Perioperative and clinical outcomes in the management of epithelial ovarian cancer using a robotic or abdominal approach.

OBJECTIVE: To evaluate the feasibility and efficacy of robotic-assisted management of epithelial ovarian cancer. METHODS: Retrospective review of robotic-assisted or abdominal ovarian cancer cases presenting with pelvic mass, initial staging, or debulking after neoadjuvant chemotherapy performed by a single surgeon (2008-2012). Patient characteristics and outcomes were compared using chi-squared or Student's t-tests. RESULTS: There were 63 robotic and 26 abdominal cases. Patient characteristics were similar for age, uterine weight, and BMI, with prior abdominal surgery more common in the abdominal group (p=0.0257). Robotic operative time was longer (p<0.0001), while blood loss (p<0.0001) and hospital stay (p=0.0009) were reduced. Major complication rates (16% vs. 23%, p=0.4209) and lymphadenectomy yields (13 vs. 11 nodes, p=0.2310) were similar. Neoadjuvant chemotherapy was more common in the robotic group (52% vs. 15%, p=0.0013). Residual disease rates for all cases (73% vs. 50%, p=0.880) and for Stage II-IV cases (61% vs. 40%, p=0.929) were equivalent. Follow-up was longer for the abdominal group; however, an equivalent percentage of patients had at least 1 year of follow-up (57% vs. 77%, p=0.0789). At 1 year, survival and no evidence of disease (NED) rates were equivalent for all cases (survival: 97% vs. 90%, p=0.2501; NED: 81% vs. 85%, p=0.6773) and for Stage II-IV cases (survival: 96% vs. 88%, p=0.3080; NED: 76% vs. 81%, p=0.6920). CONCLUSIONS: A robotic approach for the management of epithelial ovarian cancer, including patients treated with neoadjuvant chemotherapy, is feasible and effective. Debulking, recurrence, and survival rates were similar to laparotomy at 1 year.

Robotic surgery for staging of serous papillary and clear cell carcinoma of the endometrium.

BACKGROUND: The feasibility of robotic staging for high-risk endometrial cancer is unclear. METHODS: Retrospective review of papillary serous and clear cell endometrial cancer open staging (OS) and robotic staging (RS) cases (2009-2011) by two gynaecological oncologists. RESULTS: There were 15 OS and 17 RS cases (no conversions). Age, uterine weight and body mass index were comparable, with more stage I RS cases. Operative time (172.5 vs 124.2 min, p = 0.0005), blood loss (71.9 vs 310.0 ml, p = 0.0002), hospital stay (5.4 vs 1.2 days, p = 0.0016) and lymphadenectomy yield (16.8 vs 10.2 nodes, p = 0.0041) were decreased for RS. Optimal cytoreduction rates (100% vs 93%, p = 0.2794), follow-up (19.9 vs 27.1 months, p = 0.2283) and recurrences (three vs five, p = 0.5395) were equivalent. Disease-free survival (54.5% vs 66.7%, p = 0.5302) and overall survival rates (81.8% vs 80.0%, p = 0.9075) were equivalent. CONCLUSIONS: Robotic staging is feasible with minimal blood loss, a short operative time and recovery and good optimal cytoreduction rates.