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Long-term overall survival was higher in patients with endometrial cancer who underwent robotic-assisted laparoscopic surgery compared with conventional laparoscopic surgery, but progression-free survival did not differ between groups, according to findings published in the American Journal of Obstetrics & Gynecology.

“Hence, 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,” researchers wrote.

The study is the first randomized controlled trial to compare long-term outcomes with robotic-assisted vs conventional laparoscopy in patients with endometrial cancer. It included 97 patients with low-grade endometrial cancer who underwent minimally invasive surgery between 2010 and 2013. Researchers randomly assigned patients preoperatively to either robotic-assisted or conventional laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy.

The 49 patients in the robotic-assisted laparoscopy group and the 48 patients in the conventional laparoscopy group were followed for a minimum of 10 years.

Survival Rates & Incidence of Complications

The analysis showed favorable overall survival in the robotic-assisted laparoscopy group compared with the conventional laparoscopy group. Rates of overall survival were 97.9% with robotic-assisted and 98.0% with conventional laparoscopy at 3 years, 93.7% with robotic-assisted and 91.8% with conventional laparoscopy at 5 years, and 85.4% with robotic-assisted and 75.5% with conventional laparoscopy at 5 years.

Rates of progression-free survival were similar between groups: 89.6% with robotic-assisted and 87.8% with conventional laparoscopy at 3 years, 87.5% with robotic-assisted and 85.7% with conventional laparoscopy at 5 years, and 87.5% with robotic-assisted and 83.6% with conventional laparoscopy at 10 years.

According to the study, trocar site hernia was more common after robotic-assisted laparoscopy, affecting 18.2% of patients compared with 4.1% of those who underwent conventional laparoscopy.

“The possibility of trocar site hernia should be kept in mind at follow-up visits of patients,” researchers wrote. “The symptoms associated with the hernia can initially be mild, with noticeable discomfort emerging following the acute phase of cancer recovery.”

The study found a similar incidence of lymphocele, lymphedema, and other long-term complications between groups.

“No alarming safety signals were detected in the robotic-assisted group,” researchers wrote, “since the rate of long-term complications differed only in the incidence of trocar site hernia.”