Журнал клинических случаев

Robotic vs. open surgery in obese women with low-grade endometrial cancer: comparison of costs and quality of life measures

Abstract

Zvi Vaknin

Statement of the Problem: Low-grade-endometrial-cancer (LGEC) is the most common gynecological-cancer in developed-countries. Women who develop LGEC tend to be obese and to suffer from many co-morbidities that challenge the surgeon. The literature demonstrates the supremacy of minimal-invasive-surgeries (MIS) for this group of patients. Robotic-surgery (RS), an advanced MIS, costs are high and healthcare-systems do-not include specific reimbursement for this approach.

Methodology &Theoretical-Orientation: This retrospective study compared perioperative-measures, costs, quality-of-life and survival after open (OS) vs. RS, among obese-women (BMI≥30) diagnosed with LGEC. in two tertiary-medical-centers in the center of Israel during 2013–2016. Quality-of-life was evaluated by Physical&Mental Components of the SF-36 and a recovery-from-surgery questionnaire. Overall-survival-outcomes were obtained from patients’ files. Surgical-outcomes (operating and anesthesia times, length of hospital-stay, and intraoperative&postoperative-complications according to the Clavien-Dindo-classification scale) were reviewed. Findings:  In all, 138 women underwent OS (n = 61) or RS (n = 77) during the study-period. The groups had similar BMI, comorbidities, demographics and tumor characteristics. RS was associated with shorter hospital-stays (mean 1.7 vs. 4.8 days; P<.0001) and fewer postoperative-complications (Clavien-Dindo > 2, 5.2% vs. 19.7%; P=.0008), but longer operating-theater time (3.8 vs. 2.8 h; P<.001). Costs are equivalent when at least 350 RSs are performed annually, without the initial system costs. Quality-of-life measures were better after RS. SF-36 showed better measures for RS. After RS, patients tended to recover quicker. Overall, 5-year-survival was 89.8% for the OS group vs. 94% for the RS group (log-rank, P=0.330). Conclusions: Obese-women with LGEC had better quality-of- life after RS vs. OS. They also had shorter hospital-stays and fewer postoperative-complications. Centers with high-volumes of RS can achieve similar costs when comparing both methods. These results were achieved without jeopardizing survival.