Laparotomic versus robotic surgery in elderly patients with endometrial cancer: A systematic review and meta-analysis

Abstract

Background: Although robotics has been shown to improve outcomes in some high-difficulty surgical category patients, it is unclear if such an approach may improve outcomes in elderly patients with endometrial carcinoma (EC).

Objective: To compare robotic and laparotomic surgery in the treatment and staging of elderly EC patients.

Materials and methods: A systematic review and meta-analysis was performed assessing the risk of overall, intra-operative, and peri-operative complications associated with the surgical approach (laparotomic vs robotic) for elderly patients with EC by relative risk (RR). Pooled means ± standard deviation of length of stay were compared with the unpaired t test. Subgroup analyses for overall complications were performed based on different age cut-offs (>70, >65, and >75 years) and severity of complications (minor and major). A value of P less than 0.05 was considered significant.

Results: Five studies with 7629 EC patients were included. Pooled RR for robotic compared with laparotomic surgery was 0.40 (P < 0.001) for overall, 0.46 (P = 0.18) for intra-operative, and 0.43 (P < 0.001) for peri-operative complications. Pooled difference between means ± standard deviation of length of stay for robotic versus laparotomic surgery was -3.34 (P < 0.001). At subgroup analyses, pooled RR of overall complications for robotic surgery versus laparotomic surgery was 0.34 (P < 0.001) in the >70 years, 0.51 (P < 0.01) in the >65 years, 0.20 (P = 0.12) in the >75 years groups. Pooled RR was 0.50 (P = 0.1) in the minor complications subgroup, and 0.42 (P = 0.002) in the major complications subgroup.

Conclusion: Robotics might be a viable alternative to the laparotomic approach for EC in elderly patients because it significantly decreases the risk of overall and peri-operative complications (mainly major complications), and the length of stay when compared with laparotomy. The decrease in risk of overall complications is greater with increasing patient age.

Keywords: cancer; endometrium; laparotomy; robotics; surgery; tumor.

FIGURE 1

Forest plot of individual studies and pooled relative risk for overall complications in robotic surgery and laparotomic surgery groups of patients treated for endometrial cancer [Colour figure can be viewed at wileyonlinelibrary.com]

FIGURE 2

Forest plot of individual studies and pooled relative risk for intra‐operative complications in robotic surgery and laparotomic surgery groups of patients treated for endometrial cancer [Colour figure can be viewed at wileyonlinelibrary.com]

FIGURE 3

Forest plot of individual studies and pooled relative risk for peri‐operative complications in robotic surgery and laparotomic surgery groups of patients treated for endometrial cancer [Colour figure can be viewed at wileyonlinelibrary.com]

FIGURE 4

Forest plot of individual studies and pooled mean ± standard deviation (SD) for length of stay in hospital in robotic surgery and laparotomic surgery groups of patients treated for endometrial cancer [Colour figure can be viewed at wileyonlinelibrary.com]

FIGURE 5

Forest plot of individual studies and pooled relative risk for overall complications in robotic surgery and laparotomic surgery groups of patients treated for endometrial cancer stratified for age cut‐off as follows: (a) 70 years; (b) 65 years; (c) 75 years [Colour figure can be viewed at wileyonlinelibrary.com]

FIGURE 6

Forest plot of individual studies and pooled relative risk for overall complications in robotic surgery and laparotomic surgery groups of patients treated for endometrial cancer stratified for severity of complications as (a) minor complications and (b) major complications [Colour figure can be viewed at wileyonlinelibrary.com]