoscopic lymphadenectomy and vaginal or laparoscopic hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer: morbidity and survival. Am J Obstet Gynecol, 1999, 181(2), p. 376–381.
25. Malur, S. Laparoscopic-assisted vaginal versus abdominal surgery in patients with endometrial cancer – a prospective randomized trial. Gynecol Oncol, 2001, 80, p. 239–244.
26. Miskovic, D., Ni, M., Wyles, SM., et al. Learning curve and case selection in laparoscopic colorectal surgery: systematic review and international multicenter analysis of 4852 cases. Dis Colon Rectum, 2012, 55(12), p. 1300–1310.
27. Mok, ZW., Yong, EL., Low, JJ., et al. Clinical outcomes in endometrial cancer care when the standard of care shifts from open surgery to robotics. Int J Gynecol Cancer, 2012, 22(5), p. 819–825.
28. Naumann, RW.,Coleman, RL. The use of adjuvant radiation therapy in early endometrial cancer by members of the Society of Gynecologic Oncologists in 2005. Gynecol Oncol, 2007, 105(1), p. 7–12.
29. Paley, PJ., Veljovich, DS., Shah, CA., et al. Surgical outcomes in gynecologic oncology in the era of robotics: analysis of first 1000 cases. Am J Obstet Gynecol, 2011, 204(6), p. 551 e1–9.
30. Payne, TN., Dauterive, FR. A comparison of total laparoscopic hysterectomy to robotically assisted hysterectomy: surgical outcomes in a community practice. J Minim Invasive Gynecol, 2008, 15(3), p. 286–291.
31. Reich, HDJ., McGlynn, F. Laparoscopic hysterectomy. J Gynecol Surg, 1989, 5, p. 213–216.
32. Reynolds, RK., Advincula, AP. Robot-assisted laparoscopic hysterectomy: technique and initial experience. Am J Surg, 2006, 191(4), p. 555–560.
33. Rudy, L., De Wilde, AH. Robotic surgery – Advance or gimminck? Best Practise and Research Clinical Obstetrics and Gynecology, 2013, 27, p. 457–469.
34. Seamon, LG., Cohn, DE., Richardson, DL., et al. Robotic hysterectomy and pelvic-aortic lymphadenectomy for endometrial cancer. Obstet Gynecol, 2008, 112(6), p. 1207–1213.
35. Sert, BM., Abeler, VM. Robotic-assisted laparoscopic radical hysterectomy (Piver type III) with pelvic node dissection-casereport. Eur J Gynaecol Oncol, 2006, 27(5), p. 531–533.
36. Sgarbura, O.,Vasilescu, C. The decisive role of the patient-side surgeon in robotic surgery. Surg Endosc, 2010, 24(12), p. 3149–3155.
37. Subramaniam, A., Kim, KH., Bryant, SA., et al. A cohort study evaluating robotic versus laparotomy surgical outcomes of obese women with endometrial carcinoma. Gynecol Oncol, 2011, 122(3), p. 604–607.
38. Susie Lau, KB. Relationship between body mass index and robotic surgery outcomes of women diagnosed with endometrial cancer. Int J Gynecol Cancer, 2011, 21(4), p. 722–729.
39. Tang, KY., Gardiner, SK., Gould, C., et al. Robotic surgical staging for obese patients with endometrial cancer. Am J Obstet Gynecol, 2012, 206(6), p. 513 e1–6.
40. Tomulescu, V., Popescu, I. Unilateral extended thoracoscopic thymectomy for nontumoral myasthenia gravis – a new standard. Semin Thorac Cardiovasc Surg, 2012, 24(2), p. 115–122.
41. Vigano, L., Laurent, A., Tayar, C., et al. The learning curve in laparoscopic liver resection: improved feasibility and reproducibility. Ann Surg, 2009, 250(5), p. 772–782.
42. Walker, JMR., Piedmonte, M. Phase III trial of laparoscopy versus laparotomy for surgical resection and comprehensive surgical staging of uterine cancer: A Gynecologic Oncology Group study funded by the National Cancer Institute. Gynecol Oncol, 2006, 101.
43. Whiteside, JL. Robotic gynecologic surgery: a brave new world? Obstet Gynecol, 2008, 112(6), p. 1198–1200.
44. Woelk, JL., Casiano, ER., Weaver, AL., et al. The learning curve of robotic hysterectomy. Obstet Gynecol, 2013, 121(1), p. 87–95.
Štítky
Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineČlánok vyšiel v časopise
Czech Gynaecology
2015 Číslo 5
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