TY - JOUR

T1 - Robotic-assisted laparoscopic hysterectomy for women with endometrial cancer

AU - Herling, Suzanne Forsyth

AU - Møller, Ann M

AU - Palle, Connie

AU - Grynnerup, Anja

AU - Thomsen, Thordis

PY - 2017

Y1 - 2017

N2 - INTRODUCTION: Robotic-assisted laparoscopic hysterectomy (RALH) has become a widely used approach for women with endometrial cancer and has replaced laparotomy. It has been questioned if the increased costs are justified by superior surgical outcomes. The aim of the present study was to examine the frequency, types and severity of post-operative complications after total abdominal hysterectomy (TAH) and RALH using the Clavien-Dindo classification of surgical outcomes.METHODS: A non-randomised, controlled before and after study of 360 women was conducted; 202 underwent RALH and 158 TAH (historical controls).RESULTS: RALH had significant advantages compared with TAH: fewer and less severe post-operative complications and a shorter length of hospital stay. The absolute risk reduction for post-operative complications was 13% (95% confidence interval: 4.29-20.87%). Women treated with TAH had significantly more severe complications (grade ≥ 3) than those treated with RALH; 12% versus 3% (p = 0.001). Infections (urinary and port site) were the most frequent post-operative complications overall. The duration of RALH in the operation theatre was longer, while the duration of stay in the post-anaesthesia care unit was shorter for patients undergoing RALH.CONCLUSIONS: RALH appears advantageous for women treated for endometrial cancer in terms of post-operative complications. We recommend the use of the Clavien-Dindo classification of surgical outcomes for quality assessment.FUNDING: departmental only.TRIAL REGISTRATION: Danish Health Authority (3-2013-111/1/KAHO).

AB - INTRODUCTION: Robotic-assisted laparoscopic hysterectomy (RALH) has become a widely used approach for women with endometrial cancer and has replaced laparotomy. It has been questioned if the increased costs are justified by superior surgical outcomes. The aim of the present study was to examine the frequency, types and severity of post-operative complications after total abdominal hysterectomy (TAH) and RALH using the Clavien-Dindo classification of surgical outcomes.METHODS: A non-randomised, controlled before and after study of 360 women was conducted; 202 underwent RALH and 158 TAH (historical controls).RESULTS: RALH had significant advantages compared with TAH: fewer and less severe post-operative complications and a shorter length of hospital stay. The absolute risk reduction for post-operative complications was 13% (95% confidence interval: 4.29-20.87%). Women treated with TAH had significantly more severe complications (grade ≥ 3) than those treated with RALH; 12% versus 3% (p = 0.001). Infections (urinary and port site) were the most frequent post-operative complications overall. The duration of RALH in the operation theatre was longer, while the duration of stay in the post-anaesthesia care unit was shorter for patients undergoing RALH.CONCLUSIONS: RALH appears advantageous for women treated for endometrial cancer in terms of post-operative complications. We recommend the use of the Clavien-Dindo classification of surgical outcomes for quality assessment.FUNDING: departmental only.TRIAL REGISTRATION: Danish Health Authority (3-2013-111/1/KAHO).

KW - Aged

KW - Controlled Before-After Studies

KW - Denmark

KW - Endometrial Neoplasms/surgery

KW - Female

KW - Humans

KW - Hysterectomy/adverse effects

KW - Laparoscopy/methods

KW - Length of Stay

KW - Middle Aged

KW - Postoperative Complications/diagnosis

KW - Robotic Surgical Procedures/adverse effects

M3 - Journal article

C2 - 28260596

VL - 64

JO - Danish Medical Journal

JF - Danish Medical Journal

SN - 2245-1919

IS - 3

M1 - A5343

ER -