Clinical Outcomes of Robotic Versus Open Radical Hysterectomy in Endometrial Cancer Staging: An Experience at a Tertiary Referral Care Center

Abstract

Abstract

Objective:

Comprehensive surgical staging is the mainstay of initial treatment for most patients with endometrial cancer. This study compared hysterectomy and lymphadenectomy for endometrial-cancer staging via robotics and open routes in terms of clinicopathologic factors, perioperative outcomes, recurrences, and survival.

Materials and Methods:

Patients were identified retrospectively to find those with clinically uterus-confined endometrial cancers, who underwent staging via a robotic approach between October 2011 and October 2016. These patients were matched in a 1:1 ratio with patients staged via conventional laparotomy during the same time period. Data were analyzed for demographics, operative time, blood loss, surgicopathologic factors, complications, conversions, length of hospital stay, adjuvant treatment, recurrences, and follow-up.

Results:

The study included 150 patients (75 in a robotic-surgery group and 75 in an open-surgery group). The overall rate of complications was much higher in the open-surgery group (38.6%), compared to the robotic surgery group (9.3%; p = 0.0001). Statistically significant differences occurred in both groups in terms of reduced estimated blood loss in the robotic-surgery group (149.99 ± 85.77 mL), compared to the open-surgery group (444.2 ± 273.09 mL; p < 0.0001), leading to transfusions in 10.6% patients in the robotic-surgery group and 49.3% patients in the open-surgery group (p < 0.0001). There was a lower median operative time in the robotic-surgery group than in the open-surgery group (160 minutes versus 180 minutes; p = 0.038). The median length of stay in the hospital was 3 versus 5 days in the robotic-surgery and open-surgery groups, respectively (p < 0.0001). The age and body mass indices were similar in both groups (p = 0.073 and p = 0.18, respectively). The nodal yields (27 versus 26; p = 0.869), grades (p = 0.11), International Federation of Gynecology and Obstetrics stages (p = 0.78), and histology (p = 0.546) were similar in both groups as were deep myometrial invasions (p = 0.51) and lymphovascular-space invasions (p = 0.54). Recurrences occurred in 9.3% of robotic-surgery and 14.6% of open-surgery cases (p = 0.451), with death due to disease in 6.6% versus 10.6% in the robotic-surgery and open-surgery groups (p = 0.608).

Conclusions:

Robotic staging for endometrial cancer has clear advantages over conventional laparotomy in terms of less operative time, reduced blood loss, shorter hospital stay, and fewer complications without compromising the oncologic outcomes. Recurrences and disease related-mortality are not influenced by this minimally invasive modality.