Robotic-assisted laparoscopy increases endometrial cancer survival rates

Robotic-assisted laparoscopy increases endometrial cancer survival rates | Image Credit: © Svitlana - © Svitlana - stock.adobe.com.

Robotic-assisted laparoscopy surgery (RALS) leads to a slight increase in survival benefit in endometrial cancer (EC) vs conventional laparoscopy surgery (CLS), according to a recent study published in the American Journal of Obstetrics & Gynecology.¹

Rising incidence of endometrial cancer

A rise in EC incidence has been reported worldwide, linked to an increase in obesity prevalence and aging population. Currently, hysterectomy and bilateral salpingo-oophorectomy (BSO) are the main methods of treatment, though patients with high-risk features undergo adjuvant therapy. RALS has been offered since 2005 for enhanced recovery in EC.²

“However, data on long-term survival after RALS are still scarce and based on retrospective cohort studies only,” wrote investigators.¹ “Most studies, but not all, indicate similar oncological long-term outcomes compared to CLS.”

Study design and patient selection

Investigators conducted a randomized controlled trial to compare RALS and CLS in EC. Participants included patients undergoing minimally invasive surgical surgery for low-grade EC between December 2010 and October 2013. These individuals were randomized 1:1 to receive either RALS or CLS. Those with a narrow vagina or too large uterus were excluded from the analysis.

Patients were stratified based on overweight status and age. The overall operating time was reported as the primary outcome, while secondary outcomes included short-term surgical complications, overall survival (OS), progression-free survival (PFS), and long-term surgical complications.

All patients underwent laparoscopic hysterectomy, BSO, and pelvic lymphadenectomy, with differing surgical techniques utilized across groups. Those in the RALS group underwent the open entry technique, while those in the CLS group underwent entering in the umbilicus with a Verress needle.

Follow-up and patient outcomes

Follow-up lasted for at least 10 years, with a mean follow-up time of 11.2 years in the CLS group and 11.9 years in the RALS group. Similar age, body mass index, and medical history were reported between groups. Five patients in the CLS group converted to laparotomy vs none in the RALS group.

Improved OS was reported in the RALS group vs the CLS group, and this improvement remained when only evaluating stage 1 and stage 2 patients. Death was reported in 23.7% of patients overall, 32.7% in the CLS group, and 14.6% of the RALS group.

Median times from surgery to death of 7.2 years and 6.2 years were reported in the CLS and RALS groups, respectively. Both groups had 4 confirmed disease-related deaths.

Three-year, 5-year, and 10-year survival was reported in 98%, 91.9%, and 75.5%, respectively, of the CLS group vs 97.9%, 93.7%, and 85.4%, respectively, of the RALS group. The RALS group reported a reduced hazard ratio for death at 0.415 vs the CLS group.

Links were reported between preexisting comorbidity and high-grade tumor presence with worse OS, but the mode of surgery and age remained statistically significant in the multivariable regression analysis.

Progression-free survival and postoperative complications

Similar PFS was also reported between groups, with 3-year PFS rates of 87.8% in the CLS group and 85.7% in the RALS group. EC recurrence occurred in 16.3% and 12.5%, respectively, and median times from surgery to first recurrence were 24 and 23 months, respectively. Finally, 10-year PFS rates were 83.6% and 87.5%, respectively.

The odds of developing trocar site hernia were increased from RALS vs CLS, with an odds ratio of 5.42. Operations occurred for all but 2 hernias in the RALS group, taking place between 7 and 35 months after the primary operation. Other complications included lymphocele, which was reported in 8.2% of the CLS group and 18.8% of the RALs group.

Conclusion

These results indicated a slight increase in OS among patients with EC after RALS vs CLS. However, no differences were reported in PFS.

“Adding the lower rates of conversions and enhanced recovery associated with RALS, the use of RALS in EC seems justifiable and safe but future studies are required to denote the possible survival benefits of RALS,” concluded investigators.

References

1. Kivekäs E, Staff S, Huhtala HSA, et al. Robotic-assisted versus conventional laparoscopic surgery for endometrial cancer: long-term results of a randomized controlled trial. Am J Obstet Gynecol. 2025;232:304.e1-8. doi:10.1016/j.ajog.2024.08.028
2. Henry JA, Abdullah F. Global surgical care in the UN. Post-2015 Sustainable Development Agenda. World J Surg. 2016;40(1):1-5. doi:10.1007/s00268-015-3249-4