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16 Robotic-assisted radical hysterectomy (RRH) for early stage cervical cancer (CC): patterns of recurrence, survival, and the surgeon experience factor

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Objectives To evaluate factors associated with recurrence and survival after RRH for CC. Methods Pts with early stage CC who underwent RRH(4/2007–12/2017) were evaluated. Inclusion criteria: >one year follow up,… Click to show full abstract

Objectives To evaluate factors associated with recurrence and survival after RRH for CC. Methods Pts with early stage CC who underwent RRH(4/2007–12/2017) were evaluated. Inclusion criteria: >one year follow up, adenocarcinoma or squamous carcinoma, stage IA2 or IB1(FIGO 2014 guidelines), and pathologic tumor size(TS) of ≤4 cm. The first 10 learning curve cases per surgeon (A) were compared to all subsequent cases (B). Results 144 RRH pts were identified and 90 met inclusion criteria. There were 40 A and 50 B patients. Median follow up was 61± 34.3 months (A=71.5, B=52.5). There were 7(7.8%) recurrences with median DFS of 12±8.3 months. Recurrence in A(n=6,15%) exceeded B(n=1,2%) (p=0.025). DSDR was 10% A v 2% B(p= 0.184). The 4.5 yr DFS was 84.8%(95 CI±7%) in A v 98%(95 CI ±3%) in B. Positive vaginal margin status(A=10% v B=0%, p=0.034) was the only difference. All recurrences had TS ≥2cm. Of the 42 TS ≥2cm, 5/14(36%) adenocarcinoma recurred compared to 2/28(7%) squamous (p=0.057). Three recurrences had carcinomatosis with mean DFS and OS of 5.3 ±2.3(95% CI ±4.5) and 28.3±30.9(95% CI ±60) months compared to 17.8±6.3(95% CI ±13) and 80.6±48.6(95% CI ±95.2) months for cases with local/pulmonary metastasis(n=4) (p=0.014). Using a multiple logistic regression model, adenocarcinoma(p=.024) and first 10 experience cases(p=0.048) remained significant for recurrence. Abstract 16 Table 1 Conclusions Early stage CC treated with RRH has a unique pattern of recurrence with carcinomatosis that results in shortened DFS. Recurrences were associated with adenocarcinoma and first 10 cases of surgeon experience.

Keywords: recurrence; surgeon experience; early stage; recurrence survival; stage

Journal Title: International Journal of Gynecological Cancer
Year Published: 2019

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