Survival after a nationwide adoption of robotic minimally invasive surgery for early-stage cervical cancer - A population-based study

Eur J Cancer. 2020 Mar:128:47-56. doi: 10.1016/j.ejca.2019.12.020. Epub 2020 Mar 5.


Aim: Lately, the safety of minimally invasive surgery (MIS) in the treatment of cervical cancer (CC) has been questioned. This study aimed to evaluate the risk of recurrence and survival after a nationwide adoption of robotic MIS for the treatment of early-stage CC in Denmark.

Methods: Population-based data on all Danish women with early-stage CC, who underwent radical hysterectomy January 1st 2005-June 30th 2017 were retrieved from the Danish Gynecologic Cancer Database and enriched with follow-up data on recurrence, death and cause of death. The cohort was divided into two groups according to the year of robotic MIS introduction at each cancer centre. Chi-squared or Fischer test, the Kaplan Meier method and multivariate Cox regression were used for comparison between groups.

Results: One thousand one hundred twenty-five patients with CC were included; 530 underwent surgery before (group 1) and 595 underwent surgery after (group 2) the introduction of robotic MIS. The 5-year rate of recurrence was low: 8.2% and 6.3% (p = 0.55) in group 1 and 2, respectively. In adjusted analyses, this corresponded to a five-year disease-free survival, hazard ratio (HR) 1.23 [95% confidence interval (CI) 0.79-1.93]. No difference in site of recurrence (P = 0.19) was observed. The cumulative cancer-specific survival was 94.1% and 95.9% (P = 0.10) in group 1 and 2, respectively, corresponding to a HR 0.60 [95% CI 0.32-1.11] in adjusted analyses.

Conclusion: In this population-based cohort study, the Danish nationwide adoption of robotic MIS for early-stage CC was not associated with increased risk of recurrence or reduction in survival outcomes.

Keywords: Cancer recurrence; Cancer-specific survival; Cervical cancer; Disease-free survival; Minimally invasive surgery; Overall survival; Population-based study; Radical hysterectomy; Robotic surgery.

MeSH terms

  • Adult
  • Cohort Studies
  • Denmark / epidemiology
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Humans
  • Hysterectomy / adverse effects
  • Hysterectomy / methods*
  • Hysterectomy / statistics & numerical data
  • Middle Aged
  • Neoplasm Recurrence, Local / epidemiology*
  • Neoplasm Recurrence, Local / prevention & control
  • Neoplasm Staging
  • Proportional Hazards Models
  • Risk Assessment
  • Robotic Surgical Procedures / adverse effects
  • Robotic Surgical Procedures / methods*
  • Robotic Surgical Procedures / statistics & numerical data
  • Survival Rate
  • Uterine Cervical Neoplasms / mortality
  • Uterine Cervical Neoplasms / pathology
  • Uterine Cervical Neoplasms / surgery*
  • Uterus / pathology
  • Uterus / surgery