title: Surgical and oncological outcome of robotic surgery compared to laparoscopic and abdominal surgery in the management of endometrial cancer.
abstract: OBJECTIVE
  To compare different techniques of minimally invasive surgery (laparoscopy and robotics) to abdominal surgery in order to identify the optimal surgical technique in the treatment of endometrial cancer.
  
  
  METHODS
  A single-institutional, matched, retrospective, cohort study was performed. All patients with clinical stage I or occult stage II endometrial cancer who underwent robotic hysterectomy, bilateral salpingo-oophorectomy ± lymphadenectomy from August 2010 and December 2013 were identified. Surgical and oncological outcomes were compared with patients matched by age, body mass index, tumor histology, and grade, who underwent abdominal or laparoscopic surgery between January 2001 and December 2013.
  
  
  RESULTS
  Three groups were identified: 177 laparotomies (group A), 277 laparoscopies (group B) and 72 robotics (group C). There were no statistically significant differences between the three groups in terms of age, BMI and FIGO stage. The operative time was shortest in group B (p = 0.0001). Blood loss and transfusions were equivalent in group B and C, while they were greater in group A (p = 0.0001). The intra-operative, early and late postoperative complications, rate of conversion, the re-intervention and median hospital stay were lower in group C. The rate of recurrence and death from disease was similar in all three groups.
  
  
  CONCLUSIONS
  Minimally invasive surgery was superior to abdominal surgery in terms of surgical outcomes. Robotic surgery was superior to laparoscopy in terms of intra- and post-operative complications, conversion rates, length of hospital stay and re-interventions. In terms of oncological outcomes the three groups were equivalent.
authors.affiliation: Gynecologic Oncology Unit, "Regina Elena" National Cancer Institute, Rome, Italy. Electronic address: giacomo.corrado@alice.it.
authors.forename: G
authors.initials: G
authors.lastname: Corrado
authors.affiliation: Gynecologic Oncology Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Cutillo
authors.affiliation: Department of Surgery, Section of Gynaecology and Obstetrics, Tor Vergata University, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Pomati
authors.affiliation: Gynecologic Oncology Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Mancini
authors.affiliation: Scientific Direction, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Sperduti
authors.affiliation: Department of Surgery, Section of Gynaecology and Obstetrics, Tor Vergata University, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Patrizi
authors.affiliation: Department of Surgery, Section of Gynaecology and Obstetrics, Tor Vergata University, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Saltari
authors.affiliation: Gynecologic Oncology Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Vincenzoni
authors.affiliation: Gynecologic Oncology Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Baiocco
authors.affiliation: Gynecologic Oncology Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Vizza
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: Abdominal hysterectomy; Endometrial cancer; Laparoscopic hysterectomy; Minimally invasive surgery; Robotic hysterectomy