title: Oncological outcome and long-term complications in robot-assisted radical surgery for early stage cervical cancer: an observational cohort study.
abstract: OBJECTIVE
  To report the oncological outcome and long-term complications of radical surgery by robot-assisted laparoscopy in early stage cervical cancer.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Tertiary referral centre.
  
  
  METHODS
  About 100 cervical cancer patients treated consecutively with robot-assisted radical surgery between 2008 and 2013.
  
  
  METHODS
  Two gynaecological oncologists specialised in minimally invasive surgery performed all surgeries on a three/four-armed robotic system. Procedures consisted of pelvic lymph node dissection combined with a radical hysterectomy, radical vaginal trachelectomy or parametrectomy.
  
  
  METHODS
  Recurrence, survival and long-term complication rates.
  
  
  RESULTS
  104 robot-assisted laparoscopies were performed in 100 patients (stage IA1-IIB), with a median follow-up of 29.5 months (range 2.5-67.1 months). Thirteen cases were diagnosed with a loco-regional (8%), distant (4%) or combined (1%) recurrence at a median of 14.4 months (range 2.9-34.8 months). All mortality (7%) was cervical cancer-related and due to recurrent disease. Four recurrences receive palliative care and two are in complete remission. The overall 5-year progression-free and disease-specific survival rates are 81.4 and 88.7%, respectively. Frequent complications were lymphoedema (26%), lower urinary tract symptoms (19%), urinary tract infection (17%) and sexual disorders (9%). Five patients had a vaginal cuff dehiscence. No complication-related mortality occurred.
  
  
  CONCLUSIONS
  The recurrence, survival and long-term complication rates of robot-assisted radical surgery for early stage cervical cancer in this cohort are reassuring concerning its continued clinical use.
authors.affiliation: Department of Gynaecological Oncology, Woman and Baby Division, University Medical Centre Utrecht, Utrecht, the Netherlands.
authors.forename: J P
authors.initials: JP
authors.lastname: Hoogendam
authors.forename: R H M
authors.initials: RH
authors.lastname: Verheijen
authors.forename: I
authors.initials: I
authors.lastname: Wegner
authors.forename: R P
authors.initials: RP
authors.lastname: Zweemer
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision / Q000379:methods; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010388:Pelvis; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012371:Robotics; D016019:Survival Analysis; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*
keywords: Cervical cancer; complications; recurrence; robot-assisted laparoscopy; survival