Patient-related factors for surgical modality selection in early-stage endometrial cancer: a retrospective comparative study of laparoscopic and robotic surgery
Several studies have compared surgical outcomes between laparoscopic and robotic surgery for endometrial cancer. However, there are no clear recommendations for selecting between the two minimally invasive surgery (MIS) approaches. This study aimed to compare the performance of the two MIS approaches in early-stage endometrial cancer and to identify patient-related factors influencing modality selection. We included patients who underwent laparoscopic or robotic surgery for preoperative clinical stage IA endometrial cancer at Kanagawa Cancer Center between May 2020 and August 2024. The choice of surgical modality was not entirely random and was primarily influenced by equipment availability. We compared surgical outcomes and analyzed factors associated with longer operative time and greater estimated blood loss. Overall, 204 patients were enrolled, with 95 (46.6%) in the laparoscopic group and 109 (53.4%) in the robotic group. The laparoscopic group had shorter operative times and greater estimated blood loss than the robotic group. Multivariable analyses showed that a robotic approach and a body mass index (BMI) of 30 or higher were associated with longer operative times. No factors were significantly associated with estimated blood loss. Subgroup analyses revealed that operative time was significantly shorter only among patients with BMI < 30 undergoing laparoscopic surgery (hazard ratio = 1.94; 95% confidence interval, 1.34-2.82), highlighting the impact of BMI on surgical efficiency. During a median follow-up period of 21.0 months, no recurrences were observed in either group. In institutions offering both laparoscopic and robotic surgery, a BMI of 30 may serve as a practical threshold for selecting the MIS modality in early-stage endometrial cancer. 2024 Eki 15, data of registration: 20th January 2025, retrospectively registered.