Robotic surgery faster with similar outcomes for endometrial cancer

1. Compared with traditional laparoscopy, robotic-assisted laparoscopic surgery was significantly faster with a shorter time in the operating room among endometrial cancer patients.

2. Other surgical outcomes were similar between the 2 groups.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Endometrial cancer is the most common form of gynecologic cancer and impacts over 300,000 new women globally each year. Risk factors like obesity, anovulation and other sources of unopposed estrogen increase a woman’s likelihood of developing endometrial cancer. Fortunately, in developed countries, the vast majority of cases are diagnosed in the earliest stages where surgery to remove the uterus can still be curative. As surgical techniques have developed, minimally invasive laparoscopic techniques have replaced open laparotomy. In recent years, robotic-assisted laparoscopy has become increasingly popular as an alternative to traditional laparoscopy for many indications. Numerous studies have called into question whether it provides a clear benefit in staging and treating endometrial cancer. In this randomized controlled trial, surgeons in Finland compared surgical outcomes with traditional with robotic-assisted laparoscopy to treat endometrial cancer.

The robotic surgeries were on average 30 minutes faster, with a significantly shorter time spent in the operating room, comparable surgical outcomes, and no significant increase in complications compared to the traditional laparoscopic surgeries. This study is the first randomized trail to compare traditional and robotic-assisted laparoscopy in women being treated for endometrial cancer. Robotic surgery times can vary widely depending on the skill and experience of the surgeon such that this single-institution study design is one limitation of these findings; it’s unclear whether the same effect would be seen in a wider group of surgeons. In the future, a multi-centered randomized trial would help to address this concern.

Click to read the study in AJOG

Relevant Reading: Robotic assisted surgery for gynaecological cancer [Cochrane Review]

In-Depth [randomized controlled trial]: Over a 3-year period, endometrial cancer patients were randomized to receive hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy by either a robotic-assisted laparoscopic (n = 50) or a traditional laparoscopic approach (n = 49). The primary outcome was operative time. Secondary outcomes included total time in the operating room and surgical outcomes, measured by number of lymph notes harvested, complications, and length of post-operative hospital stay.

Robotic assisted surgeries were faster than traditional laparoscopic procedures (139 vs. 170 minutes, p < 0.001). Total time spent in the operating room was also shorter for the robotic surgery group (197 vs. 228 minutes, p < 0.001). There were more conversions to laparotomy in the traditional group (5 vs. 0, p = 0.027). All other surgical outcomes measured were comparable between the groups.

Image: PD

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