KISSIMMEE, Fla. (EGMN) – Robotic laparoscopic surgery is an acceptable alternative to laparotomy for the surgical staging of endometrial cancer, based on results of a retrospective study of 97 patients.
While node retrieval numbers were similar for the two procedures, robotic surgery was associated with significantly less blood loss and shorter hospital stays. Moreover, patients undergoing robotic surgery had fewer intraoperative complications, despite being significantly more overweight than those undergoing laparotomy, Dr. Meenu Goel said at the annual meeting of the American Association of Gynecologic Laparoscopists.
Dr. Goel of Indiana University, Indianapolis, examined outcomes for 97 patients who underwent surgical staging for endometrial cancer from 2003 to 2008. The 38 patients who had laparotomies underwent surgery from 2003 to 2005, when this was the standard approach at the hospital. From 2006 to 2008, all endometrial cancer staging was performed with robotic laparoscopy; this cohort included 59 patients.
Patients in the open surgery group were significantly older than those in the robotic surgery group (66 vs. 59 years). But those in the robotic group were significantly heavier, with a mean body mass index of 39 kg/m2, compared with 32 for the open group; 46% of patients in the robotic group were morbidly obese, compared with 16% of those in the open group.
Operative times were 175 vs. 185 minutes, respectively, for the open and robotic groups. The number of pelvic nodes retrieved was similar (9 in the open group vs. 11 in the robotic group), as was the number of aortic nodes (3 in the open group vs. 2 in the robotic group). Half of the patients in each group were diagnosed with stage III cancer, “probably due to the fact that we are a referral hospital,” Dr. Goel said.
The open group had a significantly longer mean hospital stay (3 days vs. 1 day).
The rate of complications was significantly less in the robotic group than in the open group (3% vs. 13%). There were two complications in the robotic group: a tear in the right external iliac vein that required open management and a transfusion, and a pelvic abscess, which was treated with postoperative antibiotics. There were five complications in the open surgery group: two cases of wound dehiscence, one intraoperative small bowel resection, one cardiac arrhythmia that required a pacemaker, and one pulmonary embolism.
Dr. Goel had no disclosures relevant to her study.
Copyright (c) 2009 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
佛罗里达州基西米(EGMN)——一项纳入97例患者的回顾性研究结果显示，机器人腹腔镜手术可代替剖腹术，用于子宫内膜癌的手术分期。
Meenu Goel博士在美国妇科腹腔镜检查医师协会(American Association of Gynecologic Laparoscopists)年会上说，两种手术方法检出的淋巴结数量相似，但机器人手术组的失血量明显更少，且住院时间明显更短。此外，机器人手术组的术中并发症较少，尽管该组患者比剖腹术组患者超重更明显。
印第安纳波利斯印第安纳大学的Goel 博士评价了2003~2008年进行手术分期的97例子宫内膜癌患者的转归。行剖腹术的38例患者在2003~2005年进行手术，这一时期，剖腹术是该医院的标准手术方法。从2006年至2008年，所有子宫内膜癌分期均通过机器人腹腔镜手术进行；该队列共纳入59例患者。
开放手术组患者的年龄显著大于机器人手术组(66岁对59岁)。但机器人手术组患者的体重比开放手术组更重，两组的平均体重指数分别为39kg/m2和32kg/m2，病态肥胖患者比例分别为46%和16%。
开放手术组和机器人手术组的手术时间分别为175min和185min。开放手术组和机器人手术组的盆腔淋巴结检出数量相似，分别为9枚和11枚；两组的主动脉淋巴结检出数量也相似，分别为3枚和2枚。Goel 博士表示，每组中有半数的患者被诊断为III期癌，“这可能是因为我们是一家转诊医院。”
开放手术组的平均住院时间明显更长(3d对1d)。
机器人手术组的并发症发生率显著少于开放手术组(3%对13%)。机器人手术组有2例并发症：1例右髂外静脉撕裂，需开放处置及输血；1例盆腔脓肿，术后应用抗生素治疗。开放手术组有5例并发症：2例伤口裂开，1例术中切除小肠，1例心律失常(需起搏器)，1例肺栓塞。
Goel博士没有与其研究相关的任何经济利益披露。
爱思唯尔 版权所有
