Long-term survival in obese patients after robotic or open surgery for endometrial cancer

Abstract

Objective: To evaluate surgical outcomes and survival after primary robotic or open surgery in obese women with endometrial cancer (EC).

Methods: The study included obese women (BMI ≥ 30 kg/m²) with EC who underwent primary surgery before and after the introduction of robotics between 2006 and 2014. Data on complications, survival, and recurrence was obtained through the National Cancer Registry and medical files. Survival curves were calculated for overall (OS), relative (RS) and disease-free survival (DFS). Cox proportional hazards regression models to assess OS and DFS.

Results: In total, 217 patients were identified, 131 robotic and 86 open surgical procedures. Significantly lower estimated blood loss, surgical time and hospital stay were found in the robotic group and the relative risk ratio of complications grades II-V, using the Clavien Dindo classification, was 0.54 (95% CI 0.31-0.93) for the robotic compared to the open group. A significant difference in OS (p = 0.029) and RS (p = 0.024) in favor of robotics was shown in the univariable survival curves, using log rank tests. No difference was seen for DFS. The 5-year RS was 96.2% (95% CI 89.7-103.3) for the robotic and 81.6% (95% CI 72.1-92.3) for the open group. Multivariable analysis showed high risk histology to be an independent risk factor, for both OS (HR 2.90; 95% CI 1.42-5.93; p < 0.05) and DFS (HR 2.74; 95% CI 1.45-5.17; p < 0.05). Robotic surgery was not found a significant independent factor for survival.

Conclusions: Robotic surgery in obese women with EC had equivalent long-term and disease-free survival compared to open with significantly less complications, lower estimated blood loss, shorter surgical time and hospital stay.

Keywords: Disease-free survival; Endometrial cancer; Long-term survival; Obesity; Prognostic factors; Robotic surgery.