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Uterine Cancer
Clinical Outcomes in Endometrial Cancer Care When the Standard of Care Shifts From Open Surgery to Robotics
  1. Zhun Wei Mok,
  2. Eu Leong Yong, MRCOG, PhD,
  3. Jeffrey Jen Hui Low, FRCOG, FRANZCOG, MMed(O&G), FAMS(O&G) and
  4. Joseph Soon Yau Ng, MD, FACOG, FAMS
  1. Department of Obstetrics and Gynecology, National University Hospital, Yong Loo Lin School of Medicine, National University of Singapore, Republic of Singapore.
  1. Address correspondence and reprint requests to Joseph Soon Yau Ng, MD, FACOG, FAMS, Division of Gynecological Oncology, Department of Obstetrics and Gynecology, National University Hospital, Lower Kent Ridge Rd, Singapore 119074, Republic of Singapore. E-mail: Joseph_ng@nuhs.edu.sg.

Abstract

Introduction In Singapore, the standard of care for endometrial cancer staging remains laparotomy.1 Since the introduction of gynecologic robotic surgery, there have been more data comparing robotic surgery to laparoscopy in the management of endometrial cancer. This study reviewed clinical outcomes in endometrial cancer in a program that moved from laparotomy to robotic surgery.

Methods A retrospective review was performed on 124 consecutive endometrial cancer patients. Preoperative data and postoperative outcomes of 34 patients undergoing robotic surgical staging were compared with 90 patients who underwent open endometrial cancer staging during the same period and in the year before the introduction of robotics.

Results There were no significant differences in the mean age, body mass index, rates of diabetes, hypertension, previous surgery, parity, medical conditions, size of specimens, histologic type, or stage of cancer between the robotic and the open surgery groups. The first 20 robotic-assisted cases had a mean (SD) operative time of 196 (60) minutes, and the next 14 cases had a mean time of 124 (64) minutes comparable to that for open surgery. The mean number of lymph nodes retrieved during robot-assisted staging was smaller than open laparotomy in the first 20 cases but not significantly different for the subsequent 14 cases. Robot-assisted surgery was associated with lower intraoperative blood loss (110 [24] vs 250 [83] mL, P < 0.05), a lower rate of postoperative complications (8.8% vs 26.8%, P = 0.032), a lower wound complication rate (0% vs 9.9%, P = 0.044), a decreased requirement for postoperative parenteral analgesia (5.9% vs 51.1, P < 0.001), and shorter length of hospitalization (2.0 [1.1] vs 6.0 [4.5] days, P < 0.001) compared to patients in the open laparotomy group.

Conclusions Our series shows that outcomes traditionally associated with laparoscopic endometrial cancer staging are achievable by laparoscopy-naive gynecologic cancer surgeons moving from laparotomy to robot-assisted endometrial cancer staging after a relatively small number of cases.

  • Robotics
  • Endometrial cancer
  • Laparoscopic naive
  • Open surgery

https://doi.org/10.1097/IGC.0b013e31824c5cd2

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    Footnotes

    • Presented at the 17th International Meeting of the European Society of Gynecological Oncology Meeting, Milan, Italy.

    • The authors have no conflict of interest to declare.

    • The authors did not receive funding for this study.

    • Ethical approval for this study was obtained from the Discipline Specific Review Board of the National Health Care Group Singapore.