Department of Obstetrics and Gynecology, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Republic of Singapore.
Int J Gynecol Cancer. 2012 Jun;22(5):819-25. doi: 10.1097/IGC.0b013e31824c5cd2.
In Singapore, the standard of care for endometrial cancer staging remains laparotomy. Since the introduction of gynecologic robotic surgery, there have been more data comparing robotic surgery to laparoscopy in the management of endometrial cancer. This study reviewed clinical outcomes in endometrial cancer in a program that moved from laparotomy to robotic surgery.
A retrospective review was performed on 124 consecutive endometrial cancer patients. Preoperative data and postoperative outcomes of 34 patients undergoing robotic surgical staging were compared with 90 patients who underwent open endometrial cancer staging during the same period and in the year before the introduction of robotics.
There were no significant differences in the mean age, body mass index, rates of diabetes, hypertension, previous surgery, parity, medical conditions, size of specimens, histologic type, or stage of cancer between the robotic and the open surgery groups. The first 20 robotic-assisted cases had a mean (SD) operative time of 196 (60) minutes, and the next 14 cases had a mean time of 124 (64) minutes comparable to that for open surgery. The mean number of lymph nodes retrieved during robot-assisted staging was smaller than open laparotomy in the first 20 cases but not significantly different for the subsequent 14 cases. Robot-assisted surgery was associated with lower intraoperative blood loss (110 [24] vs 250 [83] mL, P < 0.05), a lower rate of postoperative complications (8.8% vs 26.8%, P = 0.032), a lower wound complication rate (0% vs 9.9%, P = 0.044), a decreased requirement for postoperative parenteral analgesia (5.9% vs 51.1, P < 0.001), and shorter length of hospitalization (2.0 [1.1] vs 6.0 [4.5] days, P < 0.001) compared to patients in the open laparotomy group.
Our series shows that outcomes traditionally associated with laparoscopic endometrial cancer staging are achievable by laparoscopy-naive gynecologic cancer surgeons moving from laparotomy to robot-assisted endometrial cancer staging after a relatively small number of cases.
在新加坡，子宫内膜癌分期的标准治疗仍然是剖腹手术。自从妇科机器人手术问世以来，已经有更多的数据比较了机器人手术与腹腔镜手术在子宫内膜癌治疗中的应用。本研究回顾了一个从剖腹手术转为机器人手术的项目中子宫内膜癌的临床结果。
对 124 例连续子宫内膜癌患者进行回顾性分析。比较了 34 例接受机器人手术分期的患者和同期及机器人手术引入前一年接受开腹子宫内膜癌分期的 90 例患者的术前数据和术后结果。
机器人手术组和开腹手术组的平均年龄、体重指数、糖尿病、高血压、既往手术、产次、医疗状况、标本大小、组织学类型或癌症分期无显著差异。前 20 例机器人辅助病例的平均（SD）手术时间为 196（60）分钟，随后的 14 例手术时间为 124（64）分钟，与开腹手术相当。机器人辅助分期时，前 20 例患者的平均淋巴结检出数少于开腹手术，但随后的 14 例患者差异无统计学意义。机器人辅助手术与术中出血量减少（110[24]比 250[83]ml，P<0.05）、术后并发症发生率降低（8.8%比 26.8%，P=0.032）、切口并发症发生率降低（0%比 9.9%，P=0.044）、术后需要静脉止痛药物减少（5.9%比 51.1%，P<0.001）和住院时间缩短（2.0[1.1]比 6.0[4.5]天，P<0.001）相关。与开腹手术组相比，这组患者的住院时间缩短。
本研究系列表明，对于从剖腹手术转为机器人辅助子宫内膜癌分期的腹腔镜手术新手妇科癌症外科医生来说，在进行了相对较少的病例后，传统上与腹腔镜子宫内膜癌分期相关的结果是可以实现的。
