Outcome of robot-assisted surgery for stage IA endometrial cancer compared to open and laparoscopic surgeries: A retrospective study at a single institution

Abstract

Abstract Background Few studies have compared the efficacy of robot-assisted, laparoscopic, and open surgeries for endometrial cancer. When considering the position of robotic surgery in Japan, it was necessary to determine whether it was effective or not. We aimed to compare the efficacy and safety of these three types of surgeries for early-stage endometrial cancer. Methods In total, 175 patients with endometrial cancer of preoperative stage IA, who had undergone laparotomic (n=80), laparoscopic (n=40), or robot-assisted (n=55) modified radical hysterectomy at our hospital from 2010 to 2022, were included; surgical outcomes, perioperative complications, and prognoses were compared. Total operative and console times for robot-assisted surgery between patients who did or did not undergo pelvic lymphadenectomy were assessed. Results The robot-assisted group had the shortest total operative time. The estimated blood loss was lower in the laparoscopic and robot-assisted groups than in the laparotomy group. In advanced postoperative stage IA cases, there were no differences in progression-free and overall survival among the three groups. In the robot-assisted group, the operative time decreased as the number of operations increased; the learning curve was reached after 10 cases each of patients with and without pelvic lymphadenectomy. The frequency of perioperative complications of Clavien–Dindo classification Grade 1 or higher was the lowest in the robot-assisted group (p=0.02). There were no complications of Clavien–Dindo classification Grade 2 or higher in the robot-assisted group. Conclusion Robot-assisted surgery for stage IA endometrial cancer, a minimally invasive procedure, has fewer operative times and complications than those of laparoscopic and open surgeries in a single institution in JAPAN.