Clinical Relevance of Uterine Manipulation on Oncologic Outcome in Robot-Assisted versus Open Surgery in the Management of Endometrial Cancer

Abstract

In this study, we investigated the impact of uterine manipulation on endometrial cancer survival outcomes. We analyzed patients with endometrial cancer who underwent robot-assisted staging and open staging surgery between 2010 and 2020. Either uterine manipulators or vaginal tubes were utilized in robot-assisted staging. Propensity score matching was performed to correct baseline characteristics. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier curve analysis. In total, 574 patients, including those undergoing robot-assisted staging with a uterine manipulator (n = 213) or vaginal tube (n = 147) and staging laparotomy (n = 214), were analyzed. Propensity score matching was performed for age, histology, and stage as covariates. Before matching, Kaplan-Meier curve analysis showed that PFS and OS were significantly different among the three groups (p < 0.001 and p = 0.009, respectively). In the propensity-matched cohorts of 147 women, the previously suggested differences in PFS and OS were not observed in patients undergoing robot-assisted staging with a uterine manipulator or vaginal tube or open surgery. In conclusion, robotic surgery using a uterine manipulator or vaginal tube did not compromise survival outcomes in endometrial cancer management.

Keywords: endometrial neoplasms; laparoscopy; mortality; robotic surgical procedures.

Figure 1

(a) RUMI uterine manipulator with a Koh colpotomizer system and (b) McCartney vaginal tube. Korean in (b) means Severance Hospital.

Figure 2

(a) Progression-free survival; (b) overall survival in the entire cohort.

Figure 3

(a) Progression-free survival; (b) overall survival in patients with early stage disease (Stage I, II).

Figure 4

(a) Progression-free survival; (b) overall survival in the entire cohort after propensity score matching.