TY - JOUR
T1 - Survival after a nationwide adoption of robotic minimally invasive surgery for early-stage cervical cancer - A population-based study
AU - Jensen, Pernille T
AU - Schnack, Tine H
AU - Frøding, Ligita P
AU - Bjørn, Signe F
AU - Lajer, Henrik
AU - Markauskas, Algirdas
AU - Jochumsen, Kirsten M
AU - Fuglsang, Katrine
AU - Dinesen, Jacob
AU - Søgaard, Charlotte H
AU - Søgaard-Andersen, Erik
AU - Jensen, Marianne M
AU - Knudsen, Aage
AU - Øster, Laura H
AU - Høgdall, Claus
PY - 2020/3
Y1 - 2020/3
N2 - 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.
AB - 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.
KW - Cancer recurrence
KW - Cancer-specific survival
KW - Cervical cancer
KW - Disease-free survival
KW - Minimally invasive surgery
KW - Overall survival
KW - Population-based study
KW - Radical hysterectomy
KW - Robotic surgery
UR - http://www.scopus.com/inward/record.url?scp=85079122269&partnerID=8YFLogxK
U2 - 10.1016/j.ejca.2019.12.020
DO - 10.1016/j.ejca.2019.12.020
M3 - Journal article
C2 - 32109850
SN - 0959-8049
VL - 128
SP - 47
EP - 56
JO - European Journal of Cancer
JF - European Journal of Cancer
ER -