TY - JOUR
T1 - Comparison of perioperative outcomes and cost of robotic-assisted laparoscopy, laparoscopy and laparotomy for endometrial cancer
AU - Coronado, Pluvio J.
AU - Herraiz, Miguel A.
AU - Magrina, Javier F.
AU - Fasero, María
AU - Vidart, Jose A.
PY - 2012/12
Y1 - 2012/12
N2 - Objective: To analyze the perioperative outcomes and cost of three surgical approaches in the treatment of endometrial cancer: robotic, laparoscopy and laparotomy. Study design: We studied 347 patients with endometrial cancer treated in a single institution: 71 patients were operated by robotics, 84 by conventional laparoscopy and 192 by laparotomy. All patients underwent total hysterectomy, bilateral salpingoophorectomy and pelvic and para-aortic lymphadenectomy depending on the pathological features. Results: Operative time was longer in the laparoscopy group as compared to robotics and laparotomy (218.2 min, 189.2 min, and 157.4 min respectively, p = 0.000). The estimated blood loss was lower in the robotic group relative to the other groups (99.4 ml in robotic, 190.0 ml in laparoscopy and 231.5 ml in laparotomy, p = 0.000). Similar findings were observed for the pre- and post-operative mean hemoglobin levels (-1.3 g/dl, -2.3 g/dl and -2.5 g/dl respectively, p = 0.000), and transfusion rate (4.2%, 7.1% and 14.1% respectively, p = 0.036). The length of hospital stay was higher in the laparotomy group compared to robotics and laparoscopy (8.1, 3.5 and 4.6 days respectively; p = 0.000). The conversion rate to laparotomy was lower for robotics (2.4% for robotics and 8.1% for laparoscopy, p = 0.181). Overall complications were similar for robotics and laparoscopy (21.1%, 28.5%) (p = 0.079). Robotic complications were significantly lower as compared to laparotomy (21.2 vs 34.9% (p = 0.036). No differences were found relative to disease-free or overall survival among the three groups. The global costs were similar for the three approaches (p = 0.566). Conclusion: Robotics is a safe alternative to laparoscopy and laparotomy for endometrial cancer patients, offering improved perioperative outcomes and similar cost as compared to the other two surgical approaches.
AB - Objective: To analyze the perioperative outcomes and cost of three surgical approaches in the treatment of endometrial cancer: robotic, laparoscopy and laparotomy. Study design: We studied 347 patients with endometrial cancer treated in a single institution: 71 patients were operated by robotics, 84 by conventional laparoscopy and 192 by laparotomy. All patients underwent total hysterectomy, bilateral salpingoophorectomy and pelvic and para-aortic lymphadenectomy depending on the pathological features. Results: Operative time was longer in the laparoscopy group as compared to robotics and laparotomy (218.2 min, 189.2 min, and 157.4 min respectively, p = 0.000). The estimated blood loss was lower in the robotic group relative to the other groups (99.4 ml in robotic, 190.0 ml in laparoscopy and 231.5 ml in laparotomy, p = 0.000). Similar findings were observed for the pre- and post-operative mean hemoglobin levels (-1.3 g/dl, -2.3 g/dl and -2.5 g/dl respectively, p = 0.000), and transfusion rate (4.2%, 7.1% and 14.1% respectively, p = 0.036). The length of hospital stay was higher in the laparotomy group compared to robotics and laparoscopy (8.1, 3.5 and 4.6 days respectively; p = 0.000). The conversion rate to laparotomy was lower for robotics (2.4% for robotics and 8.1% for laparoscopy, p = 0.181). Overall complications were similar for robotics and laparoscopy (21.1%, 28.5%) (p = 0.079). Robotic complications were significantly lower as compared to laparotomy (21.2 vs 34.9% (p = 0.036). No differences were found relative to disease-free or overall survival among the three groups. The global costs were similar for the three approaches (p = 0.566). Conclusion: Robotics is a safe alternative to laparoscopy and laparotomy for endometrial cancer patients, offering improved perioperative outcomes and similar cost as compared to the other two surgical approaches.
KW - Cost
KW - Endometrial cancer
KW - Laparoscopy
KW - Robotic
KW - Survival
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U2 - 10.1016/j.ejogrb.2012.07.006
DO - 10.1016/j.ejogrb.2012.07.006
M3 - Article
C2 - 22819573
AN - SCOPUS:84870293594
SN - 0301-2115
VL - 165
SP - 289
EP - 294
JO - European Journal of Obstetrics and Gynecology and Reproductive Biology
JF - European Journal of Obstetrics and Gynecology and Reproductive Biology
IS - 2
ER -