Increased Institutional Surgical Experience in Robot-Assisted Radical Hysterectomy for Early Stage Cervical Cancer Reduces Recurrence Rate: Results from a Nationwide Study
Abstract
:1. Introduction
2. Material and Method
Statistical Analyses
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
p-Value | |
Tumor size at all hospitals | 0.001 |
Order of surgery at all hospitals | 0.028 |
Tumor size at three largest hospitals | 0.006 |
Order of surgery at three largest hospitals | 0.006 |
Appendix B
Appendix C
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Total (n = 635) | No Radio Chemotherapy (n = 489) | Radio Chemotherapy (n = 146) | |||||
---|---|---|---|---|---|---|---|
Introductory cohort | Experienced cohort | Introductory cohort | Experienced cohort | ||||
median (range)/number (%) | ≤50 n = 214 | p -value | >50 n = 275 | ≤50 n = 66 | p -value | >50 n = 80 | |
Age | 42.9 (22.3–86.6) | 42.0 (23.8–86.6) | p = 0.25 ᵃ | 42.8 (22.3–83.0) | 47.3 (25.3–83.2) | p = 0.77 ᵃ | 46.1 (24.9–79.9) |
BMI 1 | 25 (17–59.9) | 25.1 (17.6–59.9) | p = 0.52 ᵃ | 24.5 (17.0–48.2) | 24.7 (19.0–35.0) | p = 0.98 ᵃ | 26.1 (17–38.9) |
Smoking * |
Yes No Unknown ** |
46 (31.7%) 99 (68.3%) 69(32.3%) | p = 0.25 |
81 (37.7%) 134 (62.3%) 60 (21.8%) |
14 (33.3%) 28 (66.7%) 24 (36.4%) | p = 0.59 |
25 (38.5%) 40 (61.5%) 15 (18.8%) |
p < 0.01 | p = 0.02 | ||||||
Tumor size | 13 (0.2–62) | 11.0 (1.5–60) | p = 0.43 ᵃ | 10 (0.2–62.0) | 20 (3–48) | p = 0.08 ᵃ | 22.5 (2–50) |
Figo Stage IA2 | 71 (11.2%) | 26 (12.1%) | 43 (15.6%) | 0 (0.0%) | 2 (2.5%) | ||
Figo Stage IB1 | 564 (88.8%) | 188 (87.9%) | p = 0.27 ᵇ | 232 (84.4%) | 66 (100.0%) | p = 0.68 ᵇ | 78 (97.5%) |
Histology | |||||||
Squamous | 367 (57.8%) | 116 (54.2%) | 152 (55.3%) | 43 (65.2%) | 56 (70%) | ||
Adenocarcinoma | 233 (36.7%) | 83 (38.8%) | p = 0.24 ᵇ | 113 (41.1%) | 18 (27.2%) | p = 0.82 ᵇ | 19 (23.7%) |
Adenosquamous | 35 (5.5%) | 15 (7.0%) | 10 (3.6%) | 5 (7.6%) | 5 (6.3%) | ||
LVSI * |
Yes No Unknown ** |
38 (26.6%) 105 (73.4%) 71 (33.2%) | p = 0.64 |
46 (34.3%) 143 (75.6%) 86 (31.3%) |
39 (75.0%) 13 (25.0%) 14 (21.2%) | p = 0.65 |
42 (71.2%) 17 (28.8%) 21 (26.2%) |
p = 0.65 | p = 0.69 | ||||||
Grade * |
1 + 2 3 Unknown ** |
107 (63.7%) 61 (36.3%) 46 (21.59) | p = 0.60 |
82 (60.7%) 53 (39.3%) 140 (50.8%) |
31(53.4%) 27 (46.6%) 8 (12.1%) | p = 0.71 |
27 (52.9%) 24 (47.1%) 29 (36.3%) |
p = 0.001 | p = 0.06 | ||||||
Reason for adjuvant treatment | |||||||
Metastatic nodes |
33 (50.0%) 6 (9.1%) 27 (40.9%) | p = 0.51 ᵇ |
35 (43.7%) 5 (6.3%) 40 (50.0%) | ||||
Tumor > 40 mm | |||||||
Insufficient margins | |||||||
Recurrence ≤ 24 months | 51 (8.0%) | 20 (9.3%) | p = 0.01 ᵇ | 10 (3.6%) | 9(13.6%) | p = 0.82 ᵇ | 12(15%) |
Recurrence rate ≤ 24 months in tumors < 2 cm | 22/431 (5.1%) | 11/158 (7.0%) | p = 0.01 ᵇ | 4/215 (1.9%) | 4/31 (12.9%) 2 | p = 0.83 ᵇ | 3/27 (11.1%) 2 |
Recurrence rate ≤ 24 months in tumors ≥ 2 cm | 29/204(14.2%) | 9/56 (16.1%) | p = 0.33 ᵇ | 6/60 (10.0%) | 5/35 (14.3%) ** | p = 0.74 ᵇ | 9/53 (17.0%) ** |
All patients’ tumors < 2 cm with and without RC-T | All patients’ tumors ≥ 2 cm with and without RC-T | ||||||
Introductory cohort | p-value | Experienced cohort | Introductory cohort | p-value | Experienced cohort | ||
Recurrence rate ≤ 24 months | 15/189 (7.9%) | 0.02 ᵇ | 7/242 (2.9%) | 14/91 (15.4%) | 0.67 ᵇ | 15/113 (13.3%) |
n (%) Total n = 635 | Total n = 635 | Introductory Cohort ≤50 n = 280 | Experienced Cohort >50 n = 355 | p-Value |
---|---|---|---|---|
Postoperative complications Grade I-IIIb | 186 (29.3%) | 90 (32.1%) | 96 (27.0%) | p = 0.20 ᵃ |
Postoperative complications Grade ≥ IIIa | 26 (4.1%) | 17 (6.1%) | 9 (2.5%) | p = 0.03 ᵃ |
Intra-operatively diagnosed complications | 10 (1.6%) | 7 (2.5%) | 3 (0.8%) | p = 0.10 ᵃ |
Intra-operative and surgical postoperative complications ᵇ | 23 (3.6%) | 16 (5.7%) | 7 (2.0%) | p = 0.01 ᵃ |
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Ekdahl, L.; Wallin, E.; Alfonzo, E.; Reynisson, P.; Lönnerfors, C.; Dahm-Kähler, P.; Falconer, H.; Persson, J. Increased Institutional Surgical Experience in Robot-Assisted Radical Hysterectomy for Early Stage Cervical Cancer Reduces Recurrence Rate: Results from a Nationwide Study. J. Clin. Med. 2020, 9, 3715. https://doi.org/10.3390/jcm9113715
Ekdahl L, Wallin E, Alfonzo E, Reynisson P, Lönnerfors C, Dahm-Kähler P, Falconer H, Persson J. Increased Institutional Surgical Experience in Robot-Assisted Radical Hysterectomy for Early Stage Cervical Cancer Reduces Recurrence Rate: Results from a Nationwide Study. Journal of Clinical Medicine. 2020; 9(11):3715. https://doi.org/10.3390/jcm9113715
Chicago/Turabian StyleEkdahl, Linnea, Emelie Wallin, Emilia Alfonzo, Petur Reynisson, Celine Lönnerfors, Pernilla Dahm-Kähler, Henrik Falconer, and Jan Persson. 2020. "Increased Institutional Surgical Experience in Robot-Assisted Radical Hysterectomy for Early Stage Cervical Cancer Reduces Recurrence Rate: Results from a Nationwide Study" Journal of Clinical Medicine 9, no. 11: 3715. https://doi.org/10.3390/jcm9113715