Photo Credit: Golovchyn

The following is a summary of “Robotic-assisted versus conventional laparoscopic surgery for endometrial cancer: long-term results of a randomized controlled trial,” published in the March 2025 issue of American Journal of Obstetrics & Gynecology by Kivekäs et al. 

Robotic-assisted laparoscopy was widely used for endometrial cancer, offering fewer conversions than conventional laparoscopy, but long-term oncological data remained limited.  

Researchers conducted a retrospective study to evaluate overall survival (OS) progression-free survival, and long-term surgical complications in individuals with endometrial cancer who were randomly assigned to robotic-assisted or conventional laparoscopy.  

They performed a randomized controlled trial at the Department of Gynecology and Obstetrics of Tampere University Hospital, Finland. From 2010 to 2013, 101 individuals with low-grade endometrial cancer scheduled for minimally invasive surgery were randomly assigned (1:1) to either robotic-assisted or conventional laparoscopy. All underwent laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy. Follow-up was completed for 97 individuals (49 in the robotic-assisted laparoscopy group and 48 in the conventional laparoscopy group) for at least 10 years. Kaplan-Meier curves, log-rank test, and Cox proportional hazard models were applied for survival analysis, while binary logistic regression was employed to estimate risk factors for trocar site hernia.  

The results showed that OS was better in the robotic-assisted group (hazard ratio 0.39; 95% CI, 0.15–0.99, P=.047) compared to the conventional laparoscopy group, while no differences was observed in progression-free survival (log-rank test, P=.598). The 3-, 5-, and 10-year OS rates for the conventional laparoscopy and robotic-assisted groups were 98.0% (95% CI, 94.0–100) vs 97.9% (93.8–100), 91.8% (84.2–99.4) vs 93.7% (86.8–100), and 75.5% (64.5–87.5) vs 85.4% (75.4–95.4), respectively. Trocar site hernia occurred more frequently in the robotic-assisted group (18.2%) than in the conventional laparoscopy group (4.1%) (odds ratio 5.42, 95% CI, 1.11–26.59, P=.028). The incidence of lymphocele, lymphedema, and other long-term complications showed no significant difference between the groups.  

Investigators concluded that robotic-assisted laparoscopy demonstrated a minor OS benefit in endometrial cancer compared to conventional laparoscopy, with a comparable safety profile, but larger trials were needed to confirm the survival advantage. 

Source: ajog.org/article/S0002-9378(24)00868-8/fulltext