<h3>Objectives:</h3> In this study, we aim to investigate determinants of surgical approach among women with endometrial carcinoma (EC) and associations between surgical approach and overall survival (OS). <h3>Methods:</h3> The National Cancer Database (NCDB) was queried for women diagnosed with EC between 2010-2015. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between surgical approach and clinical characteristics. Hazard ratios (HR) and 95% CIs for associations between surgical approach and OS were calculated in the overall study population and according to potential effect modifiers. <h3>Results:</h3> 140,470 patients were included. Robotic-assisted laparoscopy (RAL) was the most common surgical approach (47.8%) followed by laparotomy (33.6%) and traditional laparoscopy (15.9%). Use of RAL increased over the study period, while percentages of cases managed by laparotomy decreased. Older women, those with insurance, those residing in zip codes with lower proportions of individuals who did not graduate from high school, and those treated at non-community cancer programs were less likely to undergo laparotomy compared to RAL. Non-White women, those with high-grade histology, and those with advanced stage were more likely to undergo laparotomy vs. RAL. Compared to RAL, other surgical approaches were associated with worse OS (laparotomy: HR 1.24, 95% CI 1.20-1.27, traditional laparoscopy: HR 1.05, 95% CI 1.01-1.09) after adjusting for age, race, histology, stage, and adjuvant treatment. We did observe significant effect modification of the relationship between surgical approach (intention to treat) and OS according to age (p-interaction<0.0001), race (p-interaction<0.0001), histology (p-interaction<0.0001), stage (p-interaction=0.03), and adjuvant treatment (p-interaction<0.0001) [Figure 1 opposite]. <h3>Conclusions:</h3> Despite increased utilization of the robotic platform for surgical staging of EC, data regarding oncologic safety is limited. In the current study, we found RAL for the management of EC was associated with improved OS. The association of surgical approach and overall survival was most pronounced in young women (<50), with low grade histology, and those not receiving adjuvant therapy where laparotomy was associated with a significantly increased risk of death compared to RAL.