Abstract
Total and radical hysterectomies are the most common treatment strategies for early-stage endometrial and cervical cancers, respectively. Surgical modalities include open surgery, laparoscopy, and more recently, minimally invasive robot-assisted surgery. We searched several electronic databases for randomized controlled trials and observational studies with a comparison group, published between 2009 and 2014. Our outcomes of interest included both perioperative and morbidity outcomes. We included 35 observational studies in this review. We did not find any randomized controlled trials. The quality of evidence for all reported outcomes was very low. For women with endometrial cancer, we found that there was a reduction in estimated blood loss between the robot-assisted surgery compared to both laparoscopy and open surgery. There was a reduction in length of hospital stay between robot-assisted surgery and open surgery but not laparoscopy. There was no difference in total lymph node removal between the three modalities. There was no difference in the rate of overall complications between the robot-assisted technique and laparoscopy. For women with cervical cancer, there were no differences in estimated blood loss or removal of lymph nodes between robot-assisted and laparoscopic procedure. Compared to laparotomy, robot-assisted hysterectomy for cervical cancer showed an overall reduction in estimated blood loss. Although robot-assisted hysterectomy is clinically effective for the treatment of both endometrial and cervical cancers, methodologically rigorous studies are lacking to draw definitive conclusions.
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Abbreviations
- RCT:
-
Randomized controlled trials
- GRADE:
-
Grading of recommendations assessment, development, and evaluation
- USA:
-
United States of America
- MeSH:
-
Medical subject headings
- SD:
-
Standard deviation
- OP:
-
Open
- RB:
-
Robotic
- LP:
-
Laparoscopic
References
Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H, Forman D, Bray F (2013) Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 49:1374–1403
Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA: Cancer J Clin 65:87–108. doi:10.3322/caac.21262
Galaal K, Bryant A, Fisher AD, Al-Khaduri M, Kew F, Lopes AD (2012) Laparoscopy versus laparotomy for the management of early stage endometrial cancer. Cochrane Database Syst Rev 9:CD006655
Janda M, Gebski V, Brand A, Hogg R, Jobling TW, Land R, Manolitsas T, McCartney A, Nascimento M, Neesham D, Nicklin JL, Oehler MK, Otton G, Perrin L, Salfinger S, Hammond I, Leung Y, Walsh T, Sykes P, Ngan H, Garrett A, Laney M, Ng TY, Tam K, Chan K, Wrede CD, Pather S, Simcock B, Farrell R, Obermair A (2010) Quality of life after total laparoscopic hysterectomy versus total abdominal hysterectomy for stage I endometrial cancer (LACE): a randomised trial. Lancet Oncol 11:772–780
Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, Spiegel G, Barakat R, Pearl ML, Sharma SK (2009) Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. J Clin Oncol 27:5331–5336
Kroft J, Li Q, Saskin R, Elit L, Bernardini MQ, Gien LT (2015) Trends over time in the use of laparoscopic hysterectomy for the treatment of endometrial cancer. Gynecol Oncol 138:536–541
Peplinski R (2006) Past, present and future of the Da Vinci robot, vol 2. UK Robotic Urology Course, Guy’s Hospital, London
Herron DM, Marohn M, SAGES-MIRA Robotic Surgery Consensus Group (2008) A consensus document on robotic surgery. Surg Endosc 22(2):313–325 (discussion 311–312)
Mendivil A, Holloway RW, Boggess JF (2009) Emergence of robotic assisted surgery in gynecologic oncology: American perspective. Gynecol Oncol 114:S24–S31
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Med 3:e123–e130
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283:2008–2012
Review Manager (RevMan) [computer program] (2014) Version 5 3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration
Balshem H, Helfand M, Schunemann HJ, Oxman AD, Kunz R, Brozek J, Vist GE, Falck-Ytter Y, Meerpohl J, Norris S, Guyatt GH (2011) GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 64:401–406
Guyatt GH, Oxman AD, Schunemann HJ, Tugwell P, Knottnerus A (2011) GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology. J Clin Epidemiol 64:380–382
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schunemann HJ (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336:924–926
Boruta DM, Fagotti A, Bradford LS, Escobar PF, Scambia G, Kushnir CL, Michener CM, Fader AN (2014) Laparoendoscopic single-site radical hysterectomy with pelvic lymphadenectomy: initial multi-institutional experience for treatment of invasive cervical cancer. J minim Invasive Gynecol 21:394–398
Cardenas-Goicoechea J, Adams S, Bhat SB, Randall TC (2010) Surgical outcomes of robotic-assisted surgical staging for endometrial cancer are equivalent to traditional laparoscopic staging at a minimally invasive surgical center. Gynecol Oncol 117:224–228
Cardenas-Goicoechea J, Soto E, Chuang L, Gretz H, Randall TC (2013) Integration of robotics into two established programs of minimally invasive surgery for endometrial cancer appears to decrease surgical complications. J Gynecol Oncol 24:21–28
Coronado PJ, Herraiz MA, Magrina JF, Fasero M, Vidart JA (2012) Comparison of perioperative outcomes and cost of robotic-assisted laparoscopy, laparoscopy and laparotomy for endometrial cancer. Eur J Obstet Gynecol Reprod Biol 165:289–294
ElSahwi KS, Hooper C, De Leon MC, Gallo TN, Ratner E, Silasi DA, Santin AD, Schwartz PE, Rutherford TJ, Azodi M (2012) Comparison between 155 cases of robotic vs. 150 cases of open surgical staging for endometrial cancer. Gynecol Oncol 124:260–264
Escobar PF, Frumovitz M, Soliman PT, Frasure HE, Fader AN, Schmeler KM, Ramirez PT (2012) Comparison of single-port laparoscopy, standard laparoscopy, and robotic surgery in patients with endometrial cancer. Ann Surg Oncol 19:1583–1588
Fagotti A, Corrado G, Fanfani F, Mancini M, Paglia A, Vizzielli G, Sindico S, Scambia G, Vizza E (2013) Robotic single-site hysterectomy (RSS-H) vs. laparoendoscopic single-site hysterectomy (LESS-H) in early endometrial cancer: a double-institution case-control study. Gynecol Oncol 130:219–223
Fagotti A, Gagliardi ML, Fanfani F, Salerno MG, Ercoli A, D’Asta M, Tortorella L, Turco LC, Escobar P, Scambia G (2012) Perioperative outcomes of total laparoendoscopic single-site hysterectomy versus total robotic hysterectomy in endometrial cancer patients: a multicentre study. Gynecol Oncol 125:552–555
Leitao MM Jr, Briscoe G, Santos K, Winder A, Jewell EL, Hoskins WJ, Chi DS, Abu-Rustum NR, Sonoda Y, Brown CL, Levine DA, Barakat RR, Gardner GJ (2012) Introduction of a computer-based surgical platform in the surgical care of patients with newly diagnosed uterine cancer: outcomes and impact on approach. Gynecol Oncol 125:394–399
Lim PC, Kang E, Park do H (2010) Learning curve and surgical outcome for robotic-assisted hysterectomy with lymphadenectomy: case-matched controlled comparison with laparoscopy and laparotomy for treatment of endometrial cancer. J Minim Invasive Gynecol 17:739–748
Lim PC, Kang E, Park do H (2011) A comparative detail analysis of the learning curve and surgical outcome for robotic hysterectomy with lymphadenectomy versus laparoscopic hysterectomy with lymphadenectomy in treatment of endometrial cancer: a case-matched controlled study of the first one hundred twenty two patients. Gynecol Oncol 120:413–418
Martino MA, Shubella J, Thomas MB, Morcrette RM, Schindler J, Williams S, Boulay R (2011) A cost analysis of postoperative management in endometrial cancer patients treated by robotics versus laparoscopic approach. Gynecol Oncol 123:528–531
Mok ZW, Yong EL, Low JJ, Ng JS (2012) Clinical outcomes in endometrial cancer care when the standard of care shifts from open surgery to robotics. Int J Gynecol Cancer 22:819–825
Paley PJ, Veljovich DS, Shah CA, Everett EN, Bondurant AE, Drescher CW, Peters WA 3rd (2011) Surgical outcomes in gynecologic oncology in the era of robotics: analysis of first 1000 cases. Am J Obstet Gynecol 204(551):e551–e559
Seamon LG, Cohn DE, Henretta MS, Kim KH, Carlson MJ, Phillips GS, Fowler JM (2009) Minimally invasive comprehensive surgical staging for endometrial cancer: robotics or laparoscopy? Gynecol Oncol 113:36–41
Subramaniam A, Kim KH, Bryant SA, Zhang B, Sikes C, Kimball KJ, Kilgore LC, Huh WK, Straughn JM Jr, Alvarez RD (2011) A cohort study evaluating robotic versus laparotomy surgical outcomes of obese women with endometrial carcinoma. Gynecol Oncol 122:604–607
Tang KY, Gardiner SK, Gould C, Osmundsen B, Collins M, Winter WE 3rd (2012) Robotic surgical staging for obese patients with endometrial cancer. Am J Obstet Gynecol 206(513):e511–e516
Turunen H, Pakarinen P, Sjoberg J, Loukovaara M (2013) Laparoscopic vs robotic-assisted surgery for endometrial carcinoma in a centre with long laparoscopic experience. J Obstet Gynaecol 33:720–724
Estape R, Lambrou N, Estape E, Vega O, Ojea T (2012) Robotic-assisted total laparoscopic hysterectomy and staging for the treatment of endometrial cancer: a comparison with conventional laparoscopy and abdominal approaches. J Robot Surg 6:199–205
Nevadunsky N, Clark R, Ghosh S, Muto M, Berkowitz R, Vitonis A, Feltmate C (2010) Comparison of robot-assisted total laparoscopic hysterectomy and total abdominal hysterectomy for treatment of endometrial cancer in obese and morbidly obese patients. J Robot Surg 4:247–252
Nicole N, Rachel C, Michael M, Ross B, Sue G, Allison V, Colleen F (2012) Robotic assisted, total laparoscopic, and total abdominal hysterectomy for management of uterine cancer. J Cancer Ther 3:162–166
Cantrell LA, Mendivil A, Gehrig PA, Boggess JF (2010) Survival outcomes for women undergoing type III robotic radical hysterectomy for cervical cancer: a 3-year experience. Gynecol Oncol 117:260–265
Chong GO, Lee YH, Hong DG, Cho YL, Park IS, Lee YS (2013) Robot versus laparoscopic nerve-sparing radical hysterectomy for cervical cancer: a comparison of the intraoperative and perioperative results of a single surgeon’s initial experience. Int J Gynecol Cancer 23:1145–1149
Geisler JP, Orr CJ, Khurshid N, Phibbs G, Manahan KJ (2010) Robotically assisted laparoscopic radical hysterectomy compared with open radical hysterectomy. Int J Gynecol Cancer 20:438–442
Göçmen A, Şanlıkan F, Uçar MG (2010) Comparison of outcomes between laparotomy and robotic technique for cervical cancer. J Robot Surg 4:123–128
Halliday DLS, Vaknin Z, Deland C, Levental M, McNamara E, Gotlieb R, Kaufer R, How J, Cohen E, Gotlieb W (2010) Robotic radical hysterectomy: comparison of outcomes and cost. J Robot Surg 4:211–216
Maggioni A, Minig L, Zanagnolo V, Peiretti M, Sanguineti F, Bocciolone L, Colombo N, Landoni F, Roviglione G, Velez JI (2009) Robotic approach for cervical cancer: comparison with laparotomy: a case control study. Gynecol Oncol 115:60–64
Nam EJ, Kim SW, Kim S, Kim JH, Jung YW, Paek JH, Lee SH, Kim JW, Kim YT (2010) A case-control study of robotic radical hysterectomy and pelvic lymphadenectomy using 3 robotic arms compared with abdominal radical hysterectomy in cervical cancer. Int J Gynecol Cancer 20:1284–1289
Schreuder HW, Zweemer RP, van Baal WM, van de Lande J, Dijkstra JC, Verheijen RH (2010) From open radical hysterectomy to robot-assisted laparoscopic radical hysterectomy for early stage cervical cancer: aspects of a single institution learning curve. Gynecol Surg 7:253–258
Sert MB, Abeler V (2011) Robot-assisted laparoscopic radical hysterectomy: comparison with total laparoscopic hysterectomy and abdominal radical hysterectomy; one surgeon’s experience at the Norwegian Radium Hospital. Gynecol Oncol 121:600–604
Soliman PT, Frumovitz M, Sun CC, Dos Reis R, Schmeler KM, Nick AM, Westin SN, Brown J, Levenback CF, Ramirez PT (2011) Radical hysterectomy: a comparison of surgical approaches after adoption of robotic surgery in gynecologic oncology. Gynecol Oncol 123:333–336
Tinelli R, Malzoni M, Cosentino F, Perone C, Fusco A, Cicinelli E, Nezhat F (2011) Robotics versus laparoscopic radical hysterectomy with lymphadenectomy in patients with early cervical cancer: a multicenter study. Ann Surg Oncol 18:2622–2628
Wright JD, Herzog TJ, Neugut AI, Burke WM, Lu YS, Lewin SN, Hershman DL (2012) Comparative effectiveness of minimally invasive and abdominal radical hysterectomy for cervical cancer. Gynecol Oncol 127:11–17
Bernardini MQ, Gien LT, Tipping H, Murphy J, Rosen BP (2012) Surgical outcome of robotic surgery in morbidly obese patient with endometrial cancer compared to laparotomy. Int J Gynecol Cancer 22:76–81
Goel MZW, Moore D (2011) Surgical staging of endometrial cancer: robotic versus open technique outcomes in a contemporary single surgeon series. J Robot Surg 5:109–114
Borgfeldt C, Kalapotharakos G, Asciutto KC, Lofgren M, Hogberg T (2016) A population-based registry study evaluating surgery in newly diagnosed uterine cancer. Acta Obstet Gynecol Scand 95(8):901–911. doi:10.1111/aogs.12918
Corrado G, Cutillo G, Pomati G, Mancini E, Sperduti I, Patrizi L, Saltari M, Vincenzoni C, Baiocco E, Vizza E (2015) Surgical and oncological outcome of robotic surgery compared to laparoscopic and abdominal surgery in the management of endometrial cancer. Eur J Surg Oncol 41:1074–1081
Herling SF, Moller AM, Palle C, Thomsen T (2016) Health-related quality of life after robotic-assisted laparoscopic hysterectomy for women with endometrial cancer—a prospective cohort study. Gynecol Oncol 140:107–113
Chan JK, Gardner AB, Taylor K, Thompson CA, Blansit K, Yu X, Kapp DS (2015) Robotic versus laparoscopic versus open surgery in morbidly obese endometrial cancer patients—a comparative analysis of total charges and complication rates. Gynecol Oncol 139:300–305
Corrado G, Chiantera V, Fanfani F, Cutillo G, Lucidi A, Mancini E, Pedone Anchora L, Scambia G, Vizza E (2016) Robotic hysterectomy in severely obese patients with endometrial cancer: a multicenter study. J Minim Invasive Gynecol 23:94–100
Corrado G, Cutillo G, Saltari M, Mancini E, Sindico S, Vici P, Sergi D, Sperduti I, Patrizi L, Pomati G, Baiocco E, Vizza E (2016) Surgical and oncological outcome of robotic surgery compared with laparoscopic and abdominal surgery in the management of locally advanced cervical cancer after neoadjuvant chemotherapy. Int J Gynecol Cancer 26:539–546
Sert BM, Boggess JF, Ahmad S, Jackson AL, Stavitzski NM, Dahl AA, Holloway RW (2016) Robot-assisted versus open radical hysterectomy: a multi-institutional experience for early-stage cervical cancer. Eur J Surg Oncol 42:513–522
Zanagnolo V, Minig L, Rollo D, Tomaselli T, Aletti G, Bocciolone L, Landoni F, Cardenas Rebollo JM, Maggioni A (2016) Clinical and oncologic outcomes of robotic versus abdominal radical hysterectomy for women with cervical cancer: experience at a referral cancer center. Int J Gynecol Cancer 26:568–574
Hao X, Han S, Wang Y (2015) Comparison of conventional laparoscopy and robotic radical hysterectomy for early-stage cervical cancer: a meta-analysis. J Cancer Res Ther 11(Suppl):C258–c264
Shazly SA, Murad MH, Dowdy SC, Gostout BS, Famuyide AO (2015) Robotic radical hysterectomy in early stage cervical cancer: a systematic review and meta-analysis. Gynecol Oncol 138:457–471
Zhou J, Xiong BH, Ma L, Cheng Y, Huang W, Zhao L (2016) Robotic vs laparoscopic radical hysterectomy for cervical cancer: a meta-analysis. Int J Med Robot 12:145–154
Mendivil AA, Rettenmaier MA, Abaid LN, Brown JV 3rd, Micha JP, Lopez KL, Goldstein BH (2016) Survival rate comparisons amongst cervical cancer patients treated with an open, robotic-assisted or laparoscopic radical hysterectomy: a five year experience. Surg Oncol 25:66–71
He H, Zeng D, Ou H, Tang Y, Li J, Zhong H (2013) Laparoscopic treatment of endometrial cancer: systematic review. J Minim Invasive Gynecol 20:413–423
Gala RB, Margulies R, Steinberg A, Murphy M, Lukban J, Jeppson P, Aschkenazi S, Olivera C, South M, Lowenstein L, Schaffer J, Balk EM, Sung V, Society of Gynecologic Surgeons Systematic Review Group (2014) Systematic review of robotic surgery in gynecology: robotic techniques compared with laparoscopy and laparotomy. J Minim Invasive Gynecol 21(3):353–361
Tapper AM, Hannola M, Zeitlin R, Isojarvi J, Sintonen H, Ikonen TS (2014) A systematic review and cost analysis of robot-assisted hysterectomy in malignant and benign conditions. Eur J Obstet Gynecol Reprod Biol 177:1–10
Weinberg L, Rao S, Escobar PF (2011) Robotic surgery in gynecology: an updated systematic review. Obstet Gynecol Int 2011:852061
Lavoue V, Zeng X, Lau S, Press JZ, Abitbol J, Gotlieb R, How J, Wang Y, Gotlieb WH (2014) Impact of robotics on the outcome of elderly patients with endometrial cancer. Gynecol Oncol 133:556–562
Di Pierro GB, Wirth JG, Ferrari M, Danuser H, Mattei A (2014) Impact of a single-surgeon learning curve on complications, positioning injuries, and renal function in patients undergoing robot-assisted radical prostatectomy and extended pelvic lymph node dissection. Urology 84:1106–1111
Zeng XZ, Lavoue V, Lau S, Press JZ, Abitbol J, Gotlieb R, How J, Wang Y, Gotlieb WH (2015) Outcome of robotic surgery for endometrial cancer as a function of patient age. Int J Gynecol Cancer 25(4):637–644. doi:10.1097/IGC.0000000000000411
Hammer GP, du Prel JB, Blettner M (2009) Avoiding bias in observational studies: part 8 in a series of articles on evaluation of scientific publications. Dtsch Arztebl Int 106:664–668
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Nevis, I.F., Vali, B., Higgins, C. et al. Robot-assisted hysterectomy for endometrial and cervical cancers: a systematic review. J Robotic Surg 11, 1–16 (2017). https://doi.org/10.1007/s11701-016-0621-9
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DOI: https://doi.org/10.1007/s11701-016-0621-9