Pernille T Jensen1, Tine H Schnack2, Ligita P Frøding3, Signe F Bjørn4, Henrik Lajer5, Algirdas Markauskas6, Kirsten M Jochumsen7, Katrine Fuglsang8, Jacob Dinesen9, Charlotte H Søgaard10, Erik Søgaard-Andersen11, Marianne M Jensen12, Aage Knudsen13, Laura H Øster14, Claus Høgdall15. 1. Department of Gynaecology, Aarhus University Hospital, 99, Palle Juul-Jensens Boulevard, DK-8200, Aarhus N, Denmark; Aarhus University, Faculty of Health, Institute of Clinical Medicine, 99, Palle Juul-Jensens Boulevard, DK-8200, Aarhus N, Denmark; University of Southern Denmark, Faculty of Health Sciences, Clinical Institute, 19, JB Winsloews Vej, DK-5000, Odense, Denmark. Electronic address: petije@rm.dk. 2. Department of Gynaecology, Copenhagen University Hospital, Rigshospitalet. 9, Blegdamsvej, DK-2100, Copenhagen, Denmark. Electronic address: tine.henrichsen.schnack@regionh.dk. 3. Department of Gynaecology, Copenhagen University Hospital, Rigshospitalet. 9, Blegdamsvej, DK-2100, Copenhagen, Denmark. Electronic address: ligita.paskeviciute.froeding@regionh.dk. 4. Department of Gynaecology, Copenhagen University Hospital, Rigshospitalet. 9, Blegdamsvej, DK-2100, Copenhagen, Denmark. Electronic address: signe.frahm.bjoern@regionh.dk. 5. Department of Gynaecology, Copenhagen University Hospital, Rigshospitalet. 9, Blegdamsvej, DK-2100, Copenhagen, Denmark. Electronic address: lajer@dadlnet.dk. 6. Department of Gynaecology, Odense University Hospital. 29, Sdr. Boulevard, DK-5000, Odense, Denmark. Electronic address: algirdas.markauskas@rsyd.dk. 7. Department of Gynaecology, Odense University Hospital. 29, Sdr. Boulevard, DK-5000, Odense, Denmark. Electronic address: kirsten.jochumsen@rsyd.dk. 8. Department of Gynaecology, Aarhus University Hospital, 99, Palle Juul-Jensens Boulevard, DK-8200, Aarhus N, Denmark. Electronic address: katrfugl@rm.dk. 9. Department of Gynaecology, Aarhus University Hospital, 99, Palle Juul-Jensens Boulevard, DK-8200, Aarhus N, Denmark. Electronic address: jad@dadlnet.dk. 10. Department of Gynaecology, Aarhus University Hospital, 99, Palle Juul-Jensens Boulevard, DK-8200, Aarhus N, Denmark. Electronic address: charlotte.hasselholt.soegaard@regionh.dk. 11. Department of Gynaecology, Aalborg University Hospital. 15, Reberbansgade, DK-9000, Aalborg, Denmark. Electronic address: esa@rn.dk. 12. Department of Gynaecology, Aalborg University Hospital. 15, Reberbansgade, DK-9000, Aalborg, Denmark. Electronic address: mamuj@rn.dk. 13. Department of Gynaecology, Aalborg University Hospital. 15, Reberbansgade, DK-9000, Aalborg, Denmark. Electronic address: aak@rn.dk. 14. Department of Gynaecology, Herlev University Hospital. 75, Herlev Ringvej, DK-2730 Herlev, Denmark. Electronic address: laura.amalie.hauerberg.oester@regionh.dk. 15. Department of Gynaecology, Copenhagen University Hospital, Rigshospitalet. 9, Blegdamsvej, DK-2100, Copenhagen, Denmark. Electronic address: claus.hogdall@regionh.dk.
Abstract
AIM: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
AIM: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.