168 Recurrence and survival after robotic-assisted radical hysterectomy (RRH) for early stage cervical cancer (CC): experience may matter. (18th September 2019) - Fitszimmons, C
Abstract : Objectives: In light of the LACC Trial results, we evaluated RFS and OS following RRH before and after 10 cases per surgeon. Methods: Patients with early-stage CC (4/2007–12/2017) who underwent RRH were evaluated and first 10 learning curve cases per surgeon (Group A) were compared to all subsequent cases (Group B). Inclusion criteria mirrored the LACC trial: > one-year follow-up, adenocarcinoma or squamous carcinoma, FIGO-2014 stage IA2 or IB1, and pathologic tumor size of ≤4 cm. Results: 144 RRH patients were identified and 90 met inclusion criteria from 6 attending surgeons. 40 patients met Group A and 50 Group B criteria. Median follow-up was 61± 34.3 months (A=71.5, B=52.5). The 5-year RFS was 92% (95 CI±4%) and the DSDR 5.5% (n=5). There were 7(7.8%) recurrences with median RFS of 12±8.3 months. Recurrence in Group A (n=6, 15%) exceeded Group B (n=1, 2%), p =0.025. DSDR was 10% Group A vs. 2% B ( p =0.184). The 4.5-year RFS was 84.8% (95 CI±7%) in Group A vs. 98% (95 CI±3%) in Group B. There were no differences in risk factors for recurrence between groups A and B. (TS >2, LN (+), adjuvant therapy (AT), and LVSI p >0.05), except (+) vaginal margin status (A=10% vs B=0%, p =0.034). All recurrent cases had TS >2 cm. Conclusions: Recurrence of disease following RRH clustered in the first 10 cases per surgeon in our center and was associated with (+) vaginal margins and TS 2 cm. This data suggests an inter-surgeon variability and a possible learning curve effect.