5607 Background: To determine progression-free survival (PFS) and overall survival (OS) for patients with early stage cervical cancer surgically treated using robotic-assisted laparoscopy compared to open radical hysterectomy. Methods: A retrospective analysis of women that underwent a robotic-assisted surgery (RAS) for early stage cervical cancer was performed. Surgical procedures included radical hysterectomy, parametrectomy, and trachelectomy from 2005 to May 2012. Patient demographics, clinicopathologic data, and disease status were analyzed. Comparison was made to open radical hysterectomies (ORH) from 2000 to May 2012. Survival statistics were analyzed using the Kaplan-Meier method. Results: 147 patients underwent RAS; 97 patients underwent ORH in our comparison group. Surgery was aborted in 8 RAS and 5 ORH due to extent of disease. The robotic surgical treatments included 121 (82.3%) radical hysterectomies, 14 (9.5%) trachelectomies, and 12 (8.2%) parametrectomies. In the RAS, the mean age was 44.3 (range 17-75); the mean body mass index (BMI) was 27.7 (range 16-50). Most patients presented with clinical stage IBI disease (79.9%). Squamous cell histology was most common (55.4%) followed by adenosquamous (36.7%). No significant differences were found between the RAS and ORH with regards age, BMI, surgical stage, grade, short and long-term complications, and comorbidities. The mean follow up time was 24.7 (range 0-82.1) months. Recurrence was documented in 3 patients after RAS and 11 patients after ORH; 3 deaths were recorded in the RAS group and 10 in the ORH. One patient had persistent adenocarcinoma in situ after robotic trachelectomy. Compared to ORH, there was a significantly better PFS in RAS (HR .312, CI 0 .099-0.98, p = 0.046) while no difference was seen in OS (p = 0.172). Conclusions: The results demonstrate that RAS is associated with lower rates of recurrence and no difference in overall survival. These findings provide further evidence that robotic-assisted surgical treatment is not associated with inferior results when compared to laparotomy or traditional laparoscopy. As robotic-assisted surgery is associated with a less steep learning curve, it may become the surgical approach of choice.
Challenges and Controversies in the Surgical Treatment of Cervical Cancer: Open Radical Hysterectomy versus Minimally Invasive Radical Hysterectomy
