Department of Obstetrics and Gynecology, Hospital Clínico San Carlos, Complutense University of Madrid, Spain.
Eur J Obstet Gynecol Reprod Biol. 2012 Dec;165(2):289-94. doi: 10.1016/j.ejogrb.2012.07.006. Epub 2012 Jul 21.
To analyze the perioperative outcomes and cost of three surgical approaches in the treatment of endometrial cancer: robotic, laparoscopy and laparotomy.
We studied 347 patients with endometrial cancer treated in a single institution: 71 patients were operated by robotics, 84 by conventional laparoscopy and 192 by laparotomy. All patients underwent total hysterectomy, bilateral salpingoophorectomy and pelvic and para-aortic lymphadenectomy depending on the pathological features.
Operative time was longer in the laparoscopy group as compared to robotics and laparotomy (218.2 min, 189.2 min, and 157.4 min respectively, p=0.000). The estimated blood loss was lower in the robotic group relative to the other groups (99.4 ml in robotic, 190.0 ml in laparoscopy and 231.5 ml in laparotomy, p=0.000). Similar findings were observed for the pre- and post-operative mean hemoglobin levels (-1.3g/dl, -2.3g/dl and -2.5 g/dl respectively, p=0.000), and transfusion rate (4.2%, 7.1% and 14.1% respectively, p=0.036). The length of hospital stay was higher in the laparotomy group compared to robotics and laparoscopy (8.1, 3.5 and 4.6 days respectively; p=0.000). The conversion rate to laparotomy was lower for robotics (2.4% for robotics and 8.1% for laparoscopy, p=0.181). Overall complications were similar for robotics and laparoscopy (21.1%, 28.5%) (p=0.079). Robotic complications were significantly lower as compared to laparotomy (21.2 vs 34.9% (p=0.036). No differences were found relative to disease-free or overall survival among the three groups. The global costs were similar for the three approaches (p=0.566).
Robotics is a safe alternative to laparoscopy and laparotomy for endometrial cancer patients, offering improved perioperative outcomes and similar cost as compared to the other two surgical approaches.
分析三种手术方法治疗子宫内膜癌的围手术期结果和成本：机器人手术、腹腔镜手术和剖腹手术。
我们研究了在一家机构接受治疗的 347 名子宫内膜癌患者：71 名患者接受机器人手术，84 名患者接受传统腹腔镜手术，192 名患者接受剖腹手术。所有患者均根据病理特征行全子宫切除术、双侧输卵管卵巢切除术和盆腔及主动脉旁淋巴结切除术。
与机器人手术和剖腹手术相比，腹腔镜手术的手术时间更长（分别为 218.2 分钟、189.2 分钟和 157.4 分钟，p=0.000）。机器人组的估计失血量低于其他组（分别为 99.4 毫升、190.0 毫升和 231.5 毫升，p=0.000）。机器人组和腹腔镜组的术前和术后平均血红蛋白水平（分别为-1.3g/dl、-2.3g/dl 和-2.5 g/dl，p=0.000）和输血率（分别为 4.2%、7.1%和 14.1%，p=0.036）也有类似的发现。与机器人手术和腹腔镜手术相比，剖腹手术的住院时间更长（分别为 8.1、3.5 和 4.6 天，p=0.000）。机器人手术中转开腹的比例较低（机器人手术为 2.4%，腹腔镜手术为 8.1%，p=0.181）。机器人手术和腹腔镜手术的总并发症发生率相似（21.1%、28.5%）（p=0.079）。与开腹手术相比，机器人手术的并发症发生率显著降低（21.2%比 34.9%，p=0.036）。三组之间无无疾病生存或总生存差异。三种方法的全球费用相似（p=0.566）。
对于子宫内膜癌患者，机器人手术是腹腔镜手术和剖腹手术的一种安全替代方法，在围手术期结果方面有改善，且与其他两种手术方法的成本相似。
