A comparison of outcomes following robotic-assisted staging and laparotomy in patients with early stage endometrioid adenocarcinoma of the uterus with uterine weight under 480 g

Abstract

To directly compare perioperative morbidity and hospital stay after robotic-assisted staging and laparotomy in patients with early stage endometrial endometrioid adenocarcinoma and uterine weight under 480 g. Retrospective cohort study. The West Clinic in Memphis, TN, USA. Patients with Stage IA and Stage IB endometrial endometrioid adenocarcinoma and uterine weight less than 480 g from June 2007 to January 2011. Patients underwent hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection with or without para-aortic lymph node dissection using robotic-assisted surgery or open laparotomy. Perioperative complications and morbidity, length of hospital stay, progression-free survival, overall survival, time to recurrence, and time do death from disease. A total of 160 patients who underwent laparotomy and 165 patients who received robotic-assisted staging were identified. Compared with robotic-assisted staging, laparotomy was associated with increased hospital stay (3 days vs. 1.4 days, p < 0.001), greater estimated blood loss (237 cm3 vs. 102 cm3, p < 0.001), larger uterine weight (136 g vs. 116 g, p < 0.001), as well as higher incidence of postoperative complications [29.3% vs. 6.7%, odds ratio (OR) 5.82, 95% confidence interval (CI) 2.1–11.7] including postoperative ileus (9.0% vs. 1.0%, OR 7.82, 95% CI 1.7–35.0), wound infection (6.0% vs. 1.0%, OR 5.43, 95% CI 1.2–25.2), and postoperative atelectasis (4.0% vs. 0%, p < 0.01). There were no differences in projected 5-year progression-free and overall survival rates. Use of the daVinci robotic system was associated with less intraoperative blood loss, fewer postoperative complications, and shorter hospital stay compared with laparotomy for patients with uterine weight less than 480 g.