RecruitingNot ApplicableNCT06348719

Medico-economic Evaluation of Robot-assisted Laparoscopy Compared With Conventional Laparoscopy in Hysterectomy for Endometrial Cancer.

Medico-economic Evaluation of Robot-assisted Laparoscopy Compared With Conventional Laparoscopy in Hysterectomy for Endometrial Cancer: Multicentre Randomised Controlled Trial


Sponsor

Rennes University Hospital

Enrollment

1,680 participants

Start Date

Sep 23, 2024

Study Type

INTERVENTIONAL

Conditions

Summary

The standard treatment for endometrial cancer is surgery, as long as the stage of the disease and the patient's condition allow. It consists of hysterectomy (TSH) with bilateral adnexectomy. The recommended surgical approach is the minimally invasive or laparoscopic route, whose oncological safety has been demonstrated by the LAP2 study. Since 2010 and the arrival of robotic surgery in gynaecology, the robot-assisted laparoscopic approach has gradually been used for endometrial cancer Hysterectomy. Several studies have suggested that the cost and effectiveness of laparoscopy may vary according to the age and body mass index of the patient. The investigators therefore hypothesise that robot-assisted laparoscopy may be more efficient than conventional laparoscopy for endometrial cancer hysterectomy in the context of an advanced learning curve in France. The investigators therefore hypothesise that robot-assisted laparoscopy could be more efficient than conventional laparoscopy for endometrial cancer hysterectomy in the context of an advanced learning curve in France. The investigators will also test the efficiency of the surgical technique as a function of age and Body mass Index.


Eligibility

Sex: FEMALEMin Age: 18 Years

Inclusion Criteria44

  • Randomized Study:
  • Patient with low-risk or intermediate-risk endometrial carcinoma (on pre-operative workup including histology on endometrial biopsy and pelvic and lumbo-aortic MRI) , i.e. patients with endometrioid-type endometrial adenocarcinoma cancer low-grade (grade 1 or 2) and pre-therapeutic FIGO stage I (FIGO classification 2023) on MRI.
  • Indication for minimally invasive STH (laparoscopy) given by the surgeon during the pre-op consultation.
  • Patient accepts the matching of pseudonymized data with the French National Health Data System (SNDS)
  • Major patient.
  • Patient having received information on the protocol and having signed a consent form, thus accepting randomization in the robot-assisted intervention group versus conventional laparoscopy.
  • Patient operated on by a surgeon with less than 30 cases of robotic surgery in the last year and/or with less than 50 cases of total robotic experience at the time of patient inclusion.
  • Patient refuses to participate in randomized controlled trial (refuses randomization)
  • The surgeon refuses the patient's participation in the randomized controlled trial (does not wish to randomize the patient).
  • The center does not have a robot
  • The center does not have a laparoscopic column with fluorescence
  • Person under legal protection (safeguard of justice, curatorship, guardianship) or person deprived of liberty;
  • Patient not affiliated to a French social security scheme
  • Patient participating in another interventional trial or in Jardé off-label research that impacts study data, or in RIPH3 that impacts study data
  • Pregnant or breast-feeding patient
  • Patient with low-risk or intermediate-risk endometrial carcinoma (on pre-operative workup including histology on endometrial biopsy and pelvic and lumbo-aortic MRI) , i.e. patient with endometrioid-type endometrial adenocarcinoma cancer low-grade (grade 1 or 2) and pre-therapeutic FIGO stage I (FIGO classification 2023) on MRI .
  • Indication for minimally invasive STH (laparoscopy) given by the surgeon during the pre-op consultation.
  • Patient accepts the matching of pseudonymized data with the French National Health Data System (SNDS)
  • Major patient.
  • Patient not included in randomized controlled trial because :
  • Patient refuses to participate in randomized controlled trial (refusing randomization)
  • The surgeon refuses the patient's participation in the randomized controlled trial (does not wish to randomize the patient)
  • The center does not have a robot
  • The center does not have a laparoscopic column with fluorescence
  • The surgeon does not meet the required learning curve criteria (as a reminder: ≥ 30 cases of robotic surgery in the last year and with total robotic experience ≥ 50 procedures ) at the time of patient inclusion
  • Patient has been informed about the protocol and has signed a consent form.
  • Person under legal protection (safeguard of justice, curatorship, guardianship) or person deprived of liberty;
  • Patient not affiliated to a French social security scheme
  • Patient participating in another interventional trial or in Jardé off-label research that impacts study data, or in RIPH3 that impacts study data
  • Pregnant or breast-feeding patient
  • Patient with low-risk or intermediate-risk endometrial carcinoma (on pre-operative workup including histology on endometrial biopsy and pelvic and lumbo-aortic MRI) , i.e. patient with endometrioid-type endometrial adenocarcinoma cancer low-grade (grade 1 or 2) and pre-therapeutic FIGO stage I (FIGO classification 2023) on MRI).
  • STH performed during the inclusion period of the randomized controlled trial and/or the prospective cohortat a participating center, regardless of the approach used, not included in the randomized controlled trial and in the prospective cohort.
  • Patient not objecting to the collection and use of her data
  • Patient of legal age.
  • Person under legal protection (safeguard of justice, curatorship, guardianship) or person deprived of liberty;
  • Patient not affiliated to a French social security scheme
  • Surgeons :
  • Surgeon performing hysterectomy on patients included in the randomized study and/or prospective cohort
  • Surgeon not objecting to the collection and use of his data
  • None
  • First surgical assistance in the field :
  • First surgical assistance in the field performing hysterectomy on patients included in the randomized study and/or prospective cohort
  • First surgical assistance in the field not objecting to the collection and use of his data
  • None

Exclusion Criteria6

  • Minimally invasive procedure contraindicated by pre-operative anesthesia.
  • Patient operated on by a robot other than one of the intuitive robot variants (Si, X and Xi).
  • Prospective cohort:
  • Minimally invasive procedure contraindicated by pre-operative anesthesia.
  • Patient operated on by a robot other than one of the intuitive robot variants (Si, X and Xi).
  • Retrospective cohort:

Interventions

PROCEDURERobot-assisted laparoscopy

The experimental procedure corresponds to robot-assisted laparoscopy.

PROCEDUREconventional laparoscopy

The "control" procedure corresponds to conventional laparoscopy.

OTHERProspective cohort study

A prospective cohort of patients will be set up to support the randomized controlled trial. Patients will be offered participation in this cohort if the center is unable to participate in the randomized trial (i.e., does not have a robot, or does not have a laparoscopic column with fluorescence), if the patient refuses randomization in the randomized controlled trial, if the surgeon refuses to randomize the patient, or if the surgeon does not meet the learning curve criteria required for robotic surgery. These patients will be followed in exactly the same way as patients included in the randomized controlled trial, once their consent has been obtained.

OTHERRetrospective cohort study

Retrospective data collection from the medical records of all patients who underwent hysterectomy for low- or intermediate-risk endometrial cancer during the inclusion period at a participating center and who were not included in the randomized controlled trial or prospective cohort; up to a limit of 1000 inclusions. For this retrospective cohort, only data concerning initial age, BMI, histological type of cancer and surgical approach used will be collected.

OTHERinformation and consent

information and consent

OTHERrandomization

Randomization

OTHERCollection of socio-demographic, clinical, biological, imaging and histopathological data, treatment decision, recurrence

Collection of socio-demographic, clinical, biological, imaging and histopathological data, treatment decision, recurrence

OTHERSurgical data collection

Surgical data collection at Day 0

OTHERBiological data collection

Biological data collection at Day 1

OTHERCollection of histological data from the surgical specimen

Collection of histological data from the surgical specimen et Day 42

OTHERPhone calls

Phone calls at Day 1, Day 3,Day 7,Day14,Day 21 , Month 3

OTHERPain assessment

Pain assessment at day 1 , Day 3,Day 7,Day14,Day 21 , Month 3

OTHERCollect of data on non-reimbursed transport

Collect of data on non-reimbursed transport at Day 3,Day 7,Day14,Day 21 , day 42, Month 3, month 6

OTHERCollect of everyday help

Collect of everyday help at inclusion, Day 3,Day 7,Day14,Day 21 , day 42, Month 3, month 6

OTHERCollection of the business resumption date

Collection of the business resumption date at Day 3,Day 7,Day14,Day 21 , day 42, Month 3, month 6

OTHERSF36 questionnaire

SF36 questionnaire at inclusion, Day 3,Day 7,Day14,Day 21 , day 42, month 6

OTHERQuestionnaire EQ5D-5L

Questionnaire EQ5D-5L at day 1, Day 3,Day 7,Day14,Day 21 , day 42, month 3, month 6

OTHERFIGO Stadium

FIGO Stadium at inclusion and Day 42

OTHERCollection of treatments (analgesics and anticoagulants up to J42, complication-related treatments, etc.)

Collection of treatments (analgesics and anticoagulants up to J42, complication-related treatments, etc.) at day 1, Day 3,Day 7,Day14,Day 21 , day 42, month 3, month 6

OTHERCollection of adjuvant treatments

Collection of adjuvant treatments at month 6

OTHERRecording of any complications, emergency room visits/unscheduled consultations, additional work stoppages to the initial one

Recording of any complications, emergency room visits/unscheduled consultations, additional work stoppages to the initial one at Day 3,Day 7,Day14,Day 21 , day 42, month 3, month 6

OTHERCollection of data

Collection of data on age, baseline, BMI, histological type of cancer and surgical approach used


Locations(15)

CHU de Lille, Hôpital Jeanne de Flandre

Lille, France

CHU LIMOGES, Hôpital Mère-Enfant

Limoges, France

Hôpital Lariboisière/Hôpital Saint Louis

Paris, France

Hôpital Cochin

Paris, France

Hôpital Européen Georges Pompidou

Paris, France

Hôpital Bichat

Paris, France

Hôpital Tenon AP-HP

Paris, France

Hôpital Pitié Salpêtrière

Paris, France

Hôpital Lyon Sud - Hospices Civils de Lyon

Pierre-Bénite, France

Hôpital privé des côtes d'Armor

Plérin, France

CHU de Rennes

Rennes, France

CHU de Rouen

Rouen, France

CHU de Saint Etienne

Saint-Etienne, France

CHU de Strasbourg - Hôpital de Hautepierre

Strasbourg, France

CHU de Tours - Hôpital Bretonneau

Tours, France

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NCT06348719