Acute outcomes with robotic versus laparoscopic and open hysterectomy for endometrial cancer: a retrospective cohort study from Alberta, Canada.

BACKGROUND

We sought to compare real-world outcomes of robotic hysterectomy (RH) with laparoscopic (LH) and open (OH) hysterectomy among adults living with endometrial cancer in Alberta, Canada.

METHODS

We used administrative data to identify adults living with endometrial cancer who underwent a total hysterectomy (2012 to 2022) in Alberta. We applied generalized linear regression models and adjusted for confounders using propensity score overlap weighting. We presented predicted means and estimated probabilities with 95% confidence intervals (CIs).

RESULTS

We included 4555 patients. In adjusted analyses, patients who underwent RH had a shorter length of hospital stay (1.2 [95% CI 1.2 to 1.3] d) than those who underwent LH (2.0 [95% CI 1.9 to 2.1] d) or OH (3.7 [95% CI 3.6 to 3.8] d). Duration of surgery for RH was shorter than LH (172 [95% CI 169 to 174] min v. 186 [95% CI 183 to 189] min), and longer than OH (173 [95% CI 171 to 175] min v. 169 [95% CI 167 to 171] min). Compared with patients who underwent OH, those who underwent RH had reduced probabilities of blood transfusions (2.2% [95% CI 1.3% to 3.9%] v. 6.6% [95% CI 4.8% to 9.0%]), perioperative complications (12.7% [95% CI 10.2% to 15.8%] v. 20.5% [95% CI 17.3% to 24.0%]), infections (16.5% [95% CI 13.6% to 19.8%] v. 33.8% [95% CI 30.0% to 37.9%]), and 30-day acute care readmissions (11.7% [95% CI 9.2% to 14.6%] v. 17.9% [95% CI 14.9% to 21.3]); no differences were observed in comparisons with LH.

CONCLUSION

Among adults living with endometrial cancer in Alberta, RH was associated with a shorter length of hospital stay than LH and OH; we also noted fewer blood transfusions, complications, infections, and readmissions for RH compared with OH but not LH. Findings can be used in the context of surgical volumes and outcomes, along with other considerations, to guide decisions.