Comparison of Robotic Surgery with Laparoscopy and Laparotomy for Treatment of Endometrial Cancer: A Meta-Analysis

Abstract

PurposeTo compare the relative merits among robotic surgery, laparoscopy, and laparotomy for patients with endometrial cancer by conducting a meta-analysis.MethodsThe MEDLINE, Embase, PubMed, Web of Science, and Cochrane Library databases were searched. Studies clearly documenting a comparison between robotic surgery and laparoscopy or between robotic surgery and laparotomy for endometrial cancer were selected. The outcome measures included operating time (OT), number of complications, length of hospital stay (LOHS), estimated blood loss (EBL), number of transfusions, total lymph nodes harvested (TLNH), and number of conversions. Pooled odds ratios and weighted mean differences with 95% confidence intervals were calculated using either a fixed-effects or random-effects model.ResultsTwenty-two studies were included in the meta-analysis. These studies involved a total of 4420 patients, 3403 of whom underwent both robotic surgery and laparoscopy and 1017 of whom underwent both robotic surgery and laparotomy. The EBL (p = 0.01) and number of conversions (p = 0.0008) were significantly lower and the number of complications (p<0.0001) was significantly higher in robotic surgery than in laparoscopy. The OT, LOHS, number of transfusions, and TLNH showed no significant differences between robotic surgery and laparoscopy. The number of complications (p<0.00001), LOHS (p<0.00001), EBL (p<0.00001), and number of transfusions (p = 0.03) were significantly lower and the OT (p<0.00001) was significantly longer in robotic surgery than in laparotomy. The TLNH showed no significant difference between robotic surgery and laparotomy.ConclusionsRobotic surgery is generally safer and more reliable than laparoscopy and laparotomy for patients with endometrial cancer. Robotic surgery is associated with significantly lower EBL than both laparoscopy and laparotomy; fewer conversions but more complications than laparoscopy; and shorter LOHS, fewer complications, and fewer transfusions but a longer OT than laparoscopy. Further studies are required.

Surgical and oncological outcome of robotic surgery compared to laparoscopic and abdominal surgery in the management of endometrial cancer

“…In contrast to our study, in a meta-analysis involving 3403 patients, Ran L et al 10 reported shorter operative time and lower blood loss, but higher complication rates in robotic surgery than laparoscopy. Moreover, in the meta-analysis of Ran L et al 10 the hospital stay and transfusion rates were equivalent in robotic surgery and laparoscopy. Instead, in our study, hospital stay was shorter in robotic group than in laparoscopy group (Table 2), but this result could be linked to the higher complication rates that we obtained in laparoscopy Group (Table 3).…”

Intra-Abdominal Cooling System Limits Ischemia–Reperfusion Injury During Robot-Assisted Renal Transplantation

“…Interestingly, in the Chicago group's study 10, the cold ischemia time was 47 min longer in the robotic group than the open surgery group. Based on our experience and the results of large meta‐analyses and series, the use of robotic assistance is likely responsible for an increase in operative time, as compared to open or laparoscopic surgery 17, 18, 19, 20, 21. We thus believe that a longer anastomosis time and uncontrolled kidney rewarming are valid concerns in robot‐assisted kidney transplantation.…”

Outcomes in women undergoing robotic‐assisted laparoscopic hysterectomy compared to conventional laparoscopic hysterectomy at a tertiary hospital in Western Australia

“…In a metaanalysis of patients undergoing surgery for endometrial cancer, TLH was associated with a higher complication rate compared to RALH although the absolute numbers of events in both groups were low. 4 A meta-analysis of 26 non-randomised studies that included more than 4000 patients with early stage cervical cancer showed that perioperative outcomes were no different between RALH and TLH. 16 In the current study, there were no observed differences between the RALH and TLH groups in post-operative pain at 24 h, or the use of opioid analgesia.…”

“…3 Retrospective studies suggest that in patients with endometrial cancers RALH may be associated with a shorter hospital stay, less blood loss and fewer complications compared to TLH. 4 However, in women with benign disease, RALH has not been shown to improve outcomes and is associated with longer operating times and higher cost compared to TLH. 5 The American…”