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Analysis of abdominal vs. robotic radical hysterectomies for patients with cervical cancer: a Bulgarian experience

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Abstract

To assess and compare the peri-operative, oncologic, and survival outcomes for women with cervical cancer (CC) treated with abdominal radical hysterectomy (ARH) versus robotic radical hysterectomy (RRH) approaches in Bulgaria. We retrospectively analyzed patients with histologically diagnosed CC operated via ARH or RRH methods during January-2008 to April-2019. The data analyzed include patients and tumor characteristics, peri-operative outcomes, and disease status. Kaplan–Meier method and Cox regression analysis were performed to determine disease-free survival (DFS) and overall survival (OS). There were consecutive 1347 patients (ARH = 1006, RRH = 341), which formed the basis of study analyses. Women in the RRH group had significantly shorter median hospital length-of-stay than ARH cases (7 vs. 11 days, p < 0.001), higher post-operative hemoglobin (116 vs. 108 g/L, p < 0.001), and fewer blood transfusions (7.3% vs. 21.5%, p < 0.001), respectively. The overall incidence of post-operative complications was also lower in the RRH vs. ARH group (2.1% vs. 9.4%, p < 0.001). Median follow-up time for ARH vs. RRH groups was 4.32 vs. 5.24 years, respectively (p < 0.001). Kaplan–Meier analysis demonstrated that the RRH cohort had a significantly higher survival rate compared to the ARH group (CC-specific death 8.5% vs. 16.5% respectively). Mean time to recurrence did not differ significantly in either surgical approach (p = 0.495). Cox multivariate regression showed no significant impact of surgical approach on DFS or OS. No significant difference in DFS or OS between ARH vs. RRH for CC was observed. RRH approach does not lead to inferior oncologic outcomes and is associated with better peri-operative outcomes. In regard to “all stages” of CC, we found robotic surgery safer compared to laparotomy, and thus consider RRH a better surgical treatment option for patients with CC.

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Acknowledgments

This work was supported by Medical University-Pleven, Pleven, Bulgaria, which is greatly appreciated.

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Authors and Affiliations

  1. Medical University Pleven, University Hospital Saint Marina–Pleven, Pleven, 5800, Bulgaria

    Grigor A. Gorchev, Slavcho T. Tomov, Desislava K. Kiprova, Aleksandar D. Lyubenov, Nadezhda Hinkova & Vesela D. Tomova

  2. Gynecologic Oncology Program, AdventHealth Cancer Institute, FSU and UCF Colleges of Medicine, 2501 N. Orange Ave., Suite 786, Orlando, FL, 32804, USA

    Sarfraz Ahmad

Authors
  1. Grigor A. Gorchev
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  2. Slavcho T. Tomov
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  3. Desislava K. Kiprova
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  4. Aleksandar D. Lyubenov
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  6. Vesela D. Tomova
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Contributions

GAG: performed surgeries, conceived the study design and its implementation, data review and analyses, data interpretation, manuscript writing, and take responsibility for the paper. STT: performed surgeries, co-conceived the study design and its implementation, data review and analyses, data interpretation, and manuscript writing, and take responsibility for the paper. DKK: assisted in surgeries, participated in data collection, management, analyses, interpretation (including quality control), statistical advice, created graphs and tables, and help writing the first draft. ADL: participated in data collection, analyses, interpretation, statistical advice, organization, and help in writing the draft. NHH: participated in data collection, analyses, interpretation, statistical advice, organization, and help in writing the draft. VDT: participated in data collection, analyses, interpretation, statistical advice, organization, and help in writing the draft. SA: assisted in study design, scientific discussions, literature search, data interpretation and organization, help drafted the manuscript and submission process, and take responsibility for the paper.

Corresponding authors

Correspondence to Slavcho T. Tomov or Sarfraz Ahmad.

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None of the authors has any potential financial or commercial conflict of interest associated with this original research manuscript.

Ethics approval

This retrospective study was approved by the Research Ethics Commission of Medical University-Pleven, Bulgaria.

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This retrospective study is classified as quality improvement and hypothesis generating, which is allowed by our Institutional Review Board (Research Ethics Commission) and no patient consent was required.

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The manuscript has been read by all authors who have consented to its publication.

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11701_2021_1244_MOESM1_ESM.pdf

Supplementary file1 (PDF 124 KB) Supplementary Figure 1. (A) Identified intra-operative complications in abdominal radical hysterectomy (ARH) and robotic radical hysterectomy (RRH), and. (B) Identified post-operative complications in RRH and ARH.

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Gorchev, G.A., Tomov, S.T., Kiprova, D.K. et al. Analysis of abdominal vs. robotic radical hysterectomies for patients with cervical cancer: a Bulgarian experience. J Robotic Surg 16, 339–352 (2022). https://doi.org/10.1007/s11701-021-01244-1

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  • DOI: https://doi.org/10.1007/s11701-021-01244-1

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