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No survival difference between robotic and open radical hysterectomy for women with early-stage cervical cancer: results from a nationwide population-based cohort study

Journal article
Authors Emilia Alfonzo
E. Wallin
L. Ekdahl
C. Staf
A. F. Rådestad
P. Reynisson
K. Stålberg
H. Falconer
J. Persson
Pernilla Dahm-Kähler
Published in European Journal of Cancer
Volume 116
Pages 169-177
ISSN 0959-8049
Publication year 2019
Published at Institute of Clinical Sciences, Department of Obstetrics and Gynecology
Pages 169-177
Language en
Keywords Cervical cancer, Disease-free survival, Radical hysterectomy, Robotic, Surgery, Survival, antineoplastic agent, adenocarcinoma, adenosquamous carcinoma, adult, aged, Article, cancer adjuvant therapy, cancer diagnosis, cancer registry, cancer staging, cancer surgery, cohort analysis, controlled study, disease free survival, early diagnosis, female, human, human tissue, major clinical study, medical record review, open surgery, overall survival, population research, priority journal, retrospective study, robot assisted surgery, squamous cell carcinoma, tissue section, uterine cervix cancer, very elderly
Subject categories Obstetrics and women's diseases, Cancer and Oncology


Purpose: The aim of the study was to compare overall survival (OS) and disease-free survival (DFS) after open and robotic radical hysterectomy for early-stage cervical cancer. Patients and methods: This was a nationwide population-based cohort study on all women with cervical cancer stage IA1-IB of squamous, adenocarcinoma or adenosquamous histological subtypes, from January 2011 to December 2017, for whom radical hysterectomy was performed. The Swedish Quality Register of Gynaecologic Cancer was used for identification. To ensure quality and conformity of data and to disclose patients not yet registered, hospital registries were reviewed and validated. Cox and propensity score regression analysis and univariable and multivariable regression analysis were performed in regard to OS and DFS. Results: There were 864 women (236 open and 628 robotic) included in the study. The 5-year OS was 92% and 94% and DFS was 84% and 88% for the open and robotic cohorts, respectively. The recurrence pattern was similar in both groups. Using propensity score analysis and matched cohorts of 232 women in each surgical group, no significant differences were seen in survival: 5-year OS of 92% in both groups (hazard ratio [HR], 1.00; 95% confidence interval [CI], 0.50–2.01) and DFS of 85% vs 84% in the open and robotic cohort, respectively (HR, 1.08; 95% CI, 0.66–1.78). In univariable and multivariable analysis with OS as the end-point, no significant factors were found, and in regard to DFS, tumour size (p < 0.001) and grade 3 (p = 0.02) were found as independent significant risk factors. Conclusion: In a complete nationwide population-based cohort, where radical hysterectomy for early-stage cervical cancer is highly centralised, neither long-term survival nor pattern of recurrence differed significantly between open and robotic surgery. © 2019 The Authors

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