Surgical Outcomes of Open, Laparoscopic, and Robotic-Assisted Approaches for Stage I Endometrial Cancer: Insights From a Real-World Study by the Indian Gynecologic-Onco Study Group

摘要

Background: There is limited clinical evidence from India comparing robotic-assisted surgery (RAS), laparoscopic surgery (LPS), and open laparotomy (OL) approaches for managing stage 1 endometrial cancer (EC). This multicenter study aimed to evaluate and compare the perioperative and short-term outcomes of these techniques across high-volume Indian institutions. Methodology: This multicenter, retrospective, non-randomized comparative study reviewed medical records of consecutive patients who underwent OL, LPS, or RAS for stage 1 EC between January 2010 and December 2023. Results: A total of 2,090 patient records were analyzed, including 1,223 in the RAS group, 451 in the LPS group, and 416 in the OL group. The average age was 59.66 ± 9.31 years, with no significant differences between groups. The overall mean operative time was 220.51 ± 93.73 minutes, with the RAS group demonstrating a significantly shorter duration than both OL and LPS groups (P < 0.001). The mean estimated blood loss was 128.87 ± 226.75 mL, with the RAS group resulting in the least blood loss, followed by the LPS and OL groups (P < 0.001). The need for intraoperative blood transfusion was also lowest in the RAS group. Intraoperative complications were more frequent in the OL group, while conversion to open surgery was higher in the LPS group (P < 0.001). Hospital stay was shortest in the RAS group (2.71 days), followed by the LPS (3.77 days) and OL (5.95 days) groups (P < 0.001). Postoperative complications were significantly fewer in the RAS and LPS groups than in the OL group. Positive margins were lowest in the RAS group (P < 0.001). Sentinel lymph node sampling was highest in the RAS group (P < 0.001). Patients in the RAS group started adjuvant treatment sooner than the LPS (P < 0.001) and OL (P = 0.004) groups. Conclusions: This study reports the first multicentric evidence for RAS in Indian settings, compared to conventional approaches, and offers encouraging outcomes.