Oncologic Outcomes of Robotic Radical Hysterectomy (RRH) for Patients with Early-Stage Cervical Cancer: Experience at a
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ORIGINAL ARTICLE – TRANSLATIONAL RESEARCH
Oncologic Outcomes of Robotic Radical Hysterectomy (RRH) for Patients with Early-Stage Cervical Cancer: Experience at a Referral Cancer Center Vanna Zanagnolo, MD1, Clara Baroni, MD2, Maria Teresa Achilarre, MD1, Alessia Aloisi, MD1, Ilaria Betella, MD1, Stefano Bogliolo, MD1, Annalisa Garbi, MD1, Matteo Maruccio, MD1, Francesco Multinu, MD1, Giovanni Aletti, MD1, and Angelo Maggioni, MD1 1
Department of Gynecology Oncology, Robotic Gynecologic Cancer Surgery Unit, IEO, European Institute of Oncology IRCCS, Milan, 20141 Milan, Italy; 2Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
ABSTRACT Purpose. To evaluate oncologic outcomes of early stage cervical cancer patients who underwent robotic radical hysterectomy (RRH) in a referral center, a retrospective analysis was performed. Methods. From January 2010 to December 2018, medical records of stage IA2–IIA1 cervical cancer patients, who underwent radical hysterectomy at our institute, were retrospectively reviewed. We focused our analysis on those who underwent RRH. Results. A total of 198 patients were included in the final analysis. Median follow up was 52 months. At last followup, 188 (94.9%) women were disease-free, 9 (4.5%) had died, and 1 (0.5%) was alive with recurrent disease. At 4.5 years, PFS was 93.1% (SE ± 2.1) and OS was 95.1% (SE ± 1.8). Stratified by tumor size, PFS for tumor \ 2 cm versus tumor C 2 cm was statistically different (96.8% ± 2.3 and 87.9% ± 4.1 respectively, p = 0.01), as well as OS (100% and 89.8% ± 40 respectively, p = 0.01).Stratified by evidence of tumor at time of robotic surgery, PFS was statistically different in women with no residual tumor after conisation versus those with residual disease (100% ± 2.5 and 90.8% ± 2.8 respectively, p = 0.04). A recurrence occurred in 11 patients (5.6%).
Ó Society of Surgical Oncology 2020 First Received: 14 April 2020 Accepted: 26 July 2020 V. Zanagnolo, MD e-mail: [email protected]
Conclusions. Based on our results, we could speculate that robotic approach, along with some technical precautions to avoid spillage, might be safe as primary treatment of earlystage cervical cancer, especially for tumor \ 2 cm and in case of no evidence of disease at time of radical hysterectomy after previous conisation.
Cervical cancer is the fourth most frequent cancer in women with an estimated 570,000 new cases in 2018 representing 6.6% of all female cancer.1 Surgery (radical hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy) is typically reserved for early-stage disease (FIGO stage 2018 IA–IB2 and selected IIA1,2 whereas chemoradiation is the primary treatment for stage IB3–IVA.3,4 During past few decades, radical hysterectomy for earlystage cervical cancer has been performed either by laparotomy or minimally invasive approach (laparoscopic or robotic), both considered acceptable and safe based on the results of prospective and retrospective studies that showed that m
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