The Impact of Surgical Practice on Oncological Outcomes in Robot-Assisted Radical Hysterectomy for Early-Stage Cervical Cancer, Spanish National Registry

• Published in: Cancers Vol. 14; no. 3; p. 698
• Main Authors: Fernandez-Gonzalez, Sergi, Ponce, Jordi, Martínez-Maestre, María Ángeles, Barahona, Marc, Gómez-Hidalgo, Natalia R, Díaz-Feijoo, Berta, Casajuana, Andrea, Gracia, Myriam, Frias-Gomez, Jon, Benavente, Yolanda, Costas, Laura, Martí, Lola, Melero, Lidia, Silvan, Jose Manuel, Beiro, Eva, Lobo, Ignacio, De la Rosa, Jesús, Coronado, Pluvio J, Gil-Moreno, Antonio
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 29.01.2022; MDPI
• Subjects: Audits; Biopsy; Body mass index; Cancer therapies; Cervical cancer; Clinical trials; Diagnosis; Histology; Hospitals; Hysterectomy; Invasiveness; Lymph nodes; Lymphatic system; Magnetic resonance imaging; Mortality; Robotic surgery; Statistical analysis; Womens health; United States > US; Spain; radical hysterectomy; recurrence; disease-free survival; oncological outcome; surgical practice; early-stage cervical cancer; robotic surgery; surgery
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers14030698

This study aimed to assess whether surgical practice had a significant impact on oncological outcomes among women who underwent robot-assisted radical hysterectomy for early-stage cervical cancer (≤IB1 or IIA1, FIGO 2009). The secondary objective was to audit the pre-surgical quality indicators (QI) proposed by the European Society of Gynaecological Oncology (ESGO). The top 5 of 10 centers in Spain and Portugal were included in the analysis. The hospitals were divided into group A ( = 118) and group B ( = 97), with recurrence rates of <10% and >10%, respectively. After balancing both groups using the propensity score, the ORs for all events were higher and statistically significant for group B (recurrences OR = 1.23, 95% CI = 1.13-1.15, -value = 0.001; death OR = 1.10, 95% CI = 1.02-1.18, -value = 0.012; disease-specific mortality OR = 1.11, 95% CI = 1.04-1.19, -value = 0.002). A higher surgical volume, higher participation in clinical trials, higher rate of MRI use for diagnosis, greater use of sentinel lymph node biopsies, and a favorable learning curve with low rates of early recurrences were observed among the centers with better oncological outcomes. These factors might have a significant impact on oncological outcomes not only after robot-assisted surgery, but also after laparoscopies and open surgeries in the treatment of cervical cancer.