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Minimal invasive surgery (MIS) has been associated with lower disease-free survival than open surgery among women who underwent radical hysterectomy for early-stage cervical cancer. However, the mechanisms by which MIS increases mortality in cervical cancer remain uncertain. We aimed to determine if surgical practice among centers using robotic surgery has an impact on oncological outcomes. We evaluated 215 women with early-stage cervical cancer (≤IB1 or IIA1, FIGO 2009) who underwent robot-assisted radical hysterectomy in five Spanish tertiary centers between 2009 and 2018. A higher surgical volume, higher participation in clinical trials, higher rate of MRI use for diagnosis, greater use of sentinel lymph node biopsies, and a favorable learning curve with low rates of early recurrences were observed for the centers with better oncological outcomes. These factors might have a significant impact on oncological outcomes in all surgical approaches. Abstract: This study aimed to assess whether surgical practice had a significant impact on oncological outcomes among women who underwent robot-assisted radical hysterectomy for early-stage cervical cancer (≤IB1 or IIA1, FIGO 2009). The secondary objective was to audit the pre-surgical quality indicators (QI) proposed by the European Society of Gynaecological Oncology (ESGO). The top 5 of 10 centers in Spain and Portugal were included in the analysis. The hospitals were divided into group A (n = 118) and group B (n = 97), with recurrence rates of 10%, respectively. After balancing both groups using the propensity score, the ORs for all events were higher and statistically significant for group B (recurrences OR = 1.23, 95% CI = 1.13-1.15, p-value = 0.001; death OR = 1.10, 95% CI = 1.02-1.18, p-value = 0.012; disease-specific mortality ORr = 1.11, 95% CI = 1.04-1.19, p-value = 0.002). A higher surgical volume, higher participation in clinical trials, higher rate of MRI use for diagnosis, greater use of sentinel lymph node biopsies, and a favorable learning curve with low rates of early recurrences were observed among the centers with better oncological outcomes. These factors might have a significant impact on oncological outcomes not only after robot-assisted surgery, but also after laparoscopies and open surgeries in the treatment of cervical cancer.

Resumen Objetivo Presentacion de nuestra experiencia desde octubre del 2009 hasta diciembre del 2011 y comparacion de los resultados y las complicaciones con el amplio estudio publicado en el American Journal of Obstetrics and Gynecology (AJOG) en 2011. Material y metodos Estudio prospectivo de nuestros primeros 55 carcinomas de cuerpo uterino: 50 adenocarcinomas endometrioides, 2 adenocarcinomas seroso-papilares de endometrio y 3 tumores mullerianos mixtos (TMM), tratados mediante laparoscopia asistida por robot (da Vinci) en el Hospital Universitario de Basurto desde octubre del 2009 hasta diciembre del 2011. Las variables analizadas han sido: edad, indice de masa corporal (IMC), tipos histologicos, estadios, tipos de tratamientos, medias del tiempo quirurgico, media del numero de ganglios obtenidos y numero y porcentaje de ganglios invadidos, sangrado operatorio y conversiones a laparotomia. Asi mismo, se han analizado el numero y el porcentaje de las complicaciones intraoperatorias, postoperatorias y totales. Resultados Media de ganglios pelvicos: 14,44 vs. 13,16. Tiempo operatorio: 181,1/286,5 min vs. 196,33 min. Conversion a laparotomia: 5,45% vs. 2,9%. Complicaciones totales: 16,36% vs. 6,4%. Conclusiones 1) El numero de ganglios pelvicos obtenidos y el tiempo operatorio son similares a los publicados en el estudio del AJOG; 2) la conversion a laparotomia y el porcentaje de complicaciones totales son superiores a los referidos en el estudio del AJOG, quizas debido al menor numero de casos y a la menor experiencia (curva de aprendizaje); 3) la laparoscopia asistida por robot es una via adecuada y con gran futuro en el tratamiento y la estadificacion de los carcinomas de cuerpo uterino.