OBJECTIVE: To compare the open versus robotic surgical approaches and provide surgical outcome data on patients who have undergone radical trachelectomy (RT). METHODS: We identified patients who underwent open (ORT) or robotic radical trachelectomy (RRT) between September 2005 and June 2011. Tumor characteristics, perioperative, operative and obstetrical outcomes were analyzed. RESULTS: Thirty-seven patients with early stage cervical cancer that desired future fertility underwent attempted radical trachelectomy, and 32 patients (20 with 1B1, 11 with 1A2, and 5 with 1A1 with LVSI/poorly differentiated histology) had successful completion of RT. Five (1 open/4 robotic) underwent conversion to radical hysterectomy secondary to close (<5mm) endocervical margin (p=0.08). The median age at diagnosis was 28.9 years (range; 21.4-37.2), 70% were nulliparous, and 9 had a visible lesion. Twenty-five patients (68%) underwent ORT and 12 (32%) underwent RRT. RRT was associated with less blood loss (62.5 mL vs. 300 mL, p=0.0001) and decreased length of postoperative stay (1 vs. 4 days, p<0.001), with no difference in operative time or histopathologic outcomes. Twenty-three patients (62%) had no residual cervical disease on final pathology. Common long-term morbidities were irregular menstrual bleeding or amenorrhea (25%), cerclage erosion (13%), or cervical stenosis (9%). Although there was a higher rate of conversion to hysterectomy in the robotic surgery cohort, rates of serious morbidities among the cohorts were comparable (robotic: 33% vs. open: 24%, p=0.70). Eleven (36%) patients are actively attempting pregnancy and three have achieved pregnancy. The median time of follow up is 17.0 months (range 0.30-64.9 months). There are no documented recurrences. CONCLUSIONS: RRT results in less blood loss and decreased length of hospital stay with no compromise in histopathologic outcomes.
OBJECTIVE: To compare the open versus robotic surgical approaches and provide surgical outcome data on patients who have undergone radical trachelectomy (RT). METHODS: We identified patients who underwent open (ORT) or robotic radical trachelectomy (RRT) between September 2005 and June 2011. Tumor characteristics, perioperative, operative and obstetrical outcomes were analyzed. RESULTS: Thirty-seven patients with early stage cervical cancer that desired future fertility underwent attempted radical trachelectomy, and 32 patients (20 with 1B1, 11 with 1A2, and 5 with 1A1 with LVSI/poorly differentiated histology) had successful completion of RT. Five (1 open/4 robotic) underwent conversion to radical hysterectomy secondary to close (<5mm) endocervical margin (p=0.08). The median age at diagnosis was 28.9 years (range; 21.4-37.2), 70% were nulliparous, and 9 had a visible lesion. Twenty-five patients (68%) underwent ORT and 12 (32%) underwent RRT. RRT was associated with less blood loss (62.5 mL vs. 300 mL, p=0.0001) and decreased length of postoperative stay (1 vs. 4 days, p<0.001), with no difference in operative time or histopathologic outcomes. Twenty-three patients (62%) had no residual cervical disease on final pathology. Common long-term morbidities were irregular menstrual bleeding or amenorrhea (25%), cerclage erosion (13%), or cervical stenosis (9%). Although there was a higher rate of conversion to hysterectomy in the robotic surgery cohort, rates of serious morbidities among the cohorts were comparable (robotic: 33% vs. open: 24%, p=0.70). Eleven (36%) patients are actively attempting pregnancy and three have achieved pregnancy. The median time of follow up is 17.0 months (range 0.30-64.9 months). There are no documented recurrences. CONCLUSIONS: RRT results in less blood loss and decreased length of hospital stay with no compromise in histopathologic outcomes.
Authors: Akila Subramaniam; Kenneth H Kim; Shannon A Bryant; Bin Zhang; Christa Sikes; Kristopher J Kimball; Larry C Kilgore; Warner K Huh; John M Straughn; Ronald D Alvarez Journal: Gynecol Oncol Date: 2011-06-11 Impact factor: 5.482
Authors: Raimund Winter; Josef Haas; Olaf Reich; Rudolf Koemetter; Karl Tamussino; Manfred Lahousen; Edgar Petru; Hellmuth Pickel Journal: Gynecol Oncol Date: 2002-02 Impact factor: 5.482
Authors: Margaret H Einstein; Kay J Park; Yukio Sonoda; Jeanne Carter; Dennis S Chi; Richard R Barakat; Nadeem R Abu-Rustum Journal: Gynecol Oncol Date: 2008-10-29 Impact factor: 5.482
Authors: N D Fleming; P T Ramirez; P T Soliman; K M Schmeler; G B Chisholm; A M Nick; S N Westin; M Frumovitz Journal: Gynecol Oncol Date: 2016-10-11 Impact factor: 5.482
Authors: Stephanie L Wethington; Yukio Sonoda; Kay J Park; Kaled M Alektiar; William P Tew; Dennis S Chi; Mario M Leitao; Elizabeth L Jewell; Richard R Barakat; Nadeem R Abu-Rustum Journal: Int J Gynecol Cancer Date: 2013-07 Impact factor: 3.437
Authors: Evan S Smith; Ashley S Moon; Robin O'Hanlon; Mario M Leitao; Yukio Sonoda; Nadeem R Abu-Rustum; Jennifer J Mueller Journal: Obstet Gynecol Date: 2020-09 Impact factor: 7.623