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Title: | The impact of surgical practice on oncological outcomes in robot-assisted radical hysterectomy for early-stage cervical cancer, Spanish National Registry |
Author: | Fernandez-Gonzalez, Sergi Ponce i Sebastià, Jordi Martínez-Maestre, María Ángeles Barahona Orpinell, Marc Gómez-Hidalgo, Natalia R. Díaz Feijoo, Berta Casajuana, Andrea Gracia, Myriam Frias-Gomez, Jon Benavente, Yolanda Costas, Laura Martí, Lola Melero, Lidia Silvan, Jose Manuel Beiro, Eva Lobo, Ignacio De la Rosa, Jesús Coronado, Pluvio J. Gil-Moreno, Antonio |
Keywords: | Càncer ginecològic Cirurgia ginecològica Oncologia Gynecologic cancer Gynecologic surgery Oncology |
Issue Date: | 2022 |
Publisher: | MDPI |
Abstract: | Minimal invasive surgery (MIS) has been associated with lower disease-free survival than open surgery among women who underwent radical hysterectomy for early-stage cervical cancer. However, the mechanisms by which MIS increases mortality in cervical cancer remain uncertain. We aimed to determine if surgical practice among centers using robotic surgery has an impact on oncological outcomes. We evaluated 215 women with early-stage cervical cancer (≤IB1 or IIA1, FIGO 2009) who underwent robot-assisted radical hysterectomy in five Spanish tertiary centers between 2009 and 2018. A higher surgical volume, higher participation in clinical trials, higher rate of MRI use for diagnosis, greater use of sentinel lymph node biopsies, and a favorable learning curve with low rates of early recurrences were observed for the centers with better oncological outcomes. These factors might have a significant impact on oncological outcomes in all surgical approaches. Abstract: This study aimed to assess whether surgical practice had a significant impact on oncological outcomes among women who underwent robot-assisted radical hysterectomy for early-stage cervical cancer (≤IB1 or IIA1, FIGO 2009). The secondary objective was to audit the pre-surgical quality indicators (QI) proposed by the European Society of Gynaecological Oncology (ESGO). The top 5 of 10 centers in Spain and Portugal were included in the analysis. The hospitals were divided into group A (n = 118) and group B (n = 97), with recurrence rates of 10%, respectively. After balancing both groups using the propensity score, the ORs for all events were higher and statistically significant for group B (recurrences OR = 1.23, 95% CI = 1.13-1.15, p-value = 0.001; death OR = 1.10, 95% CI = 1.02-1.18, p-value = 0.012; disease-specific mortality ORr = 1.11, 95% CI = 1.04-1.19, p-value = 0.002). A higher surgical volume, higher participation in clinical trials, higher rate of MRI use for diagnosis, greater use of sentinel lymph node biopsies, and a favorable learning curve with low rates of early recurrences were observed among the centers with better oncological outcomes. These factors might have a significant impact on oncological outcomes not only after robot-assisted surgery, but also after laparoscopies and open surgeries in the treatment of cervical cancer. |
Note: | Reproducció del document publicat a: https://doi.org/10.3390/cancers14030698 |
It is part of: | Cancers, 2022, vol. 14, p. 698 |
URI: | http://hdl.handle.net/2445/183991 |
Related resource: | https://doi.org/10.3390/cancers14030698 |
ISSN: | 2072-6694 |
Appears in Collections: | Articles publicats en revistes (Ciències Clíniques) Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL)) |
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