Siv Lykke Jørgensen1, Ole Mogensen2, Chunsen S Wu3, Malene Korsholm4, Ken Lund5, Pernille T Jensen6. 1. Department of Gynaecology and Obstetrics, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; OPEN, Odense Patient Data Explorative Network, Odense University Hospital, B. Winsløws Vej 9 A, 5000 Odense C, Denmark; Department of Clinical Health, Faculty of Health Sciences, Clinical Institute, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense C, Denmark. Electronic address: siv.lykke.joergensen@rsyd.dk. 2. Department of Clinical Health, Faculty of Health Sciences, Clinical Institute, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense C, Denmark; Department of Pelvic Cancer, Karolinska University Hospital and Karolinska Institute, SE-171 77 Stockholm, Sweden. Electronic address: o.mogensen@health.sdu.dk. 3. Department of Gynaecology and Obstetrics, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; Department of Clinical Health, Faculty of Health Sciences, Clinical Institute, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense C, Denmark. Electronic address: Chunsen.wu@rsyd.dk. 4. Department of Gynaecology and Obstetrics, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; OPEN, Odense Patient Data Explorative Network, Odense University Hospital, B. Winsløws Vej 9 A, 5000 Odense C, Denmark; Department of Clinical Health, Faculty of Health Sciences, Clinical Institute, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense C, Denmark; Danish Centre for Health Economics (DaCHE), Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9B, 1st Floor, 5000 Odense C, Denmark. Electronic address: Malene.korshols@rsyd.dk. 5. Centre for Clinical Epidemiology, Odense University Hospital, Kløvervænget 30, 5000 Odense, Denmark; Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark. Electronic address: Ken.lund@rsyd.dk. 6. Department of Gynaecology and Obstetrics, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark; Department of Clinical Health, Faculty of Health Sciences, Clinical Institute, University of Southern Denmark, J.B. Winsløws Vej 19, 5000 Odense C, Denmark. Electronic address: Pernille.tine.jensen@rsyd.dk.
Abstract
PURPOSE: The purpose of the study was to evaluate the association between a nationwide introduction of robotic minimally invasive surgery (RMIS) and survival in women with early-stage endometrial cancer. MATERIALS AND METHODS: Prospective data on consecutive women with early-stage endometrial cancer who underwent surgery during January 2005 to June 2015 in Denmark were identified in the nationwide Danish Gynaecological Cancer Database. Data were linked with national registries regarding comorbidity, education, income and death. The cohort was divided according to the time they underwent surgery: Group 1 before RMIS introduction in their respective region and Group 2 after RMIS introduction. Five-year overall survival was compared by multivariate Cox proportional hazards models stratified by histopathological risk between Groups 1 and 2 and between surgical modalities within Group 2: total abdominal hysterectomy (TAH), laparoscopic minimally invasive surgery (LMIS) and RMIS. RESULTS: Women in Group 1 (N = 3091) had significantly lower overall survival compared with those in Group 2 (N = 2563; hazard ratio [HR], 1.22; 95% confidence interval [CI], 1.05-1.42). Age, smoking, socioeconomic status, American Society of Anaesthesiologists (ASA) score, comorbidity and histopathological risk influenced the overall survival. Following RMIS adoption, TAH was associated with higher mortality compared with LMIS and RMIS (HR, 1.42; 95% CI 1.02-1.97 and HR, 1.70; 95% CI 1.31-2.19 for LMIS and RMIS, respectively). There was no significant survival difference between RMIS and LMIS (HR, 1.19; 95% CI 0.85-1.68). CONCLUSION: The national introduction of robotic surgery for early-stage endometrial cancer was associated with improved survival irrespective of age, body mass index, ASA score, comorbidity, smoking, socioeconomic status and histopathological risk.
PURPOSE: The purpose of the study was to evaluate the association between a nationwide introduction of robotic minimally invasive surgery (RMIS) and survival in women with early-stage endometrial cancer. MATERIALS AND METHODS: Prospective data on consecutive women with early-stage endometrial cancer who underwent surgery during January 2005 to June 2015 in Denmark were identified in the nationwide Danish Gynaecological Cancer Database. Data were linked with national registries regarding comorbidity, education, income and death. The cohort was divided according to the time they underwent surgery: Group 1 before RMIS introduction in their respective region and Group 2 after RMIS introduction. Five-year overall survival was compared by multivariate Cox proportional hazards models stratified by histopathological risk between Groups 1 and 2 and between surgical modalities within Group 2: total abdominal hysterectomy (TAH), laparoscopic minimally invasive surgery (LMIS) and RMIS. RESULTS: Women in Group 1 (N = 3091) had significantly lower overall survival compared with those in Group 2 (N = 2563; hazard ratio [HR], 1.22; 95% confidence interval [CI], 1.05-1.42). Age, smoking, socioeconomic status, American Society of Anaesthesiologists (ASA) score, comorbidity and histopathological risk influenced the overall survival. Following RMIS adoption, TAH was associated with higher mortality compared with LMIS and RMIS (HR, 1.42; 95% CI 1.02-1.97 and HR, 1.70; 95% CI 1.31-2.19 for LMIS and RMIS, respectively). There was no significant survival difference between RMIS and LMIS (HR, 1.19; 95% CI 0.85-1.68). CONCLUSION: The national introduction of robotic surgery for early-stage endometrial cancer was associated with improved survival irrespective of age, body mass index, ASA score, comorbidity, smoking, socioeconomic status and histopathological risk.
Authors: Slavcho T Tomov; Grigor A Gorchev; Desislava K Kiprova; Aleksandar D Lyubenov; Nadezhda H Hinkova; Vesela D Tomova; Zornitsa V Gorcheva; Sarfraz Ahmad Journal: J Robot Surg Date: 2022-02-10
Authors: Christer Borgfeldt; Erik Holmberg; Janusz Marcickiewicz; Karin Stålberg; Bengt Tholander; Elisabeth Åvall Lundqvist; Angelique Flöter-Rådestad; Maria Bjurberg; Pernilla Dahm-Kähler; Kristina Hellman; Elisabet Hjerpe; Preben Kjölhede; Per Rosenberg; Thomas Högberg Journal: BMC Cancer Date: 2021-06-02 Impact factor: 4.430