Understanding Robotic Surgery in Cervical Cancer

Minimally invasive surgery, such as robotic surgery, may result in a better recovery and quality of life for patients with early-stage cervical cancer compared to standard of care; however, efficacy is still being evaluated, according to an expert.

Dr. Kristen L. Bixel, assistant professor at The Ohio State University Comprehensive Cancer Center, spoke with CURE® about the difference between open and robotic surgery and a current ongoing trial she is the lead investigator on which is evaluating robotic surgery in patients with early-stage cervical cancer.

The current standard of care for this patient population is a radical hysterectomy, which includes removal of the uterus, cervix, fallopian tubes, tissue beside the cervix and the top of the vagina, she explained.

This standard was set in 2018 by a clinical trial which demonstrated that patients who had open surgery, compared to minimally invasive — such as robotic — had better outcomes. In particular, recurrence rate and death from cervical cancer was higher with minimally invasive surgery.

“However, there were some things that we could learn from that trial in terms of the surgical technique and subsequent studies afterwards that led us to believe that we may be able to modify that technique to make the outcomes similar and then afford our patients the benefits of minimally invasive surgery,” she said. “And so, this trial is using the robotic platform. In layman's terms, I call it fancy laparoscopy; It's using very similar small incisions and a robotic device that's controlled by the surgeon to perform the surgery.”

Patients in the trial have early-stage disease and need to be a good candidate for the robotic approach. Currently, robotic surgery is not offered for this patient population.

“Off study, that's a more difficult conversation, because based on the current data that we have, certainly patients have autonomy and if they fully understand the potential increased risk and they are willing to accept that because of the recovery benefits, that's a physician patient discussion,” she noted.

Recovery and a lack of side effects is one of the benefits of robotic surgery, compared to open surgery, that Bixel mentioned.

Robotic surgery is completed through small incisions, typically resulting in a faster recovery, less pain, shorter hospital stay, less blood loss and lower rates of complications such as wounds or infections. Whereas open surgery is typically a large single incision that can be made vertically or horizontally and more complications, such as blood clotting and infections, can occur post-surgery.

“I hope that we're able to demonstrate that this is a safe option for patients,” Bixel concluded. “It will improve their recoveries and, we hope that it provides similar oncologic outcomes. I certainly don't want to be performing a procedure that's going to put my patient at increased risk of recurrence. But if I can perform this better tolerated procedure, and have similar outcomes, I think that really can help our patients.”

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