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168 Recurrence and survival after robotic-assisted radical hysterectomy (RRH) for early stage cervical cancer (CC): experience may matter
  1. C Fitszimmons,
  2. A Stephens,
  3. J Kennard,
  4. M Manyam,
  5. J Pepe,
  6. K DeCoff,
  7. S Ahmad,
  8. N McKenzie,
  9. J Kendrick and
  10. R Holloway
  1. AdveHealth Cancer Institute, Gynecologic Oncology, Orlando, USA


Objectives In light of the LACC Trial results, we evaluated RFS and OS following RRH before and after 10 cases per surgeon.

Methods Patients with early-stage CC (4/2007–12/2017) who underwent RRH were evaluated and first 10 learning curve cases per surgeon (Group A) were compared to all subsequent cases (Group B). Inclusion criteria mirrored the LACC trial: > one-year follow-up, adenocarcinoma or squamous carcinoma, FIGO-2014 stage IA2 or IB1, and pathologic tumor size of ≤4 cm.

Results 144 RRH patients were identified and 90 met inclusion criteria from 6 attending surgeons. 40 patients met Group A and 50 Group B criteria. Median follow-up was 61± 34.3 months (A=71.5, B=52.5). The 5-year RFS was 92% (95 CI±4%) and the DSDR 5.5% (n=5). There were 7(7.8%) recurrences with median RFS of 12±8.3 months. Recurrence in Group A (n=6, 15%) exceeded Group B (n=1, 2%), p=0.025. DSDR was 10% Group A vs. 2% B (p=0.184). The 4.5-year RFS was 84.8% (95 CI±7%) in Group A vs. 98% (95 CI±3%) in Group B. There were no differences in risk factors for recurrence between groups A and B. (TS >2, LN (+), adjuvant therapy (AT), and LVSI p>0.05), except (+) vaginal margin status (A=10% vs B=0%, p=0.034). All recurrent cases had TS >2 cm.

Conclusions Recurrence of disease following RRH clustered in the first 10 cases per surgeon in our center and was associated with (+) vaginal margins and TS 2 cm. This data suggests an inter-surgeon variability and a possible learning curve effect.

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