Impact of Surgical Modality on Endometrial Cancer Treatment: A Pragmatic Single-Center Analysis

Objectives: Single-center prospective comparative analysis of case selection and surgical outcomes in patients with endometrial cancer, using three surgical modalities.Methods: A total of 119 patients with endometrial cancer were recruited consecutively and, most of them were allotted to the robotic surgery and laparoscopic surgery cohorts. A few patients whose cancers were considered unfit for minimally invasive surgery underwent open surgery.Results: There were 119 patients in the study: 37 had robotic staging; 64 had laparoscopic staging; and 18 had open (laparotomic) surgical staging. The mean operative times were similar among the robotic, laparoscopic, and open-surgery groups (172.43 minutes versus 169.45 minutes versus 166.67 minutes, p = 0.927). The open-surgery cohort had a higher mean blood loss (217.22 mL versus 195.00 mL versus 123.91 mL; p = 0.041), similar blood transfusion rates (22.2% versus 10.8% versus 9.4%; p = 0.320), longer mean hospital stays (4.76 days versus 3.09 days versus 2.89 days; p = 0.000), and a higher rate of postoperative complications (55.6% versus 22.2%, versus 18.7%; p = 0.006), compared with the robotic and laparoscopic cohorts, all respectively. There was no significant difference in the rate of major complications and the number of lymph nodes retrieved among the groups (p = 0.424).Conclusions: Minimally invasive surgical techniques are safe and feasible for endometrial cancer, with superior outcomes to open surgery in terms of perioperative morbidity. The choice for robotic or laparoscopic modalities can be made, depending upon availability, surgeon preference, and the cost factor involved in robotic surgery. (J GYNECOL SURG 20XX:000)