1. Robotic surgery was associated with less blood loss, fewer adverse events and shorter hospital stays than open surgery for endometrial cancer in women over age 70.
2. There was no difference in 2-year disease-free survival between the two groups.
Evidence Rating Level: 2 (Good)
Study Rundown: This study found that in elderly women undergoing surgery for endometrial cancer staging, laparoscopic robotic surgery was associated with less perioperative morbidity than laparotomy. Further, there was no difference in 2-year disease-free survival. By selecting cohorts from two different time periods, where surgeries were completed either primarily with laparotomy or primarily with robotic laparoscopy, researchers were able to mitigate the effects of selection bias, which are often a limitation in cohort studies that compare different surgical approaches. Future studies might randomize by co-morbidities (e.g. obesity, COPD, heart disease) to compare outcomes in older women undergoing straight-stick laparoscopy with those undergoing robotic laparoscopy in a randomized, controlled design.
In-Depth [retrospective and prospective cohort study]: Researchers prospectively collected data on all women ≥70 years old who underwent robotic surgery for endometrial cancer staging (n=113) and compared outcomes with a retrospective database of women who had undergone traditional open surgery (n=50) prior to the introduction of the robotic surgery program. The primary outcome was peri-operative morbidity, as assessed by mean operating times, adverse events, blood loss, and hospital stay. The secondary outcome was disease-free survival.
Robotic surgery was associated with fewer minor adverse events (17% vs. 60%, p<0.001), a lower mean blood loss (75 vs. 334 mL, p<0.0001) and a shorter hospital stay (3 vs. 6 days, p<0.0001) than open surgery, though operating time was longer (244 vs. 217 min, p=0.009). After a mean follow-up time of 2 years, there was no difference in disease-free survival between groups (86% vs. 81%, p=0.61).
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