title: Clinical and Oncologic Outcomes of Robotic Versus Abdominal Radical Hysterectomy for Women With Cervical Cancer: Experience at a Referral Cancer Center.
abstract: OBJECTIVE
  To compare the clinical and oncologic outcomes of robotic radical hysterectomy (RRH) vs abdominal radical hysterectomy (ARH) in patients with cervical carcinoma.
  
  
  METHODS
  A retrospective analysis of women who underwent radical hysterectomy for cervical cancer from December 2006 to December 2014 at European Institute of Oncology was performed. Patients who underwent RRH were compared with women operated on by ARH. The groups were matched by age, body mass index, tumor size, International Federation of Gynecology and Obstetrics stage, comorbidity, previous neoadjuvant chemotherapy, histology type, and tumor grade.
  
  
  RESULTS
  A total of 203 and 104 women who underwent RRH and ARH, respectively, were analyzed. Baseline characteristics, stage of disease, histology type, and grade of differentiation were similar between groups. Surgical time was significantly shorter in the ARH group (208 vs 282 minutes, P ≤ 0.001). Robotic radical hysterectomy was associated with significantly less estimated blood loss (219 vs 104 mL, P = 0.001) and with significantly shorter hospital stay (5.2 vs 3.9 days, P ≤ 0.001). Abdominal radical hysterectomy was correlated with a significantly higher number of lymph nodes removed (25.8 vs 22, P = 0.003). None of the robotic procedures required conversion to laparotomy. A significantly higher number of patients in ARH required postoperative transfusion (11 [10.5%] vs 6 [2.9%], P = 0.006). Lower extremity lymphedema was significantly higher in ARH (28 [27.5%] vs 17 [8.3%], P = 0.001). Recurrence rates as well as progression-free survival and overall survival were similar between groups at a median follow-up of 41.64 months.
  
  
  CONCLUSIONS
  Robotic radical hysterectomy is safe and feasible and is associated with improved clinical outcomes. Although longer follow-up is needed, early data show equivalent oncologic outcomes compared with other surgical modalities.
authors.affiliation: *Department of Gynecology, European Institute of Oncology (IEO), Milan, Italy; †Department of Gynecology, Valencian Institute of Oncology (IVO), Valencia, Spain; and ‡Department of Applied Mathematics and Statistics CEU San Pablo University, Madrid, Spain.
authors.forename: Vanna
authors.initials: V
authors.lastname: Zanagnolo
authors.forename: Lucas
authors.initials: L
authors.lastname: Minig
authors.forename: Drusilla
authors.initials: D
authors.lastname: Rollo
authors.forename: Tiziana
authors.initials: T
authors.lastname: Tomaselli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Aletti
authors.forename: Luca
authors.initials: L
authors.lastname: Bocciolone
authors.forename: Fabio
authors.initials: F
authors.lastname: Landoni
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Cardenas Rebollo
authors.forename: Angelo
authors.initials: A
authors.lastname: Maggioni
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D012017:Referral and Consultation; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*