Long-term survival outcomes of robotic-assisted versus traditional laparoscopy for the treatment of stage I endometrial cancer: a National Cancer Database analysis
To compare the long-term survival outcomes of robotic-assisted versus traditional laparoscopic surgery for treatment of stage I endometrial cancer. We performed a retrospective cohort study using the National Cancer Database, including patients with stage I endometrial cancer diagnosed from 2010 to 2017 (with follow-up through 2020) who underwent treatment with either robotic-assisted or traditional laparoscopic surgery. Demographics, clinical characteristics, and outcomes were summarized using descriptive statistics. Overall survival (OS) was compared using a Cox proportional hazard model, adjusting for demographic and clinical factors; hazard ratios and 95% confidence intervals reported. A total of 127,342 patients with stage I endometrial cancer who underwent minimally invasive surgery were included. The median follow-up among those still known to be alive was 69.7 months. Almost three-quarters (74.5%) received robotic-assisted surgery, while 25.5% received traditional laparoscopic surgery. Demographic and clinical factors were similar between groups. No differences in OS were observed by surgery modality (5-year OS: 91.7% for robotic vs. 91.4% for traditional laparoscopic surgery) and this remained after adjustment for demographic and clinical factors (HR = 1.00, 95% CI 0.96-1.04). There was no difference in OS for patients with stage I endometrial cancer treated with robotic-assisted versus traditional laparoscopic surgery. These data demonstrate excellent survival outcomes in this cohort and do not favor a robotic-assisted or traditional laparoscopic approach. However, the full extent of a route-of-surgery decision may not be detected given the potential for late recurrences and deaths, highlighting the need for large, prospective studies with long duration of follow-up.