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Abstract
Introduction/Background*Patients with early-stage cervical cancer [CC] had worse prognosis when operated by minimal invasive surgery according to LACC trial. Different hypothesis were suggested such us the intrauterine manipulator, the CO2 or the lack of protective manoeuvre. However, the effect of surgical expertise among patients who underwent radical hysterectomy by the same approach has not been evaluated.
Methodology All patients with early-stage CC (FIGO IA1-IIA1) undergoing robot-assisted radical hysterectomy in Spain and Portugal from 2009 to 2018 were included. Those centres with > 15 cases were selected. Centres with recurrence rate < 10% were gathered in group A an those ≥ 10% in group B. The primary objective was to compare the oncological outcomes between groups after balancing by Propensity Score [PS] analysis. The groups were balanced in age, BMI, histology, Size, tumoral grade, ILV and adjuvant treatment. Second primary objective was to audit the pre-surgical quality indicators [QI] proposed by ESGO.
Result(s)*A total of 118 and 97 patients were well balanced (p-value 0.9483) between groups. 5 (4.3%) vs 19 (19.6%) recurrences occurred in group A vs group B, OR 1.23; (95% CI, 1,13-1,35) p-value of 0.001 after a median follow-up of 51 months. Overall mortality and disease-specific mortality were significant higher in group B, OR 1.07; (95% CI, 1.00-1.15) and 1.09; (95% CI, 1.02-1.16) respectively (figure 1). Five of eight Q.I were fulfilled by both groups. Lower rates of pre-operative assessment with M.R.I was observed in group B. 1 (20%) and 8 (42%) recurrences were observed during the first two years of robotic experience in group A and B (figure 2). Intraoperative and postoperative complications occurred in 0.8 vs 6.2% (p 0.028) and 5.1% vs 12.4% (p 0.055) in groups A and B respectively.
A) Disease-free survival rates between surgical; B) Odds of recurrence & mortality after balancing
(Group A and B) relation between time of recurrence and time of surgery
Conclusion*We observed significant differences in recurrence rate, overall mortality and specific-disease mortality between hospitals. Pre-operative assessment with M.R.I and the effect of learning curve were factors related to higher rates of recurrence. The surgical assessment might be considered as an impact factor in oncological outcomes in patients who underwent radical hysterectomy by minimal invasive approach.