Statement on the oncological safety of minimal access techniques for radical hysterectomy in early stage cervical cancer.
Society of European Robotic Gynaecological Surgeons (SERGS)
The Society of European Robotic Gynaecological Surgeons (SERGS) note the emerging data presented at the SGO in March 2018 concerning the oncological safety of minimal access techniques in the treatment of early cervical cancer. This included a study from the MD Anderson Cancer Centre examining the Surveillance, Epidemiology and End Result (SEER) database (1) and early data from the Laparoscopic Approach to Cervical Cancer (LACC) study (2), that suggest improved survival for open radical hysterectomy for early cervical cancer over minimal access techniques.
To date there are a number of comparative studies published that demonstrate lower complications, less blood loss, less blood transfusions and a quicker recovery following robotic radical hysterectomy compared to open (3-17). When reported, these studies have shown no differences in the recurrence rates between robotic and open surgery (3-8, 10, 11, 13, 15, 17).
Patients should be informed about both the early findings of the prospective studies, as well as of the more mature data from both smaller and larger retrospective studies. The society also recommends that surgeons follow standards that exist for the consent process such as that recommended by the Royal College of Obstetricians and Gynaecologists to help patients choose which approach to surgery they would prefer (18).
In light of the above data, and the shortcomings of the two yet unpublished trials presented in New Orleans, the society does not currently recommend a change in surgical practice for surgeons offering a minimally invasive approach to early cervical cancer.
The council of SERGS have convened a working party to examine existing evidence of the efficacy of robotic surgery compared to abdominal radical hysterectomy for cervical cancer.
- Rauh-Hain JA. Comparative effectiveness of minimally invasive staging surgery in women with early stage cervical cancer. Proceedings of the Society of Gynecologic Oncologists. 2018.
- Ramirez PT, Frumovitz M, Pareja R, Lopez A, Viera M, Ribeiro R, et al. Pase III randomized controled trial of laparoscopic and robotic radical hysterectomy versus abdominal hysterectomy in patients with early stage cervical cancer: LACC Trial. Proceedings of the Society of Gynecologic Oncologists. 2018.
- Cantrell LA, Mendivil A, Gehrig PA, Boggess JF. Survival outcomes for women undergoing type III robotic radical hysterectomy for cervical cancer: a 3-year experience. Gynecol Oncol. 2010;117:260-5.
- Chen CH, Chiu LH, Chang CW, Yen YK, Huang YH, Liu WM. Comparing robotic surgery with conventional laparoscopy and laparotomy for cervical cancer management. IJGC 2014;24:1105-11.
- Estape R, Lambrou N, Diaz R, Estape E, Dunkin N, Rivera A. A case matched analysis of robotic radical hysterectomy with lymphadenectomy compared with laparoscopy and laparotomy. Gynecol Oncol 2009;113:357-61. 6. Gortchev GT, Tomov S, Tantchev L, Velkova A, Radionova Z. Robot-assisted radical hysterectomy—perioperative and survival outcomes in patients with cervical cancer compared to laparoscopic and open radical surgery. Gynecol Surg 2012;9:81 – 8.
- Lowe MP, Hoekstra AV, Jairam-Thodla A, Singh DK, Buttin BM, Lurain JR, et al. A comparison of robot-assisted and traditional radical hysterectomy for early-stage cervical cancer. J Robot Surg 2009;3:19.
- Nam EJ, Kim SW, Kim S, Kim JH, Jung YW, Paek JH, et al. A case-control study of robotic radical hysterectomy and pelvic lymphadenectomy using 3 robotic arms compared with abdominal radical hysterectomy in cervical cancer. IJGC 2010;20:1284-9.
- Nevis IF, Vali B, Higgins C, Dhalla I, Urbach D, Bernardini MQ. Robot-assisted hysterectomy for endometrial and cervical cancers: a systematic review. J Robot Surg 2017;11:1-16.
- Schreuder HW, Zweemer RP, van Baal WM, van de Lande J, Dijkstra JC, Verheijen RH. From open radical hysterectomy to robot-assisted laparoscopic radical hysterectomy for early stage cervical cancer: aspects of a single institution learning curve. Gynecol Surg 2010;7:253-8.
- Sert BM, Boggess JF, Ahmad S, Jackson AL, Stavitzski NM, Dahl AA, et al. Robot-assisted versus open radical hysterectomy: A multi-institutional experience for early-stage cervical cancer. EJSO 2016;42:513-22.
- Sert MB, Abeler V. 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 2011;121:600-4.
- Shah CA, Beck T, Liao JB, Giannakopoulos NV, Veljovich D, Paley P. Surgical and oncologic outcomes after robotic radical hysterectomy as compared to open radical hysterectomy in the treatment of early cervical cancer. JGO. 2017;28:e82.
- Shazly SA, Murad MH, Dowdy SC, Gostout BS, Famuyide AO. Robotic radical hysterectomy in early stage cervical cancer: A systematic review and meta-analysis. Gynecol Oncol 2015;138:457-71.
- Wallin E, Floter Radestad A, Falconer H. Introduction of robot-assisted radical hysterectomy for early stage cervical cancer: impact on complications, costs and oncologic outcome. Acta obstetricia et gynecologica Scandinavica. 2017;96:536-42.
- Wang YZ, Deng L, Xu HC, Zhang Y, Liang ZQ. Laparoscopy versus laparotomy for the management of early stage cervical cancer. BMC cancer 2015;15:928.
- Zanagnolo V, Minig L, Rollo D, Tomaselli T, Aletti G, Bocciolone L, et al. Clinical and Oncologic Outcomes of Robotic Versus Abdominal Radical Hysterectomy for Women With Cervical Cancer: Experience at a Referral Cancer Center. IJGC 2016;26:568-74.
- EP M. Obtaining Valid Consent (Clinical Governance Advice No. 6). Royal College of Obstetricians & Gynaecologists. 2015.