Comparison perioperative outcomes for endometrial cancer staging via traditional laparotomy, laparoscopy and robotic-assisted surgery: short term initial experience

Abstract: Aim: To compare the perioperative outcomes of traditional abdominal hysterectomy (TAH), total laparoscopic hysterectomy (TLH), and robotic-assisted hysterectomy (TRH) for endometrial cancer staging, which is the most common gynecological cancer type in Turkey Materials and Methods: Fifty eight women who underwent endometrial cancer staging surgery were performed by a same gynecologic oncologist (E.B.) from February 2015 to May 2016 in Sağlık Bilimleri University Adana Numune Hospital. The primary outcome measure was perioperative complications. The secondary outcome were operative time, postoperative hemoglobin drop, blood transfusion rates and length of the hospital stay. Results: Three groups were identified.(TAH, n=23; TLH, n=10; TRH, n=25) There were no statistically significant differences between the groups in terms of age, parity, grade and depth of myometrial invasion. Overall complication rate was higher in TAH group. TRH and TLH patients were less likely to have renal failure, urinary tract infection and postoperative fever compared to TAH patients. A significantly lower drop in hemoglobin was detected in the TRH group compared with the other groups. (p= 0,797) Mean operative time was longer in TRH cases than TLH and TAH cases (300, 230, 165 minutes, respectively). The median lengths of hospitalization for TAH, TLH, and TRH patients were 5, 3, and 2 days, respectively (p < 0.0001). There were significantly fewer blood transfusion requirements in minimal invasive surgery groups (0/10 case in TLH and 3/25 cases in TRH) than traditional approaches (5/23 cases in TAH ). Conclusions:With our short term initial experience, minimally invasive surgical approach resulted in superior perioperative outcomes. Despite longer operative times, the results from this study suggest that robotic-assisted surgical staging in the management of endometrial cancer is both feasible and associated with a shorter length of hospitalization.