Robotic-assisted surgery versus conventional laparoscopy in endometrial cancer: a systematic review and meta-analysis.

BACKGROUND

Endometrial cancer is the sixth most common malignancy in women worldwide, and surgery remains the cornerstone of its treatment. Minimally invasive approaches, including conventional laparoscopy and robotic-assisted surgery are widely used; however, their relative oncologic effectiveness remains debated. This systematic review and meta-analysis compared oncologic and perioperative outcomes of robotic-assisted hysterectomy and conventional laparoscopic hysterectomy in patients with endometrial cancer.

METHODS

A systematic literature search was performed in PubMed/MEDLINE, Scopus, Embase, Cochrane and Web of Science according to PRISMA 2020 guidelines. Comparative studies evaluating robotic assisted versus laparoscopic surgery for endometrial cancer were included. Outcomes assessed included lymph node yield, recurrence, progression-free survival (PFS), overall survival (OS), and perioperative variables, including estimated blood loss (EBL), conversion to open surgery, operative time, and intraoperative complications. Random-effects meta-analyses with heterogeneity and sensitivity analyses were conducted.

RESULTS

Forty-two studies, including 91,151 patients, were analyzed. Robotic-assisted and laparoscopic surgery demonstrated equivalent oncologic outcomes, with no significant differences in recurrence, PFS, or OS. Lymph node yields were similar between approaches. Robotic surgery was associated with reduced EBL and lower conversion to open surgery, while other perioperative outcomes were comparable. Intraoperative complications were slightly more frequent in the robotic group.

CONCLUSIONS

Robotic-assisted and conventional laparoscopic hysterectomy provide equivalent oncologic and survival outcomes. Perioperative differences are modest and mainly reflect technical characteristics. Surgical platform choice may therefore be guided by institutional resources, surgeon expertise, and patient-specific factors.

PROSPERO REGISTRATION NUMBER: CRD420251274986 (registered on December 29, 2025).