Robotic-Assisted Laparoscopy Shows Slight Survival Benefit in Endometrial Cancer

A randomized controlled trial evaluating long-term outcomes of robotic-assisted vs conventional laparoscopy for endometrial cancer found a slight overall survival benefit for robotic-assisted surgery.

Robotic-assisted laparoscopy has gained popularity in endometrial cancer surgery due to its technical advantages, including a lower conversion rate compared with conventional laparoscopy. However, data on long-term oncological outcomes is primarily derived from retrospective studies. This study aimed to assess overall survival, progression-free survival, and long-term surgical complications in patients undergoing either robotic-assisted or conventional laparoscopy.

The trial was conducted at Tampere University Hospital, Finland, from 2010 to 2013, enrolling 101 patients with low-grade endometrial cancer scheduled for minimally invasive surgery. Patients were randomized 1:1 to either robotic-assisted or conventional laparoscopy, with all undergoing hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy. A total of 97 patients (49 robotic-assisted, 48 conventional) were followed for at least 10 years. Survival outcomes were analyzed using Kaplan-Meier curves, log-rank tests, and Cox proportional hazard models, while risk factors for trocar site hernia were assessed using binary logistic regression.

The results showed a favorable overall survival for robotic-assisted laparoscopy (hazard ratio, 0.39; 95% CI, 0.15-0.99; P =.047) compared with conventional laparoscopy. However, progression-free survival did not differ significantly between groups (P = .598). The 3-, 5-, and 10-year overall survival rates were 98.0%, 91.8%, and 75.5% for conventional laparoscopy, and 97.9%, 93.7%, and 85.4% for robotic-assisted laparoscopy, respectively. Trocar site hernia was more common in the robotic-assisted group (18.2% vs 4.1%; odds ratio, 5.42, 95% CI, 1.11-26.59; P = .028), but the incidence of lymphocele, lymphedema, and other long-term complications was similar between groups.

“The results of this randomized controlled trial suggest a minor overall survival benefit in endometrial cancer after robotic-assisted laparoscopy compared to conventional laparoscopy,” the authors concluded. “The use of robotic-assisted technique in the treatment of endometrial cancer seems safe, though larger randomized controlled trials are needed to confirm any potential survival benefit.”

Reference

Kivekäs E, Staff S, Huhtala HSA, et al. Robotic-assisted versus conventional laparoscopic surgery for endometrial cancer: long-term results of a randomized controlled trial. Am J Obstet Gynecol. 2025;232(3):304.e1-304.e8. doi:10.1016/j.ajog.2024.08.028