compare intra-operative and post-operative complications as well as recurrence in women withendometrial
cancer undergoing surgical stagingwith robotic-assisted
laparoscopic hysterectomy (RALH)versus total abdominal hysterectomy (TAH).
Methods: A retrospective review was performed of 416 patients who
underwent surgical staging for endometrial adenocarcinoma from January 1, 2008
to December 31, 2010. Demographics,intraand
post-operative complications, surgical-pathologic data, subsequent treatments,
and recurrence were compared in women treated with TAH versus RALH. A Student’st-test, Mann Whitney U analysis, or
chi-squared analysis were used for statistical analysis. Results: One hundred
thirty seven and 279 patients underwent TAH and RALH, respectively.
Post-operative complications were lower in the RALH group (16.8% vs 8.2%, p = 0.009)
and mean hospital stay for the TAH group versus the RALH group was 3 days
versus 1 day (p < 0.001). Demographics and intra-operative complications
were similar (p = 0.94). Uterine weight (108 gvs103 g,
p = 0.36), pelvic lymph nodes retrieved (9 vs 9, p = 0.18), and presence of
lymph-vascular involvement (11.7% vs 10.8%, p = 0.38) were similar between
groups, as were aggressive histologic subtypes (p = 0.52) and grade (p = 0.15).
Recurrence occurred in 4.4% of the TAH group and 4.3% of the RALH group (p = 0.97)
with death from disease occurring in 1.5% of the TAH group and 2.2% of the RALH
group (p = 0.64). Conclusions: RALH for endometrial adenocarcinoma is
associated with fewer post-operative complications and a shorter hospital stay
than TAH. Recurrence and death due to disease are not compromised by this
minimally invasive approach.
Cite this paper
Sato, H. , DuBeshter, B. , Robins, A. , Angel, C. , Toy, E. and Thomas, S. (2013) Does robotic surgical staging of endometrial cancer compromise outcomes?. Open Journal of Obstetrics and Gynecology
, 41-46. doi: 10.4236/ojog.2013.31010
 Siegel, R., Naishadham, J. and Jemal, A. (2012) Cancer statistics 2012. CA Cancer Journal for Clinicians, 62, 10-29. doi:10.3322/caac.20138
 Creasman, W.T., Morrow, C.P., Bundy, B.N., Homesley, H.D., Graham, J.E. and Heller, P.B. (1987) Surgical pathologic spread patterns of endometrial cancer: A gyncecology oncology group study. Cancer, 60, 2035-2041.
 Mikuta, J.J. (1993) International federation of gynecology and obstetrics staging of endometrial cancer 1988. Cancer, 71, 1460-1463. doi:10.1002/cncr.2820710409
 Neubauer, N.L. and Lurain, J.R. (2011) The role of lymphadenectomy in surgical staging of endometrial cancer. International Journal of Surgical Oncology, 2011, Article ID: 814649.
 Boggess, J.F., Gehrig, P.A., Cantrell, L., et al. (2008) A comparative study of 3 surgical methods for hysterictomy with staging for endometrial cancer: Robotic assistance, laparoscopy, laparotomy. American Journal of Obstetrics & Gynecology, 199, 360e1-360e9.
 Eletabbakh, G.H. (2002) Analysis of survival after laparoscopy in women with endometrial carcinoma. Cancer, 95, 1894-901. doi:10.1002/cncr.10928
 Zullo, F., Falbo, A. and Palomba, S. (2012) Safety of laparoscopy vs laparotomy in the surgical staging of endometrial cancer: A systematic review and metaanalysis of randomized controlled trials. American Journal of Obstetrics & Gynecology, 26, 94-100.
 Walker, J.K., Piedmonte, M.R., Spirtos, N.M., et al. (2012) Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic oncology group LAP2 study. Journal of Clinical Oncology, 20, 695-700. doi:10.1200/JCO.2011.38.8645
 Ahlering, T.E., Skarecky, D., Lee, D. and Clayman, R.V. (2003) Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: Initial experience with laparoscopic radical prostatectomy. The Journal of Urology, 170, 1738-1741.
 Intuitive Surgical (2012) Second quarter earnings 2012.
 Fader, A.N., Seamon, L.G., Escobar, P.F., et al. (2012) Minimally invasive surgery versus laparotomy in women with high grade endometrial cancer: A multi-site study performed at high volume cancer centers. Gynecologic Oncology, 126, 180-185.
 Ghezzi, F., Cromi, A., Uccella, S., et al. (2010) Laparoscopic versus open surgery for endometrial cancer: A minimum 3-year follow-up study. Annals of Surgical Oncology, 17, 271-278. doi:10.1245/s10434-009-0720-1
 Wattiez, A., Soriano, D., Cohen, S.B., et al. (2002) The learning curve of total laparoscopic hysterectomy: Comparative analysis of 1647 cases. The Journal of the American Association of Gynecologic Laparoscopists, 9, 339-345. doi:10.1016/S1074-3804(05)60414-8
 DeNardis, S.A., Holloway, R.W., Bigsby IV, G.E., Pikaart, D.P., Ahmad, S. and Finkler, N.J. (2008) Robotically assisted laparoscopic hysterectomy versus total abdominal hysterectomy and lyphadenectomy for endometrial cancer. Gynecologic Oncology, 111, 412-417.
 Lim, P.C., Kang, E. and Park, D.H. (2011) A comparative detail analysis of the learning curve and surgical outcome for robotic hysterectomy with lymphadenectomy versus laparoscopic hysterectomy with lymphadenectomy in treatment of endometrial cancer: A case-matched controlled study of the first one hundred twenty two patients. Gynecologic Oncology, 120, 413-418.
 Backes, F.J., Brudie, L.A., Farrell, M.R., et al. (2012) Short-and long-term morbidity and outcomes after robotic surgery for comprehensive endometrial cancer staging. Gynecologic Oncology, 125, 546-551.
 Sorosky, J.I. (2012) Endometrial cancer. Gynecologic Oncology, 120, 383-397.
 Lau, S., Vaknin, Z., Ramana-Kumar, A.V., Halliday, D., Franco, E.L. and Gotlieb, W.H. (2012) Outcomes and cost comparisons after introducing a robotics program for endometrial cancer surgery. Gynecologic Oncology, 119, 717-724. doi:10.1097/AOG.0b013e31824c0956
 Creutzberg, C.L., van Putten, W.L., Koper, P.C., et al. (2003) Survival after relapse in patients with endometrial cancer: Results from a randomized trial. Gynecologic Oncology, 89, 201-209.