title: Short- and long-term morbidity and outcomes after robotic surgery for comprehensive endometrial cancer staging.
abstract: OBJECTIVE
  Although intra-operative and immediate postoperative complications of robotic surgery are relatively low, little is known about long-term morbidity. We set out to assess both short- and long-term morbidities after robotic surgery for endometrial cancer staging.
  
  
  METHODS
  All patients who underwent robotic staging for EMCA between 2006 and 2009 from two institutions were identified. Patient charts were retrospectively reviewed for surgical complications and postoperative morbidities.
  
  
  RESULTS
  Five hundred three patients were identified. No differences in complication rates were found between 2006-2007 and 2008-2009, even though the median BMI increased from 29.9 (range 19-52) to 32 (range 17-70) (p=0.03). 6.4% of cases were converted to laparotomy. Median length of stay was one day (range 1-46). No cystotomies, two enterotomies, one ureteric injury, and five vessel injuries occurred (1.6% intra-operative complications). Thirty-eight (7.6%) patients developed major postoperative complications, 11 (2.2%) had wound infections, and 15 (3%) required a transfusion in the 30-day peri-operative period. The total venous thromboembolism (VTE) rate for robotic cases was 1.7%. Partial cuff dehiscence managed conservatively occurred in 5 (1%) and complete dehiscence requiring closure in 7 (1.4%) patients; Sixty-three (13.4%) patients who had robotic staging developed lymphedema, with 40 (8%) requiring physical therapy.
  
  
  CONCLUSIONS
  This study provides one of the largest cohorts of patients with robotic-assisted hysterectomy and lymphadenectomy (in 92.6%) with an assessment of morbidity. Our data demonstrates that robotic surgical staging can be safely performed with a low risk of short-term complications and lymphedema is the most frequent long-term morbidity.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, OH 43210, USA.
authors.forename: Floor J
authors.initials: FJ
authors.lastname: Backes
authors.forename: Lorna A
authors.initials: LA
authors.lastname: Brudie
authors.forename: M Ryan
authors.initials: MR
authors.lastname: Farrell
authors.forename: Sarfraz
authors.initials: S
authors.lastname: Ahmad
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Finkler
authors.forename: Glenn E
authors.initials: GE
authors.lastname: Bigsby
authors.forename: David
authors.initials: D
authors.lastname: O'Malley
authors.forename: David E
authors.initials: DE
authors.lastname: Cohn
authors.forename: Robert W
authors.initials: RW
authors.lastname: Holloway
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Fowler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult