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. DESIGN: Observational cohort study. SETTING: Tertiary referral centre. POPULATION: 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. MAIN OUTCOME MEASURES: 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. CONCLUSION: 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.