Robotic vs Open Surgery for Endometrial Cancer in Elderly Patients: Surgical Outcome, Survival, and Cost Analysis.

OBJECTIVE: This study aimed to compare robotic and open surgery in elderly women diagnosed as having endometrial cancer, in terms of costs, survival, surgical outcome, and operating time. METHODS: Women 70 years or older undergoing open and robotic surgery for endometrial cancers were included consecutively before and after the introduction of robotic surgery at a tertiary center. Costs were calculated using the case-costing system, cost per patient, including the first 30 postoperative days. Relative and overall survival outcomes were obtained from the Swedish National Cancer Registry and analyzed using the Kaplan-Meier method. Surgical outcomes including operating and anesthesia times, estimated blood loss, hospital stay, and intraoperative and postoperative complications were reviewed. RESULTS: In all, 137 and 141 women 70 years or older were identified to have undergone open and robotic surgery, respectively. The groups showed similar body mass index, comorbidities, and tumor characteristics. No statistically significant differences were seen in costs (robotic &OV0556;11,874 vs open &OV0556;11,521, P = 0.463) or 5-year survival outcomes (robotic 94% [95% confidence interval {CI}, 84-105] vs open 87% [95% CI, 78-98], P = 0.529). Robotic surgery was associated with significantly lower estimated blood loss (P < 0.001) and shorter hospital stay (P < 0.001) but longer anesthesia time (186 vs 174 minutes; P < 0.05) and operating theater time (205 vs 190 minutes; P < 0.05). There were no significant differences in intraoperative complications, but robotic surgery resulted in fewer postoperative Clavien-Dindo grade II complications. CONCLUSIONS: Elderly women can safely undergo robotic surgery for endometrial cancer and could be offered this technique to the same extent as younger patients. They may benefit from shorter hospital stay, decreased blood loss, and postoperative complications, without resulting in higher costs to the health care system or jeopardizing their survival.

A prospective, comparative study on robotic versus open-surgery hysterectomy and pelvic lymphadenectomy for endometrial carcinoma.

OBJECTIVES: The aim of this study was to compare surgical outcome, patient recovery, and costs between robot-assisted laparoscopy and laparotomy in women undergoing hysterectomy, bilateral salpingo-oophorectomy (BSOE), and pelvic lymphadenectomy for endometrial carcinoma. METHODS: Women undergoing hysterectomy, BSOE, and pelvic lymphadenectomy for endometrial carcinoma, according to regional guidelines, were prospectively, concurrently, and consecutively included from September 2010 to December 2012. Surgical outcomes such as operative time, estimated blood loss (EBL), number of lymph nodes retrieved, and complications were analyzed together with hospital stay, days until normal active daily living was retrieved, patient satisfaction with the length of the hospital stay, and cost per patient. Robot-assisted laparoscopy was performed on all cases at the Sahlgrenska University Hospital, and laparotomy was performed on all cases at 3 regional hospitals. RESULTS: Forty women underwent robot-assisted laparoscopy, and 48 underwent laparotomy. There were no differences in age, body mass index, histology, or retrieved lymph nodes. Operative time was significantly shorter in the robot-assisted laparoscopy group (P < 0.0001). The EBL was lower and hospital stay was shorter in the robot-assisted laparoscopy group (P < 0.0001). There was no statistical difference in complications between the groups, and both groups found hospital stay duration satisfactory. In the robot-assisted laparoscopy group, active daily living was normal within 5 days postoperatively, compared with 14 days in the laparotomy group (P < 0.0001). Calculated costs per treated patient did not differ statistically between the groups. CONCLUSIONS: Compared with laparotomy and robot-assisted laparoscopic hysterectomy, BSOE pelvic lymphadenectomy for endometrial carcinoma was associated with significantly shorter operative time, hospital stay, and lower EBL. Patients recovered more quickly after robot-assisted laparoscopy, with equal costs number of retrieved lymph nodes, compared with laparotomy.