title: Introduction of robot-assisted radical hysterectomy for early stage cervical cancer: impact on complications, costs and oncologic outcome.
abstract: BACKGROUND
  The objective was to assess the impact of robot-assisted radical hysterectomy (RRH) on surgical and oncologic outcome and costs compared with open radical hysterectomy (ORH) at a tertiary referral center in Sweden.
  
  
  METHODS
  In this retrospective analysis all patients treated with radical hysterectomy and pelvic lymphadenectomy for early stage uterine cervical cancer during 2006-2015 were included (n = 304). The patients were divided into two groups, ORH (n = 155) and RRH (n = 149). Patient characteristics, FIGO stage, histology, adjuvant therapy, operation time, length of stay (LOS), lymph node yield, recurrence rate and survival were retrieved from medical records. Complications were graded according to the Clavien-Dindo classification. In addition, costs related to the surgical treatments were calculated.
  
  
  RESULTS
  Blood loss, LOS and intraoperative complications were significantly lower as well as lymph node yield after RRH. No differences in postoperative complications or costs were observed between the two groups. Recurrence of disease was detected in 13.4 and 10.3% after RRH and ORH, respectively. Regression analysis demonstrated that histology, tumor size, positive lymph nodes and type of operation (RRH) were significantly associated with recurrence.
  
  
  CONCLUSIONS
  The introduction of RRH was accompanied by similar postoperative complication rates and costs but lower LOS compared with ORH. An initial learning curve may account for the higher recurrence rate observed after RRH. These data reinforce the need for structured training and monitoring of outcomes when novel treatment modalities are introduced.
authors.affiliation: Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.|Division of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Emelie
authors.identifier: http://orcid.org/0000-0002-0698-0930
authors.initials: E
authors.lastname: Wallin
authors.affiliation: Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.|Division of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Angelique
authors.initials: A
authors.lastname: Flöter Rådestad
authors.affiliation: Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.|Division of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Falconer
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011183:Postoperative Complications; D012017:Referral and Consultation; D012189:Retrospective Studies; D012371:Robotics / Q000191:economics*; D015996:Survival Rate; D013548:Sweden; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*
keywords: Cervical cancer; early-stage; intraoperative complications; open radical hysterectomy; recurrence; robotic radical hysterectomy; survival: hospital costs