Perioperative Outcomes in Robotic-Assisted Versus Conventional Laparoscopic Treatment of Endometrial Cancer

Objective: To compare perioperative outcomes of robotic-assisted (RALS) versus conventional laparoscopic surgery (CLS) in endometrial cancer. Methods: This is a retrospective analysis of a prospectively maintained database of procedures performed from January 2009 to January 2014 by a single surgeon experienced in both minimally invasive techniques. One hundred and five patients underwent surgical staging of endometrial cancer via either conventional or robotic-assisted laparoscopy. Characteristics such as age, body mass index (BMI), prior abdominal surgery, number of comorbidities, stage of disease, and extent of surgery were compared. Outcomes, including estimated blood loss (EBL), operating room time (ORT), length of stay (LOS), number of lymph nodes resected, conversion rates, and intra-operative and postoperative complications were analyzed. Results: Fifty-seven patients received RALS; 48 had CLS. RALS patients had a higher mean BMI (38.1 ± 11.8 vs. 30.1 ± 7.5 kg/m2; p=0.0003) and more comorbidities. Median ORT was longer for RALS patients [277 (135-660) vs. 223.5 (120-547) minutes; p=0.0012]. RALS ORT remained significantly longer for BMI ≥ 25 to <30, and appeared near significance in the BMI<25 and BMI>35 groups. Only in the BMI ≥ 30 to <35 group there was no apparent difference in the ORT. Among patients with endometrioid adenocarcinoma histology, ORT was longer in the RALS group [273 (135-660) vs. 222 (120-420) minutes; p=0.0018]. There was no difference in EBL or LOS between the two surgical approaches. Conclusions: In our experience, perioperative outcomes of endometrial cancer staging are comparable between RALS and CL. Furthermore, the overall ORT is significantly longer in the RALS group. Further studies of patients stratified by BMI are needed.