Robotic Versus Laparoscopic Pelvic Lymphadenectomy for Endometrial Cancer Under the Japanese Public Health Insurance System.

Background/aim: Surgery is the preferred treatment modality for endometrial cancer. In recent years, minimally invasive surgery (MIS) has become increasingly popular, and in Japan, robotic surgery has been covered by national insurance in addition to laparoscopic surgery for apparent stage IA cases since 2018. We conducted a comparative analysis of laparoscopic and robotic surgeries, including pelvic lymphadenectomy for stage IA endometrial cancer, with the aim of evaluating the efficacy of robotic surgery.

Patients and methods: A retrospective analysis was conducted for patients who underwent MIS pelvic lymphadenectomy between January 2018 and December 2023. Sixty-nine patients who underwent robotic surgery and 29 who underwent laparoscopic surgery were included in the study. All the patients underwent total hysterectomy and pelvic lymph node dissection, with preoperative diagnosis of stage 1A and G1-G2 endometrial cancer.

Results: Operative time was longer in the robotic group (median=316 vs. 272 min in the laparoscopic group, p=0.02). Intraoperative blood loss and postoperative hospital stay were lower in the robotic group (median blood loss: 0 vs. 50 ml for the laparoscopic group, p<0.01; median postoperative hospital stay: 5 vs. 8 days for the laparoscopic group, p<0.01). No statistically significant differences were found in the incidence of complications and recurrence between the two groups.

Conclusion: This retrospective analysis suggests that robotic surgery is a feasible and safe procedure for total hysterectomy and pelvic lymph node dissection in patients with preoperative diagnosis of stage IA and G1-G2 endometrial cancer.