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. 2022 May;165(2):347-352.
doi: 10.1016/j.ygyno.2022.03.007. Epub 2022 Mar 18.

Robot-assisted versus laparoscopic minimally invasive surgery for the treatment of stage I endometrial cancer

Peter A Argenta  1 , Jordan Mattson  2 , Colleen L Rivard  2 , Elizabeth Luther  2 , Alexandra Schefter  2 , Rachel I Vogel  2
Affiliations

Robot-assisted versus laparoscopic minimally invasive surgery for the treatment of stage I endometrial cancer

Peter A Argenta et al. Gynecol Oncol. 2022 May.

Abstract

Objective: Recent reports in both cervical and endometrial cancer suggest that minimally invasive surgery (MIS) had an unanticipated negative impact on long-term clinical outcomes, including recurrence and death. Given increasing use of robotic surgery since the LAP2 trial, we sought to compare the intermediate and long-term outcomes between those who underwent robotic surgery or laparoscopy for Stage I endometrial cancer.

Methods: We performed a retrospective review of patients from a single, large, academic, urban practice who underwent either laparoscopic or robot-assisted MIS (RA-MIS) for the treatment of endometrial carcinoma between 2006 and 2016, ensuring at least 5 years of potential follow-up. To adjust for differences in confounding variables between groups, propensity score-based inverse probability of treatment weighting (IPTW) was performed. Overall and recurrence-free survival were compared using Cox proportional hazards regression models adjusting for confounding weights.

Results: 1027 patients were included; 461 received laparoscopy and 566 received RA-MIS. RA-MIS use increased steadily during the study window, which resulted in longer mean surveillance in laparoscopy group (median 8.7 years versus 6.3 years, p < 0.001). RA-MIS was associated poorer recurrence-free (HR: 1.41, 95% CI: 1.12, 1.77) and overall survival (HR: 1.39, 95% CI: 1.06, 1.83). Disease-specific survival was also poorer in the RA-MIS group (HR: 3.51, 95% CI: 2.19, 5.63). Among those who recurred, median time to first recurrence was shorter in the RA-MIS group than the laparoscopy group (16.3 vs. 28.7 months, p = 0.07).

Conclusion: RA-MIS was associated with poorer long-term patient outcomes. Our data in this lower-risk population indicate relevant clinical endpoints may be occurring during intermediate and long-term follow-up windows. These findings support a prospective evaluation of the long-term outcomes of RA-MIS.

Keywords: Endometrial cancer; Laparoscopy; Minimally invasive; Robotic; Uterine cancer.

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Conflict of interest statement

Declaration of Competing Interest None of the authors have conflicts, financial or otherwise, with regard to this manuscript.

Figures

Fig. 1.
Fig. 1.
Trends in surgical strategy used over time. LS, laparoscopic; RA-MIS, robot-assisted minimally invasive surgery.
Fig. 2.
Fig. 2.
Recurrence-free survival by route-of-surgery.
Fig. 3.
Fig. 3.
Overall survival by route-of-surgery.
See this image and copyright information in PMC

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