Abstract
<h3>Study Objective</h3> Determine the comparative effectiveness of robotic-assisted versus traditional laparoscopic hysterectomy for the treatment of endometrial cancer. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Hospitals performing a minimum of 20 minimally-invasive surgeries for endometrial cancer per year recorded in the National Cancer Database between 2010 and 2018. <h3>Patients or Participants</h3> Women who underwent hysterectomy for endometrial cancer and had an epithelial histology, a Charlson comorbidity score of 0 or 1, and stage I to III disease. <h3>Interventions</h3> Route of minimally invasive hysterectomy, either robotic-assisted (RAH) or traditional laparoscopic hysterectomy (TLH) by intention-to-treat analysis. Cox proportional hazard regression was used to evaluate overall survival. <h3>Measurements and Main Results</h3> A total of 201,039 women underwent hysterectomy for endometrial cancer; 121,770 (60.6%) RAH, 37,701 (18.8%) TLH and 41,568 (20.7%) via laparotomy. From 2010 to 2018, RAH increased (40.7% to 69.9%, 3.7% per year), laparotomy decreased (43.0% to 11.0%, 4% per year), and TLH increased (16.4% to 19.1%, 0.3% per year, all p<0.001). RAH was associated with a higher likelihood of any nodal evaluation (77.5% versus 66.4%; OR 1.74 95%CI 1.70-1.79); whereas, TLH was associated with higher rates of conversion to laparotomy (7.6% versus 1.7%; OR 4.08 95%CI 4.03-4.12), increased 30-day mortality (0.29% versus 0.18%; OR 1.55 95%CI 1.21-1.99) and increased 90-day mortality (0.69% versus 0.42%; OR 1.65 95%CI 1.41-1.94). Overall survival was not different for patients who underwent minimally-invasive hysterectomy after adjustment for age, stage, histology, and Charlson comorbidity score (HR 0.98 95%CI 0.94-1.01). <h3>Conclusion</h3> RAH for endometrial cancer increased dramatically between 2010 and 2018 compared to TLH. Additionally, RAH was associated with a 4-fold lower risk of conversion to laparotomy, increased likelihood of nodal assessment, and decreased short-term mortality compared to TLH.
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