Royal Surrey: Enhanced recovery show in robotic ovarian cancer surgery study
A study, which is sponsored by Royal Surrey NHS Foundation Trust, has found patients recover from robotic surgery quicker
Advanced ovarian cancer patients who receive robotic surgery benefit from improved recovery, which could allow them to start chemotherapy and the journey to recovery sooner, a new study has found.
The study, MIRRORS, is sponsored by Royal Surrey NHS Foundation Trust and funded by women’s cancer charity GRACE. It is an initial clinical study to assess the feasibility of a larger-scale trial, and has the potential to greatly improve recovery and quality of life for women having surgery for advanced ovarian cancer following initial chemotherapy.
Ovarian cancer is the sixth most common cancer in women in the UK, with around 7,500 women diagnosed each year and more than 70 per cent of these women presenting with late-stage disease. While robotic surgery, an advanced form of minimally invasive surgery, has revolutionised operations in many areas of care, the standard procedure for advanced-stage ovarian cancer is open surgery involving a 30 to 40cm long incision in the abdomen. Recovery time in hospital is around six days and usually includes time spent in intensive care.
The MIRRORS study, which has this month been published in the International Journal of Gynaecological Cancer, set out to see whether it is possible and safe to perform robotic surgery for advanced stage ovarian cancer in patients who have already undergone initial chemotherapy. Patients in the study had an ovarian mass of less than eight centimetres. In this initial feasibility study, robotic surgery was possible in 20 out of 23 patients (87 per cent) who opted to be part of the study, and resulted in:
• Reduced blood loss during surgery.*
• Eliminated the need for most patients to spend any time in intensive care.
• Reduced the average length of time spent recovering in hospital from six days for open surgery to 1.5 days.
• Shortened the time patients needed to be fit to re-start chemotherapy from 25 days after open surgery to 18.5 days after robotic surgery.
The study was led by Miss Christina Uwins, Surgeon and Subspecialty Fellow in Gynaecological Oncology, and Mr Butler-Manuel, Consultant Surgeon in Gynaecological Oncology and Founder/Chairman of the GRACE charity.
Miss Christina Uwins said: “The symptoms of ovarian cancer, such as bloating and bladder and bowel disturbance, are similar to symptoms associated with a number of other conditions, which women put up with every day, and so it is often diagnosed late. Patients are typically older in age and can be frail, so open surgery can be hard on their bodies.
“Robotic surgery allows surgeons to perform long complex procedures though tiny cuts in the abdomen. It’s very promising that the findings of this feasibility study show that robotic surgery has the potential to significantly improve the recovery and quality of life for women undergoing this surgery.”
The next step for the team is a large scale randomised controlled trial “MIRRORS RCT” to confirm these initial findings of enhanced recovery, and to check that cancer survival following robotic surgery is comparable to standard open surgery for advanced ovarian cancer. If robotic surgery following initial chemotherapy proves comparable with regards to survival in a large-scale trial, it could lead to a significant change in practice for women diagnosed with advanced ovarian cancer.
Royal Surrey has four state-of-the-art da Vinci Xi surgical robots, the first of which was partly funded by GRACE charity in 2009. Since then, surgeons have been using robotic surgery in gynaecological oncology to operate predominantly on women with endometrial cancer. They have performed more than 2,000 procedures using a machine which has four arms with wristed instruments that move like a human hand.