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
Rennes University Hospital
1,680 participants
Sep 23, 2024
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
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
The experimental procedure corresponds to robot-assisted laparoscopy.
The "control" procedure corresponds to conventional laparoscopy.
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.
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.
information and consent
Randomization
Collection of socio-demographic, clinical, biological, imaging and histopathological data, treatment decision, recurrence
Surgical data collection at Day 0
Biological data collection at Day 1
Collection of histological data from the surgical specimen et Day 42
Phone calls at Day 1, Day 3,Day 7,Day14,Day 21 , Month 3
Pain assessment at day 1 , Day 3,Day 7,Day14,Day 21 , Month 3
Collect of data on non-reimbursed transport at Day 3,Day 7,Day14,Day 21 , day 42, Month 3, month 6
Collect of everyday help at inclusion, Day 3,Day 7,Day14,Day 21 , day 42, Month 3, month 6
Collection of the business resumption date at Day 3,Day 7,Day14,Day 21 , day 42, Month 3, month 6
SF36 questionnaire at inclusion, Day 3,Day 7,Day14,Day 21 , day 42, month 6
Questionnaire EQ5D-5L at day 1, Day 3,Day 7,Day14,Day 21 , day 42, month 3, month 6
FIGO Stadium at inclusion and Day 42
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
Collection of adjuvant treatments at month 6
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
Collection of data on age, baseline, BMI, histological type of cancer and surgical approach used
Locations(15)
View Full Details on ClinicalTrials.gov
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NCT06348719