Survival after a nationwide adoption of robotic minimally invasive surgery for early-stage cervical cancer – A population-based study

Lately, the safety of minimally invasive surgery (MIS) in the treatment of cervical cancer (CC) has been questioned. This study aimed to evaluate the risk of recurrence and survival after a nationwide adoption of robotic MIS for the treatment of early-stage CC in Denmark. Population-based data on al...

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Published in:European journal of cancer (1990) 2020-03, Vol.128, p.47-56
Main Authors: Jensen, Pernille T., Schnack, Tine H., Frøding, Ligita P., Bjørn, Signe F., Lajer, Henrik, Markauskas, Algirdas, Jochumsen, Kirsten M., Fuglsang, Katrine, Dinesen, Jacob, Søgaard, Charlotte H., Søgaard-Andersen, Erik, Jensen, Marianne M., Knudsen, Aage, Øster, Laura H., Høgdall, Claus
Format: Article
Language:English
Subjects:
Cancer recurrence
Cancer-specific survival
Cervical cancer
Disease-free survival
Minimally invasive surgery
Overall survival
Population-based study
Radical hysterectomy
Robotic surgery
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Summary:Lately, the safety of minimally invasive surgery (MIS) in the treatment of cervical cancer (CC) has been questioned. This study aimed to evaluate the risk of recurrence and survival after a nationwide adoption of robotic MIS for the treatment of early-stage CC in Denmark. Population-based data on all Danish women with early-stage CC, who underwent radical hysterectomy January 1st 2005–June 30th 2017 were retrieved from the Danish Gynecologic Cancer Database and enriched with follow-up data on recurrence, death and cause of death. The cohort was divided into two groups according to the year of robotic MIS introduction at each cancer centre. Chi-squared or Fischer test, the Kaplan Meier method and multivariate Cox regression were used for comparison between groups. One thousand one hundred twenty-five patients with CC were included; 530 underwent surgery before (group 1) and 595 underwent surgery after (group 2) the introduction of robotic MIS. The 5-year rate of recurrence was low: 8.2% and 6.3% (p = 0.55) in group 1 and 2, respectively. In adjusted analyses, this corresponded to a five-year disease-free survival, hazard ratio (HR) 1.23 [95% confidence interval (CI) 0.79-1.93]. No difference in site of recurrence (P = 0.19) was observed. The cumulative cancer-specific survival was 94.1% and 95.9% (P = 0.10) in group 1 and 2, respectively, corresponding to a HR 0.60 [95% CI 0.32–1.11] in adjusted analyses. In this population-based cohort study, the Danish nationwide adoption of robotic MIS for early-stage CC was not associated with increased risk of recurrence or reduction in survival outcomes. •Adoption of robotic surgery transitioned the approach for cervical cancer (CC) in Denmark.•No decrease in survival after transition to robotic surgery in CC.•Robotic surgery for CC does not increase the risk of recurrence.
ISSN:0959-8049
1879-0852
DOI:10.1016/j.ejca.2019.12.020