A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy

• Published in: American journal of obstetrics and gynecology Vol. 199; no. 4; pp. 360.e1 - 360.e9
• Main Authors: Boggess, John F., MD, Gehrig, Paola A., MD, Cantrell, Leigh, MD, Shafer, Aaron, MD, Ridgway, Mildred, MD, Skinner, Elizabeth N., MD, Fowler, Wesley C., MD
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01-10-2008; Elsevier
• Subjects: Aged; Biological and medical sciences; Blood Loss, Surgical - statistics & numerical data; Digestive system. Abdomen; endometrial cancer; Endometrial Neoplasms - pathology; Endometrial Neoplasms - surgery; Endoscopy; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; Hysterectomy; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Laparotomy; Length of Stay; Lymph Node Excision; Medical sciences; Middle Aged; Neoplasm Staging - methods; Obstetrics and Gynecology; Ovariectomy; robotic assistance; Robotics; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the genital tract and mammary gland; Treatment Outcome; Tumors; laparoscopy; endometrial cancer; laparotomy; hysterectomy; robotic assistance; Endometrium cancer; Staging; Gynecology; Stage classification; Laparoscopy; Malignant tumor; Hysterectomy; Method; Obstetrics; Female genital diseases; Treatment; Surgery; Uterine diseases; Endoscopy; Laparotomy; Comparative study; Cancer
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2008.08.012

Objective The purpose of this study was to compare outcomes in women who underwent endometrial cancer staging by different surgical techniques. Study Design Three hundred twenty-two women underwent endometrial cancer staging: 138 by laparotomy (TAH); 81 by laparoscopy (TLH) and 103 by robotic technique (TRH). Results The TRH cohort had a higher body mass index than the TLH cohort ( P = .0008). Lymph node yield was highest for TRH ( P < .0001); hospital stay ( P < .0001) and estimated blood loss ( P < .0001) were lowest for this cohort. Operative time was longest for TLH (213.4 minutes) followed by TRH (191.2 minutes) and TAH (146.5 minutes; P < .0001. Postoperative complication rates were lower for TRH, compared with TAH (5.9% vs 29.7%; P < .0001). Conversion rates for the robotic and laparoscopic groups were similar. Conclusion TRH with staging is feasible and preferable over TAH and may be preferable over TLH in women with endometrial cancer. Further study is necessary to determine long-term oncologic outcomes.