Nationwide introduction of robotic minimally invasive surgery was associated with improved survival and decreased odds of severe complications in women with early-stage endometrial cancer —a population-based prospective cohort study

Introduction: The oncological safety of minimally invasive techniques versus open access surgery in gynaecological cancer is currently debated. Substantial changes in the surgical management of endometrial cancer necessitates evaluation to ensure survival is not compromised and severe complications are not increased. Methodology: A nationwide prospective cohort of 5654 women with early-stage endometrial cancer hysterectomized between January 1, 2005 and June 30, 2015, were identified using the Danish Gynaecological Cancer Database. Data were linked with national registers on socioeconomic status, deaths, hospital diagnoses and treatments using each womans civil registration number. The cohort was divided according to the time they underwent surgery; group 1 underwent surgery before the introduction of robotic minimally invasive surgery (RMIS) in their respective region, and group 2 underwent surgery after. Women in group 2 were subdivided in total abdominal hysterectomy (TAH), laparoscopic minimally invasive surgery (LMIS), and RMIS. Severe complications encompassed death within 30 days, intraoperative complications, and postoperative complications diagnosed within 90 days. Five-year overall survival and odds of severe complications were compared by multivariate Cox proportional hazards models stratified by histopathological risk and multivariate logistic regression, respectively. Results Women in Group 1 (n=3091) had significantly higher mortality and odds of severe complications compared with those in Group 2 (n=2563; hazard ratio [HR], 1.22; 95%CI, 1.05-1.42 and odds-ratio [OR], 1.39; 95% confidence interval [CI], 1.11-1.74, respectively). In group 2, TAH was associated with higher mortality and increased odds of complications compared with RMIS (HR, 1.70; 95% CI 1.31-2.19 and OR, 3.87; 95%CI, 2.52-5.93, respectively). The proportion of women undergoing TAH was 85.9% and 27.8% in group 1 and 2, respectively. Conclusion: The national introduction of RMIS transitioned the surgical approach for early-stage endometrial cancer towards minimally invasive surgery. This change was associated with improved survival and significantly reduced odds of severe complications.Disclosures: The authors have no conflicts of interest to declare.