Robot assisted endometrial cancer staging – evaluation the first 100 operations and comparing the first andthe last 30 operations

Czech version

Authors: R. Marek ¹; P. Dzvinčuk ¹; Milan Kudela ¹; P. Hambálek ¹; M. Maděrka ¹; J. Zapletalová ²; R. Pilka ¹
Authors‘ workplace: Gynekologicko-porodnická klinika LF UP a FN, Olomouc, přednosta prof. MUDr. R. Pilka, Ph. D. ¹; Ústav lékařské statistiky a biofyziky LF UP, Olomouc, přednostka prof. MUDr. H. Kolářová, CSc. ²
Published in: Ceska Gynekol 2015; 80(5): 324-332

Overview

Objective:
To describe and evaluate our experience with robotically assisted laparoscopic staging of endometrial cancer in first hundred cases as compared with the first and last 30 cases of patients staged by this method.

Design:
Comparative retrospective study.

Setting:
Department of Obstetrics and Gynaecology, Faculty of Medicine and Dentistry, Palacky University in Olomouc, Czech Republic. Institute of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University in Olomouc, Czech Republic.

Methods:
The robotic centre at the Faculty Hospital in Olomouc was opened in August 2009 which enabled to perform robotically assisted laparoscopic staging of endometrial cancer. Retrospectively we evaluated the first hundred patients with the early stage of endometrial cancer who underwent hysterectomy, bilateral salpingo-oophorectomy, and pelvic/paraaortic lymphadenectomy using four-armed da Vinci S HD surgical robotic system. In the second stage of the evaluation we compared the first and the last 30 cases operated by the above mentioned minimally invasive approach. All cases were performed by two surgeons (P.R., D.P.), within the same institution in the course of learning this technique. Age, body mass index (BMI), clinical stage of disease, length of operation, nodal yield, blood loss, the pre-operative and post-operative hemoglobin concentration difference and operating complications were documented and compared.

Results:
The first hundred patients were operated by the above mentioned minimally invasive method between September 2009 nad June 2014. All patients were between 33 and 85 years of age. The average age of the entire group of patients was 65 years of age, the average BMI reached 31.0 (ranging from 18.0 to 49.0), the operating times median was 206 minutes. The estimated median of blood loss was 100 ml. The conversion of robotic surgery to a laparotomy was recordedin 6 cases. When comparing the first and the last30 operated patients there was observed a statistically significant increase in BMI in the group of the last30 operations (29.5 vs. 33.0, p = 0.004) and there was a decrease in the number of conversions from 4 to 1.In particular, however, there was a statistically significant increase in the total number of the obtained lymph nodes in the group of the last 30 vs. the first30 patients (27 vs. 17), and the increase in the number of removed pelvic lymph nodes (21 vs. 17) and the paraaortic nodes (4 vs. 0).

Conclusion:
The robotically assisted laparoscopic staging is one of several possible surgical approaches in the treatment of patients with endometrial cancer and it can be performed adequately in this way. According to the results from our patients group it is a surgical modality with significantly low blood loss, safe even for patients with high BMI and age. The increasing erudition of the surgeon is linked to the shortening of the operating time, reducing the number of conversions and the higher yield of lymph nodes and a reduction in blood loss which was reflected in particular in the comparison of the pre-operative and post-operative hemoglobin difference.

Keywords:
laparoscopy, endometrial cancer, staging, robotic surgery

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