Robotic Surgery Versus Laparotomy in Elderly Patients with Endometrial Cancer: Perioperative Outcomes and Complications

Objective: To evaluate perioperative outcomes and complications in elderly patients with endometrial cancer undergoing surgical staging with robotic assisted laparoscopy (RAL) versus laparotomy. Design: A retrospective cohort study. Materials and Methods: We included all elderly patients (≥70 years old) with endometrial cancer in one university-affiliated medical center (2009-2017). We compared outcomes between patients undergoing RAL with those undergoing laparotomy. We excluded cases who underwent vaginal hysterectomy or conventional laparoscopy. Our primary outcomes were perioperative outcome and complications, including operation time, anesthesia duration, estimated blood loss, intraoperative complications, length of stay, postoperative complications, and rates of readmission. Results: Overall, 125 patients met inclusion criteria. Of whom, 45 (36%) had RAL and 80 (64%) underwent laparotomy. There was no difference between groups in age, body mass index, stage, or histology, p > 0.05 for all. Patients undergoing RAL had significantly longer operation time (142 vs. 94 minutes, p < 0.001). Rates of lymph node sampling were higher in the RAL group than in the laparotomy group (77.7% vs. 52.5%, p = 0.006). Compared with those undergoing RAL, patients undergoing laparotomy had significantly longer length of stay (7 vs. 2 days, p < 0.001) with significantly higher rates of intraoperative and postoperative complications (18.7% vs. 4.4%, p = 0.02, and 17.5% vs. 2.2%, p = 0.001, respectively). Conclusions: Elderly patients with endometrial cancer undergoing RAL are more likely to undergo oncologic staging. Despite the potentially more morbid procedure, these patients have lower perioperative complications, with shorter hospital stay, compared with patients undergoing laparotomy.