Robot takeover.

Top Line: Laparoscopic and newer robotic surgical approaches are being advertised by wealthy cancer centers everywhere, but there’s a lot less data than billboards supporting its use in gynecologic cancers.
The Study: Outcomes for robotic resections of genitourinary (GU) cancers have been a toss up so let’s see if its role can be better crystalized in gyn oncology. Two noteworthy abstracts presented at the Society of Gynecologic Oncology (SGO) annual meeting aimed to address exactly this. The first is a hypothesis-generating propensity-matched NCDB analysis suggesting that women undergoing minimally invasive (MI) radical hysterectomies for stage IA2 to IB1 cervical cancers have a hazard ratio of death of 1.5(!) compared to those receiving a standard open approach. Which is especially intriguing considering the former were richer, whiter, and more likely to be treated at academic centers. Plus, as national utilization of MI radical hysterectomies has increased, overall survival for early stage cervical cancer has coincidently decreased. The second even more startling report is of the phase 3 non-inferiority LACC trial. It randomized 740 patients with IA1 to IB1 cervical cancer to [1] regular ole open (n=312) versus [2] MI (laparoscopic, n=266 or robotic, n=52) radical hysterectomies with a primary endpoint of disease-free survival. Not only did the MI techniques fail to meet non-inferiority thresholds, they were significantly worse. And we mean statistically / clinically / however you wanna look at it significantly worse, with almost 4x the number of recurrences or deaths 7 → 27 and over 6x the number of deaths 3 → 19. Hypothesis supported.
Bottom Line: Not for lack of trying, 21st century technology still hasn’t proven its worth against the tried (for 100 years) and true treatments of gyn cancers. | Ramirez, SGO 2018 & Melamed, SGO 2018


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