Surgical staging of endometrial cancer: robotic versus open technique outcomes in a contemporary single surgeon series

Patients prefer robotic surgery due to perceived cosmetic advantages and quicker resumption of regular activity. We compared the results of hysterectomy and surgical staging for endometrial cancer using robotic versus open techniques in patients operated on by a single surgeon. A retrospective clinical data analysis was performed of all patients who underwent surgical staging for endometrial cancer. Patients selected for open techniques underwent surgery between January 2003 and December 2005, whereas patients selected for da Vinci robotic surgery were operated on between June 2006 and June 2008. The study was approved by the Institutional Review Board (IRB). The preoperative diagnosis of endometrial cancer was confirmed using endometrial biopsy. Data were collected and comparative analyses were made using mean or chi-squared test or other appropriate statistical techniques. The study population consisted of 97 patients (open, N = 38; robotic, N = 59). Mean age was 66.5 ± 1.97 versus 59.5 ± 1.43 years, mean parity was 2.11 versus 1.93, and mean body mass index (BMI) was 32.2 ± 2.03 versus 39.3 ± 2.03 (P = 0.02) for open versus robotic surgery, respectively. Operating time and lymph node (LN) yield was 175.24 ± 4.6 versus 185.27 ± 4.4 min, number of pelvic LNs were 8.6 versus 11.34, and aortic LNs were 3.5 versus 1.9 in the open versus robotic groups, respectively. Although mean BMI was higher, blood loss, complications, and hospital stay were significantly lower for patients undergoing robotic surgery. Overall, complications occurred in 5/38 (13%) patients in the open group and 2/59 (3%) patients in the robotic group. Of the two complications in the robotic group, there was one injury to the external iliac vein requiring open surgical management with blood transfusion resulting in a hospital stay of 7 days; however, no other patient required blood transfusion in either surgical group. Robotic surgery results in less blood loss and shorter hospital stay and yields comparable number of lymph nodes, which are adequate for staging. It also results in reduced surgical risks in patients with higher BMI who are prone to higher co-morbidities. Robotic surgery is a useful minimally invasive tool for the comprehensive surgical staging of patients with endometrial cancer.