Laparoscopic versus robotic radical hysterectomy after neoadjuvant chemotherapy in locally advanced cervical cancer: a case control study.
OBJECTIVE
To compare the surgical outcome of robotic radical hysterectomy (RRH) versus laparoscopic radical hysterectomy (LRH) for the treatment of locally advanced cervical cancer (LACC) after neoadjuvant chemotherapy (NACT).


METHODS
From August 1st 2010 to July 1st 2012 a prospective data collection of women undergoing RRH for cervical cancer stage FIGO IB2 to IIB, after neoadjuvant chemotherapy, was conducted at National Cancer Institute "Regina Elena" of Rome. All patients deemed operable underwent class C1 RRH with pelvic lymphadenectomy within 4 weeks from the last chemotherapy cycle.


RESULTS
A total of 25 RRH were analyzed, and compared with 25 historic LRH cases. The groups did not differ significantly in body mass index, stage, histology, number of pelvic lymph nodes removed. The median operative time was the same in the two groups with 190 min respectively. The median estimated blood loss (EBL) was statistically significant in favor of RRH group. Median length of stay was shorter, for the RRH group (4 versus 6 days, P = 0.28). There was no significant difference in terms of intraoperative and postoperative complications between groups but in the RRH group we observed a greater number of total complications compared to the control group.


CONCLUSIONS
This study shows that RRH is safe and feasible in LACC after NACT compare to LRH. However, a comparison of oncologic outcomes and cost-benefit analysis is still needed and it has to be carefully evaluated in the future.
Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
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Vizza
Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy. Electronic address: giacomo.corrado@alice.it.
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Corrado
Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
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Mancini
Department of Medical Oncology, Medical Oncology Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
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Vici
Department of Medical Oncology, Medical Oncology Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
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Sergi
Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
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Baiocco
Academic Department of Biomedicine and Prevention and Clinical Department of Surgery, Division of Gynecology and Obstetrics, Tor Vergata University Hospital School of Medicine, Rome, Italy.
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Patrizi
Academic Department of Biomedicine and Prevention and Clinical Department of Surgery, Division of Gynecology and Obstetrics, Tor Vergata University Hospital School of Medicine, Rome, Italy.
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Saltari
Academic Department of Biomedicine and Prevention and Clinical Department of Surgery, Division of Gynecology and Obstetrics, Tor Vergata University Hospital School of Medicine, Rome, Italy.
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Pomati
Department of Oncological Surgery, Gynecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
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Cutillo
D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D018262:Adenocarcinoma, Clear Cell / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010388:Pelvis; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D055815:Young Adult
Locally advanced cervical cancer; Minimally invasive surgery; Neoadjuvant chemotherapy; Robotic radical hysterectomy