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245 The significance of surgical assessment in oncological outcomes after radical hysterectomy for early-stage cervical cancer. A multicenter study
  1. S Fernandez-Gonzalez1,
  2. M Barahona2,
  3. A Gil-Moreno3,
  4. NR Gómez-Hidalgo3,
  5. B Diaz-Feijoo4,
  6. P Coronado5,
  7. V González5,
  8. A Casajuana5,
  9. JM Silvan6,
  10. L Melero6,
  11. MA Martinez6,
  12. J Hilario de la Rosa7,
  13. I Lobo7,
  14. E Beiro7,
  15. J Frias-Gomez8,
  16. Y Benavente8,
  17. C Ortega2,
  18. E Martinez9,
  19. L Marti2 and
  20. J Ponce2
  1. 1University Hospital of Bellvitge (IDIBELL), Gynecology, L’Hospitalet de Llobregat, Spain
  2. 2University Hospital of Bellvitge (IDIBELL), Gynecology, L’Hospitalet de Llobregat (Barcelona), Spain
  3. 3Hospital Universitari Vall d’Hebron, Department of Gynecologic Oncology, Barcelona
  4. 4Hospital Clínic de Barcelona, Gynecology, Barcelona, Spain
  5. 5Hospital Clínico San Carlos, Instituto de Salud de la Mujer, Madrid, Spain
  6. 6Hospital Universitario Virgen del Rocio, Gynecology, Sevilla, Spain
  7. 7Hospital Universitario de Basurto, Gynecology, Bilbao, Spain
  8. 8Catalan Institute of Oncology (IDIBELL), Cancer Epidemiology Research Programme, L’Hospitalet de Llobregat, Spain
  9. 9University Hospital of Bellvitge (IDIBELL), Nursery, L’Hospitalet de Llobregat (Barcelona), Spain, Spain


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.

Abstract 245 Figure 1

A) Disease-free survival rates between surgical; B) Odds of recurrence & mortality after balancing

Abstract 245 Figure 2

(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.

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