Robotic Surgery versus Traditional Laparotomy: Surgical and Oncological Outcomes in Early-Stage Endometrial Cancer

Robotic Surgery versus Traditional Laparotomy: Surgical and Oncological Outcomes in Early-Stage Endometrial Cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Robotic Surgery versus Traditional Laparotomy: Surgical and Oncological Outcomes in Early-Stage Endometrial Cancer Priya Bhati, Monal Garg, Divya Panyam Vuppu, Anjali S Nair, Sheejamol VS This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4759972/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract AIM: This study aims to determine differences in surgical and survival outcomes for patients undergoing robotic surgeries versus laparotomies for early-stage endometrial cancer (EC). METHODS: This study was conducted retrospectively from 1st January 2015 to 30th June 2021 on all patients with stage I or stage II EC (FIGO 2023 Staging), irrespective of histology. Primary objective was to compare 3-year Overall Survival (OS) and Recurrence Free Survival (RFS) between robotic versus laparotomy group. RESULTS: In a study of 297 patients, 81.5% underwent robotic surgeries and 18.5% underwent open surgeries. Median age was 47.5 years. Majority (81%) of the patients had Endometroid histology. Seventy percent of the cases had stage I, and 29.6% had stage II EC. Robotic group had significantly shorter hospital stay, blood loss and operative time (p < 0.05). After a median follow-up period of 36 months, 9 deaths occured in robotic group and no deaths in laparotomy group leading to a 3-year OS of 95.4% in robotic group and 100% in laparotomy group. RFS rates of 92.5% and 86.1% in robotic and laparotomy groups, respectively (p = 0.6). However, median time to recurrence was significantly shorter in open group than robotic group (28 versus 38 months respectively, p = 0.01). CONCLUSION: No statistically significant differences between both groups were found in RFS and OS. Robotic surgeries have better surgical and equivalent oncological outcomes than open surgeries in stage I and II EC. Robotics Postoperative complications Survival Endometrial Cancer Early-stage Figures Figure 1 Figure 2 INTRODUCTION Endometrial cancer is the fifteenth most frequently diagnosed cancer in women globally and the sixth most common cancer among women [ 1 ]. In 2022, India reported 6,845 deaths from endometrial cancer, placing the country third in the world for endometrial cancer-related fatalities [ 1 ]. The increasing incidence in India is primarily due to lifestyle factors contributing to obesity. However, most cases are detected early, leading to a good prognosis [ 2 ]. The cornerstone of managing early-stage endometrial cancers is surgical staging, which is the first and most critical step in determining the optimal course of treatment [ 3 ]. Previously, open surgery was the standard for treating gynecologic malignancies [ 4 ]. However, minimally invasive approaches have now become the preferred method for staging endometrial cancer [ 4 ]. These approaches provide patients with a safer, more comfortable experience, leading to shorter hospital stays, fewer complications, and faster recovery times, all without compromising disease-free or overall survival rates [ 4 ]. The LAP2 trial [ 5 ] conducted a significant prospective randomised study comparing laparotomy and laparoscopic approaches for staging endometrial cancer , emphasising the important role of Minimally Invasive Surger ies (MIS) in treating endometrial cancer. The study revealed that the laparoscopy group had fewer postoperative complications, shorter hospital stays, and a similar Overall Survival (OS) rate. With the advancements in MIS, laparoscopic surgery is now being replaced by robot-assisted surgery as the preferred approach for early-stage uterine cancer, offering superior visualisation, precision, and patient outcomes [ 6 ]. The first da Vinci robot was introduced in the early 2000s, despite robotic assistance being introduced in surgical practice in 1980 [ 7 ]. After the FDA approval of robotics in gynaecology in 2005, its use for both benign and malignant cases has increased. According to reports, more than seventy Da Vinci surgical systems have been installed and more than 50,000 procedures have been performed in India as of 2021 [ 7 ]. Various studies and metanalysis have been published regarding the advantages of robotic mode in terms of peri-operative outcomes over conventional open approach in endometrial cancers [ 8 , 9 , 10 ]. Despite being recommended in the early stage of endometrial cancer according to current evidence, more information on long-term oncological outcomes is necessary [ 11 ]. Therefore, this study aim ed to assess and compare short-term and long-term outcomes between robotic surgery and open surgery in early-stage endometrial cancer. MATERIALS AND METHODS Study Design and Patient Selection : This was a retrospective single-institution study. Two hundred and ninety-seven cases of early-stage endometrial cancer operated between February 1, 2015, and December 31, 2021, were included. The Institutional Ethics Committee approved the study (IEC-AIMS-2024-GYNAEC ONCO-146). Patient information was collected from the institution’s Health Information System. The Primary Objective was to compare 3-year Overall Survival (OS) between robotic and laparotomy surgical modes in patients with early-stage endometrial cancer. The secondary objectives were to determine 3-year Recurrence-Free Survival (RFS), compare robotic and laparotomy groups, and compare short-term peri-operative outcomes and long-term complications between robotic and laparotomy groups. Inclusion Criteria : 1. Apparent Stage I and Stage II Endometrial Cancer 2. All Histology types and Grades 3. Underwent upfront robotic or open staging surgery Exclusion Criteria : 1. Advanced-stage (stage III and stage IV) Endometrial Cancer 2. Surgery performed outside 3. Operated via a laparoscopic approach Institutional Protocol : Da Vinci Xi Surgical System was used for all the robotic surgeries with precise four-site port placement. The surgeon carefully selected the surgical approach, taking into account the patient's body type, health conditions, and personal preferences. The comprehensive procedure included peritoneal wash cytology, simple total hysterectomy with bilateral salpingo-oophorectomy, and sentinel lymph node biopsy (SLNB) or pelvic lymph node dissection (PLND) with adherence to the MSKCC algorithm (11) using indocyanine green dye (ICG) for SLNB. If there was no dye uptake in the robotic surgery group, PLND was performed. However, PLND was more commonly conducted in the open surgery group. Adjuvant treatment decisions were based on the ESGO risk stratification (2020) [ 11 ]. Vaginal brachytherapy was administered at a dosage of 21Gy in 3 fractions for those classified as Intermediate Risk (IR). High-Intermediate Risk (HIR) and High Risk (HR) patients received External Beam radiotherapy (EBRT) with or without VBT at a dose of 45Gy in 25 fractions. Patients with type 2 histologies (serous, carcinosarcoma, or clear cell) were treated with concurrent chemo-radiation (CTRT), consisting of EBRT with cisplatin on day 1 and day 25, followed by four cycles of chemotherapy (carboplatin + paclitaxel). Defining comparative outcomes : Various demographic parameters , such as age, ASA (American Society of Anesthesiologists) classification, and Body Mass Index (BMI), were collected. Additionally, histological parameters including International Federation of Gynecology and Obstetrics (FIGO 2023) stage, histological type, grade, Lymphovascular Space Invasion (LVSI), Myometrial Invasion (MI), and the number of nodes harvested were documented. Robotic surgery operative time was the duration from docking to closure of port-site incisions for robotic surgeries, while open surgery time was the period from skin incision to closure. The amount of blood lost during the surgery was calculated by subtracting the volume of irrigation fluid from the total fluid collected in the suction container and then adding the weight of the used sponges. The length of hospital stay referred to the number of nights spent in the hospital after surgery and did not include the 1–2 days of pre-operative admission for patients who require optimisation before major surgery. We also documented any complications during and after the surgery. Postoperative complications were those that occurred within 30 days following the surgery. These complications were categorised as infections (wound infections or dehiscence), cardiopulmonary issues (atelectasis, pneumonia, pulmonary edema, heart failure, and coronary artery events), and renal problems (urinary retention, hematuria, and urinary tract infections). We followed up with our patients in person or via telephone to monitor any events, including death or recurrence. Statistical Analysis : Statistical analyses were done using IBM SPSS Statistics 20 for Windows (SPSS Inc., Chicago, IL, USA). The results are presented as mean ± SD for continuous variables and frequency (percentage) for categorical variables. RFS (recurrence-free survival) was the duration between the surgery date and the documented recurrence date, while OS (overall survival) was the time from the diagnosis date to the date of death from any cause. To compare the average OS time and RFS between groups, Kaplan-Meier curves and log-rank tests were used. Statistical significance was considered at p < 0.05, and all tests for statistical significance were two-tailed. RESULT Clinicopathological outcomes Out of 297 patients, 242 (81.5%) underwent robotic surgeries while 55 (18.5%) underwent open surgeries. The comparison of clinicopathological parameters is highlighted in Table 1 . Both groups were similar regarding mean age, mean BMI, grade, and histology type ( Table 1 ). In the robotic group, 32.4% (n = 77) patients had a BMI ≥ 30kg/m2, compared to 25% (n = 10) in the open group (p = 0.34). Endometrioid histology was found in 80.8% (n = 240) of the cohort, with 62.1% (n = 149) patients having Grade 1 and 7.5% (n = 18) having Grade 3 endometrioid histology. Stage I and Stage II were found in 209 (70.4%) and 88 (29.6%) patients, respectively. There was a significant difference in the stage-wise distribution (p = 0.02) between the groups, with most stage II patients (n = 42; 41.8%) belonging to the open group. Table 1 Comparison of clinicopathological features between robotic and open surgery groups. CATEGORY SUB-CATEGORY TOTAL (n = 297) ROBOTIC (n = 242) OPEN (n = 55) P AGE (mean, SD) 58.4 (11.2) 59.3 (9.9) 0.60 BMI (mean, SD) 28.7 (5.7) 28.3 (5.4) 0.71 HISTOLOGY Type 1 240 (80.8%) 197 (81.4%) 43 (78.2%) 0.58 Type 2 57 (19.2%) 45 (18.6%) 12 (21.8%) ENDOMETROID GRADE 1 149 (62.1%) 125 (63.5%) 24 (55.8%) 0.19 2 73 (30.4%) 60 (30.5%) 13 (30.2%) 3 18 (7.5%) 12 (6.1%) 6 (14%) MYOMETRIAL INVASION No 19 (6.4%) 17 (7%) 2 (3.6%) 0.07 < 50% 180 (60.6%) 152 (62.8%) 28 (51%) ≥ 50% 98 (33%) 73 (30.1%) 25 (45.4%) LYMPHOVASCULAR SPACE INVASION (LVSI) No 227 (76.4%) 187 (77.3%) 40 (72.7%) 0.47 Focal 70 (23.5%) 55 (22.7) 15 ( 27.3%) LYMPH NODES EVALUATION SLNB 230 (95%) 213 (88%) 17 (31%) PLND 56 (18.8%) 24 (10%) 32 (58%) Not Done 11 (3.7%) 5 (2%) 6 (11%) NUMBER OF LYMPH NODES HARVESTED B/L 5 (3–7) 9 (4–15) 0.0002 FIGO 2023 STAGE IA1 13 (4.4%) 11 (4.5%) 2 (3.6%) 0.02 IA2 135 (45.5%) 117 (48.3%) 18 (7%) IB 57 (19.2%) 46 (19%) 11 (20%) IC 4 (1.3%) 3 (1.2%) 1 (1.8%) IIA 17 (5.7%) 11 (4.5%) 6 (10.9%) IIC 71 (23.9%) 54 (22.3%) 17 (30.9%) RISK CATEGORIZATION Low 151(50.8%) 129 (53.3%) 22 (40%) 0.09 Intermediate 59 (19.8%) 49 (20.2%) 10 (18.1%) High Intermediate 17 (5.7%) 11 (4.5%) 6 (11%) High 70 (23.5%) 53 (22%) 17 (31%) ADJUVANT TREATMENT Observation 139 (46.8%) 120 (49.5%) 19 (34.5%) 0.04 VBT 108 (36.3%) 83 (34.3%) 25 (45.4%) EBRT 3 (1%) 3 (1.2%) 0 VBT + EBRT 28 (10.4%) 19 (7.8%) 9 (16.3%) CTRT + CHEMOTHERAPY 47 (15.8%) 35 (14.4%) 12 (21.8%) All patients underwent standard staging surgery for endometrial cancer. Only one robotic case was converted into a laparotomy. SLNB procedure was done in 95% of the patients, with 88% in the robotic surgery group and 31% in the open surgery group. PLND was performed in cases where SLNB mapping failed in 10% of patients in the robotic group, while it was done as a primary procedure in 58% of patients in the open group. Total lymph nodes (median) harvested was 5 (range 2–12) in the robotic group and 9 (range 4–29) in the open group (p = < 0.0001). Adjuvant treatments given were vaginal brachytherapy (VBT) in 108 (36.3%) cases, external beam radiation therapy (EBRT) plus VBT in 31 (10.4%) cases, and concurrent chemoradiotherapy (CTRT) plus chemotherapy in 47 (15.8%) cases. As patients in the open group mainly had stage II disease, more patients received VBT (45.4%) and CTRT (21.8%) compared to the robotic group where 34.3% patients received VBT and only 14.4% patients received CTRT followed by chemotherapy (p = 0.04). Short-term Outcomes : A comparison of the preoperative outcomes between the two groups is detailed in Table 2 . The robotic group exhibited significant advantages over the open group, with reduced operating time (p < 0.0001), minimal blood loss (p < 0.0001), and shorter hospital stays (p < 0.0001). Among the three patients who underwent standard laparotomy, over 500ml of blood loss was reported (p = 0.004), with one patient experiencing 1500ml of blood loss due to stage II endometrial cancer. In contrast, no patient in the robotic group experienced over 500ml of blood loss. The open group had significantly higher postoperative complication rates compared to the robotic group (47.3% vs. 4.1%; p < 0.0001). Patients in the open surgery group experienced a significantly higher incidence of postoperative complications, including blood transfusions (p = 0.02), paralytic ileus (p < 0.0001), surgical site wound infections (p < 0.0001), and fever (p < 0.0001). Two patients required wound resuturing due to wound dehiscence. Both groups had similar incidence of cardiopulmonary events (p = 0.41) and urinary tract infections (p = 0.06). Notably, urinary retention occurred in four patients in the robotic group (p = 0.75), while there were no cases of urinary retention in the open group. Table 2 Comparison of peri-operative, short-term and long-term outcomes between robotic and open surgery groups. SURGICAL OUTCOMES UNIT ROBOTIC OPEN P VALUE Operative Time (min) Mean 78 150 < 0.0001 Median 120 150 Min-Max 60–239 81–279 Estimated Blood Loss (mL) Mean 140 < 0.0001 Median 20 200 Min-Max 10–70 30–590 Duration of Hospital Stay (Days) Mean 2 2 500ML 0 3 0.004 SHORT-TERM POSTOPERATIVE COMPLICATIONS Paralytic Ileus 0 7 < 0.001 Blood Transfusion 0 2 0.02 Cardio-pulmonary (CAD) 0 2 0.41 Urinary Retention 4 0 0.75 Urinary Tract Infection 2 3 0.06 Electrolyte Imbalance 1 1 0.81 Vaginal Cuff Dehiscence 1 0 1.0 Wound Infection 0 5 < 0.001 Fever 2 4 0.011 ICU STAY 0 1 0.41 Readmission 0 1 0.41 Total Complications 10 (4.1%) 26 (47.3%) < 0.001 LONG-TERM OUTCOMES Lymphedema 2 2 0.32 Incisional Hernia 0 5 < 0.001 Recurrences 15 (6.2%) 5 (9.1%) 0.63 Death 9 (3.7%) 0 (0%) 0.30 Long-term Outcomes : Two patients in both the robotic and open surgery groups developed lymphedema (p = 0.32). The patients in the open surgery group experienced lymphedema within a year. In contrast, incisional hernia did not occur in the robotic group, but seven patients in the open group developed this complication (p = < 0.001) after nearly a year. After a median follow-up period of 36 months (ranging from 10 to 36 months), the 3-year overall survival rate was 100% in the open surgery group and 95.4% in the robotic surgery group (Fig. 1 ). In the robotic surgery group, there were nine deaths recorded, while there were no deaths in the open surgery group (p = 0.30). Out of these 9 patients, 5 died from other causes, including sepsis (n = 1), renal failure (n = 2), acute myocardial infarction (n = 1), and secondary lung malignancy (n = 1). The other 4 patients experienced death due to disease recurrences in the lung (n = 3) and vault (n = 1). Recurrences were observed in 20 patients (6.7%), with 15 in the robotic group and five in the open group (p = 0.63). The median time to recurrence was notably shorter in the open surgery cohort (29 months) compared to the robotic surgery cohort (38 months) (p = 0.01). The 3-year recurrence-free survival rates were 92.4% in the robotic group and 86.1% in the open surgery group, with no statistically significant difference found (p = 0.26; HR ratio 1.7, CI: 0.6–4.8) (Fig. 2 ). Common sites for recurrences included the vaginal stump (n = 7, 35%), abdomen (n = 8, 40%), nodal areas (n = 4, 20%), and distant sites (n = 11, 55%). Local recurrences specifically occurred in 7 patients (2.9%) in the robotic group (p = 0.31), while regional, nodal, and distant recurrences were observed in both groups. Further details about patients who experienced recurrences can be found in Table 3 . Table 3 Comparison of clinicopathological features of recurrence cases between robotic and open surgery groups. CATEGORY SUB-CATEGORY ROBOTIC (N = 15) OPEN (N = 5) P VALUE AGE Mean Age (years) 61.5 47.5 0.67 STAGE Stage IA2 3 (20%) 1 (20%) 1.0 IB 4 (26.6%) 2 (40%) IIC 8 ( 53.3%) 2 (40 %) HISTOLOGY TYPE Type 1 10 (66.6%) 5 (100%) 0.37 Type 2 5 (33.3%) 0 MI 50% 7 (46.6%) 4 (80%) LVSI No 7 (46.6%) 2 (40%) 1.0 Focal 8 (53.3%) 3 (60%) RECURRENCE SITE Vaginal Stump 7 ( 46.6% ) 0 0.31 Abdominal 7 ( 46.6% ) 1 ( 20 %) 0.91 Nodal 2 ( 13.3 %) 2 ( 40 %) 0.51 Distant 11 ( 73.3 %) 2 ( 4 %) 0.41 DISCUSSION Robotic surgery was initially utilised for gynaecological malignancies in 2007 [ 12 ] and was introduced to our institute in 2015. Since then, robotic surgery has significantly progressed and has become a standard approach in many benign and malignant cases [ 3 ]. Despite being used for over a decade, the published literature still needs a comparison of long-term outcomes with the conventional open approach. Several studies have compared the outcomes of different surgical methods for endometrial cancer. Current research suggests that laparoscopic surgery generally leads to better survival rates than open surgery [ 5 , 13 , 14 ]. Studies comparing robotic and laparoscopic approaches for endometrial cancer found no significant differences in the survival rates. [ 14 , 15 ]. However, only a few studies have looked at the long-term outcomes of robotic and open surgery approaches for endometrial cancer in all stages [ 8 , 10 , 11 ]. In a retrospective comparative analysis of 936 patients, Park et al. found similar survival outcomes between robotic and open surgeries. The estimated 3-year PFS rates were 90.87% for robotic surgery and 78.30% for open surgery. The estimated 5-year OS rates were 89.14% for robotic surgery and 79.47% for open surgery [ 8 ]. Another study by Kilgore et al. focused on 499 patients who underwent robotic surgery at a single institution and reported a 5-year OS rate of 88.7% after a median follow-up of 23 months. When comparing these results to data from the Surveillance Epidemiology and End Results (SEER) database of patients with endometrial cancer between 1975–2008, similar 5-year OS rates of 79%−87% were reported, suggesting comparable outcomes [ 16 ]. The present study also found no significant difference in the 3-year OS rate (95.4% versus 100%) and the 3-year PFS rate (92.4% versus 86.1%, p = 0.6) after a median follow-up period of 36 months between the groups. This suggests that a robotic approach is as practical as the traditional laparotomy approach for surgery in terms of survival outcomes in early-stage endometrial cancer. Studies evaluating long-term robotic surgery outcomes have reported a wide range of recurrence rates, from 1.2% with a relatively short 18-month follow-up period to 14.8% [ 9 , 13 , 17 ]. In a study by Song J et al., a statistically significant increase in recurrence rates was found in the robotic surgery group compared to the open surgery group (11.3% vs 0%). It's important to note that the study only included patients in the intermediate-risk category who were expected to have favourable outcomes. The increased recurrence rates in the robotic surgery group underscore the importance of meticulous surgical techniques and modern instruments [ 9 ]. On the flip side, some research has shown that the open surgery group has higher recurrence rates in comparison to the robotic surgery group [ 8 , 18 ]. These results were attributed to more patients with advanced stages, higher grades, and non-endometroid histology in the open surgery group. However, a study by Nayyar et al. [ 19 ] found that similar recurrence rates were reported in both groups when compared in terms of stage and histological parameters. Our study did not include patients in the advanced stages, an essential factor contributing to recurrence. This exclusion makes the results more significant. Although more stage II patients were in the open group, the recurrence rates were similar to the robotic group in our study (9% vs 6.2%). However, the open surgery group had a notably shorter median time to recurrence than the robotic surgery group (28 months versus 38 months, respectively, p = 0.01), possibly because the open group had more stage II patients. In our study, the use of uterine manipulators during robotic surgery did not result in increased or earlier recurrences, which is consistent with the findings of other studies [ 20 , 21 , 22 ]. Some studies have suggested that a longer median time to adjuvant treatment is directly linked to increased recurrences [ 9 , 23 , 24 , 25 ]. However, in our study, both groups had a median time of 1 month to start adjuvant treatment, which did not influence the recurrence rates. Data on the recurrence sites observed during the follow-up period have only been reported by a few studies, potentially due to the late adoption of robotic surgery for endometrial cancer [ 19 , 26 , 27 ]. Recurrences in the vaginal stump have been reported in 1% of patients who underwent robotic surgery [ 26 , 27 ], compared to 2.3% in patients who underwent laparotomy [ 27 ]. Surprisingly, in our study, the most common recurrence site in the robotic group was the vaginal stump (n = 7, 2.9%), while no patients in the laparotomy group developed a recurrence in the vaginal stump. Out of the seven patients who developed vaginal stump recurrences, three patients had isolated vaginal stump recurrences. This may be attributed to the fact that all patients except one had endometrioid histology, which is more likely to recur in the vagina [ 28 , 29 , 30 ]. Although significant LVSI is a well-established marker for predicting recurrences in endometrial cancer [ 31 , 32 ], higher recurrence rates have also been reported in cases of focal LVSI compared to no LVSI [ 31 , 33 ]. Restaino et al. found a gradual increase in the risk of lymph node metastasis (5%, 15%, and 33%) and distant recurrences (6.6%, 14.7%, and 24.9%) in endometrial cancer patients with no LVSI, focal LVSI, and diffuse LVSI, respectively [ 31 ]. Our study also observed that 11 (55%) out of 20 recurrences involved focal LVSI, which may have contributed to the risk of developing recurrences in early-stage endometrial cancer patients. However, none of the patients in our cohort exhibited diffuse LVSI. Therefore, focal LVSI should not be overlooked in the histopathology report, and these patients should be carefully monitored for recurrences. Our study revealed that the robotic surgery group had better peri-operative outcomes than the open surgery group. The robotic group showed a reduced operating time, less estimated blood loss, and a shorter hospital stay compared to the open group. While some studies have reported a shorter operative time in the robotic group [ 15 , 34 ], most studies, including meta-analyses, have shown longer operative times with minimally invasive surgery [ 27 , 35 ]. Our study's median operative time was significantly shorter in the robotic group (120 vs. 150 min). These differences in operative time outcomes are primarily influenced by factors such as institution type, surgeon’s experience, and patient load. Our institute handles a high caseload of endometrial cancer cases. Regarding postoperative complications, our study indicated a similar rate of postoperative complications (4.1%) in the robotic group as reported in other studies [ 36 ]. This was significantly lower than the open surgery group (47.3%, p < 0.0001). Based on previous studies [ 8 , 19 ], the number of lymph nodes (median) harvested are comparable in both groups. However, our research showed that the laparotomy group had significantly more lymph nodes retrieved compared to the robotic group. This variance could be attributed to the utilisation of SLNB mapping in the robotic group.Most patients in the open surgery group had stage II disease and underwent PLND, leading to a higher number of lymph nodes obtained in this group. This retrospective comparative analysis is one of the few studies that examines both short-term and long-term outcomes for early-stage endometrial cancer by comparing robotic and traditional laparotomy surgeries. We assessed perioperative and long-term consequences, including recurrence patterns and survival analysis. There is limited recent literature comparing robotic versus open surgery groups, making our study significant in contributing to important outcomes. However, it's important to note that the study is limited by its retrospective nature and the relatively small sample size. In conclusion, the findings indicate that robot-assisted surgery is a beneficial surgical method for treating endometrial cancer. It is both safe and less invasive than laparotomy, as demonstrated by improved perioperative results and significantly reduced short-term and long-term complications while achieving similar therapeutic outcomes. Declarations Competing Interests: The authors have no relevant financial or non-financial interests to disclose Funding: The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Acknowledgements of research support: None Authors Contributions: All authors contributed to the study's conception and design. Material preparation, data collection and the manuscript was written by Monal Garg, Divya Panyam Vuppu and Priya Bhati Data analysis was done by Anjali S Nair and Sheejamol VS A review of the manuscript was done by Priya Bhati and Divya Panyam Vuppu All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. References Bray F, Laversanne M, Sung H et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024 May-Jun;74(3):229-263. https://doi.org/10.3322/caac.21834 Sonkar D, Agarwal S, Melgandi W et al. Epidemiological characteristics of endometrial cancer patients treated at a tertiary health centre in National Capital Territory of India. J Cancer Res Ther. 2023 Jan-Mar;19(2):452-456. https://doi.org/10.4103/jcrt.jcrt_2029_21 Kuhn TM, Dhanani S, Ahmad S. An Overview of Endometrial Cancer with Novel Therapeutic Strategies. 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J Natl Compr Canc Netw. 2023 Feb;21(2):181-209. https://doi.org/10.6004/jnccn.2023.0006 Shanmugam S, Thanikachalam R, Murugan A. Comparative study of laparoscopic versus conventional open surgical staging procedure for endometrial cancer: Our institutional experience. Gynecol Minim Invasive Ther. 2020 Jan 23;9(1):29-33. https://doi.org/10.4103/GMIT.GMIT_82_19 Galaal K, Donkers H, Bryant A et al. Laparoscopy versus laparotomy for the management of early stage endometrial cancer. Cochrane Database Syst Rev. 2018 Oct 31;10(10):CD006655. https://doi.org/10.1002/14651858.CD006655.pub3 Argenta PA, Mattson J, Rivard CL et al. Robot-assisted versus laparoscopic minimally invasive surgery for the treatment of stage I endometrial cancer. Gynecol Oncol. 2022 May;165(2):347–52. https://doi.org/10.1016/j.ygyno.2022.03.007 Mäenpää MM, Nieminen K, Tomás EI et al. Robotic-assisted vs traditional laparoscopic surgery for endometrial cancer: a randomized controlled trial. Am J Obstet Gynecol. 2016 Nov;215(5):588.e1-588.e7. https://doi.org/10.1016/j.ajog.2016.06.005 Kilgore JE, Jackson AL, Ko EM et al. Recurrence-free and 5-year survival following robotic-assisted surgical staging for endometrial carcinoma. Gynecol Oncol. 2013 Apr;129(1):49–53. https://doi.org/10.1016/j.ygyno.2012.12.020 Chiou HY, Chiu LH, Chen CH et al. Comparing robotic surgery with laparoscopy and laparotomy for endometrial cancer management: A cohort study. Int J Surg. 2015 Jan;13:17–22. https://doi.org/10.1016/j.ijsu.2014.11.015 Lau S, Vaknin Z, Ramana-Kumar AV et al. Outcomes and Cost Comparisons After Introducing a Robotics Program for Endometrial Cancer Surgery. Obstet Gynecol. 2012 Apr;119(4):717-24. https://doi.org/10.1097/AOG.0b013e31824c0956 Nayyar N, Sekhon RK, Jain V et al. Clinical Outcomes of Robotic Versus Open Radical Hysterectomy in Endometrial Cancer Staging: An Experience at a Tertiary Referral Care Center. J Gynecol Surg. 2019 Oct 1;35(5):279–84. https://doi.org/10.1089/gyn.2019.0020 Eoh KJ, Kim YN, Nam EJ et al. Clinical Relevance of Uterine Manipulation on Oncologic Outcome in Robot-Assisted versus Open Surgery in the Management of Endometrial Cancer. J Clin Med. 2023 Mar 1;12(5):1950. https://doi.org/10.3390/jcm12051950 Ito H, Moritake T, Isaka K. Does the use of a uterine manipulator in robotic surgery for early‐stage endometrial cancer affect oncological outcomes? Int J Med Robot. 2022 Aug 24;18(6). https://doi.org/10.1002/rcs.2443 Meng Y, Liu Y, Lin S et al. The effects of uterine manipulators in minimally invasive hysterectomy for endometrial cancer: A systematic review and meta-analysis. Eur J Surg Oncol. 2020 Jul;46(7):1225–32. https://doi.org/10.1016/j.ejso.2020.03.213 Cattaneo R II, Hanna RK, Jacobsen G et al. Interval Between Hysterectomy and Start of Radiation Treatment Is Predictive of Recurrence in Patients With Endometrial Carcinoma.Int J Radiat Oncol Biol Phys. 2014 Mar;88(4):866–71. https://doi.org/10.1016/j.ijrobp.2013.11.247 Ghanem AI, Modh A, Burmeister C et al. Does Interval between Hysterectomy and Start of Radiation Treatment Influence Survival in Early Stage Endometrial Carcinoma? A National Cancer Database Analysis.Int J Radiat Oncol Biol Phys. 2017 Oct;99(2):E292. https://doi.org/10.1097/COC.0000000000000713 Ahmad NR, Lanciano RM, Corn BW et al. Postoperative radiation therapy for surgically staged endometrial cancer: Impact of time factors (overall treatment time and surgery-to-radiation interval) on outcome. Int J Radiat Oncol Biol Phys. 1995 Nov;33(4):837–42. https://doi.org/10.1016/0360-3016(95)00197-0 Togami S, Fukuda M, Mizuno M et al. Efficacy and prognosis of robotic surgery with sentinel node navigation surgery in endometrial cancer. J Gynecol Oncol. 2023;34(6). https://doi.org/10.3802/jgo.2023.34.e68 Hayashi S, Yamanaka Z, Kojima J et al. Retrospective comparative study of robot‐assisted surgery, laparoscopic surgery, and laparotomy for endometrial cancer in patients with a low risk of recurrence. J Obstet Gynaecol Res. 2023 Oct 17;50(1):103–12. https://doi.org/10.1111/jog.15816 Åkesson Å, Adok C, Dahm-Kähler P. Increased survival in non-endometrioid endometrial cancer after introducing lymphadenectomy and tailoring radiotherapy – A population-based cohort study. Eur J Cancer. 2022 Jul;169:54–63. https://doi.org/10.1016/j.ejca.2022.04.002 Ignatov T, Eggemann H, Costa SD et al. Endometrial cancer subtypes are associated with different patterns of recurrence. J Cancer Res Clin Oncol. 2018 Jul 19;144(10):2011–7. https://doi.org/10.1007/s00432-018-2711-8 Bendifallah S, Ouldamer L, Lavoue V et al. Patterns of recurrence and outcomes in surgically treated women with endometrial cancer according to ESMO-ESGO-ESTRO Consensus Conference risk groups: Results from the FRANCOGYN Study Group. Gynecol Oncol. 2017 Jan;144(1):107–12. https://doi.org/10.1016/j.ygyno.2016.10.025 Restaino S, Tortorella L, Dinoi G et al. Semiquantitative evaluation of lymph-vascular space invasion in patients affected by endometrial cancer: Prognostic and clinical implications. Eur J Cancer. 2021 Jan;142:29–37. https://doi.org/10.1016/j.ejca.2020.10.011 Stålberg K, Bjurberg M, Borgfeldt C et al. Lymphovascular space invasion as a predictive factor for lymph node metastases and survival in endometrioid endometrial cancer – a Swedish Gynecologic Cancer Group (SweGCG) study. Acta Oncol. 2019 Aug 2;58(11):1628–33. https://doi.org/10.1080/0284186X.2019.1643036 dos Reis R, Burzawa JK, Tsunoda AT et al. Lymphovascular Space Invasion Portends Poor Prognosis in Low-Risk Endometrial Cancer. Int J Gynecol Cancer 2015 Sep;25(7):1292–9. https://doi.org/10.1097/IGC.0000000000000490 Ikebuchi A, Komatsu H, Yamamoto K et al. Outcome of robot-assisted surgery for stage IA endometrial cancer compared to open and laparoscopic surgeries: a retrospective study at a single institution. J Robot Surg. 2024 Mar 23;18(1). https://doi.org/10.1007/s11701-024-01897-8 Janda M, Gebski V, Davies LC et al. Effect of Total Laparoscopic Hysterectomy vs Total Abdominal Hysterectomy on Disease-Free Survival Among Women With Stage I Endometrial Cancer. JAMA. 2017 Mar 28;317(12):1224. https://doi.org/10.1001/jama.2017.2068 ElSahwi KS, Hooper C, De Leon MC et al. Comparison between 155 cases of robotic vs. 150 cases of open surgical staging for endometrial cancer. Gynec. Oncol. 2012 Feb;124(2):260–4. https://doi.org/10.1016/j.ygyno.2011.09.038 Additional Declarations No competing interests reported. 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In 2022, India reported 6,845 deaths from endometrial cancer, placing the country third in the world for endometrial cancer-related fatalities [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe increasing incidence in India is primarily due to lifestyle factors contributing to obesity. However, most cases are detected early, leading to a good prognosis\u003c/span\u003e [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe cornerstone of managing early-stage endometrial cancers is surgical staging, which is the first and most critical step in determining the optimal course of treatment\u003c/span\u003e [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ePreviously, open surgery was the standard for treating gynecologic malignancies\u003c/span\u003e [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eHowever, minimally invasive approaches have now become the preferred method for staging endometrial cancer\u003c/span\u003e [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThese approaches provide patients with a safer, more comfortable experience, leading to shorter hospital stays, fewer complications, and faster recovery times, all without compromising disease-free or overall survival rates\u003c/span\u003e [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe LAP2 trial\u003c/span\u003e [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] conducted \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ea significant prospective\u003c/span\u003e randomised \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003estudy comparing laparotomy and laparoscopic approaches for staging endometrial cancer\u003c/span\u003e, emphasising \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe important role of Minimally Invasive Surger\u003c/span\u003eies \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e(MIS) in\u003c/span\u003e treating \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eendometrial cancer. The study revealed that the laparoscopy group had fewer postoperative complications, shorter hospital stays, and a similar Overall Survival (OS) rate. With the advancements in MIS, laparoscopic surgery is now being replaced by robot-assisted surgery as the preferred approach for early-stage uterine cancer, offering superior\u003c/span\u003e visualisation, \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eprecision, and patient outcomes\u003c/span\u003e [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe first da Vinci robot was introduced in the early 2000s, despite robotic assistance being introduced in surgical practice in 1980\u003c/span\u003e [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAfter the FDA approval of robotics in\u003c/span\u003e gynaecology \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ein 2005, its use for both benign and malignant cases has\u003c/span\u003e increased. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAccording to reports, more than\u003c/span\u003e seventy \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eDa Vinci surgical systems have been installed and more than 50,000 procedures have been performed in India as of 2021\u003c/span\u003e [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eVarious studies and metanalysis have been published regarding the advantages of robotic mode in terms of peri-operative outcomes over conventional open approach in endometrial cancers\u003c/span\u003e [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Despite being recommended in the early stage of endometrial cancer according to current evidence, more information on long-term oncological outcomes is necessary [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eTherefore, this study aim\u003c/span\u003eed \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eto assess and compare short-term and long-term outcomes between robotic surgery and open surgery in early-stage endometrial cancer.\u003c/span\u003e\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eStudy Design and Patient Selection\u003c/span\u003e:\u003c/p\u003e\n\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThis was a retrospective\u003c/span\u003e single-institution \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003estudy. Two hundred and\u003c/span\u003e ninety-seven cases of early-stage endometrial cancer operated between February 1, 2015, and December 31, 2021, were included. The Institutional Ethics Committee approved the study (IEC-AIMS-2024-GYNAEC ONCO-146). \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ePatient information was collected from the institution\u0026rsquo;s Health Information System.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe Primary Objective was to compare 3-year Overall Survival (OS) between robotic and laparotomy surgical modes in patients with early-stage endometrial cancer. The secondary objectives were to determine 3-year Recurrence-Free Survival (RFS), compare robotic and laparotomy groups, and compare short-term peri-operative outcomes and long-term complications between robotic and laparotomy groups.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eInclusion Criteria\u003c/span\u003e:\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e1. Apparent Stage I and Stage II Endometrial Cancer\u003c/span\u003e\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2. All Histology types and Grades\u003c/span\u003e\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e3. Underwent upfront robotic or open staging surgery\u003c/span\u003e\u003cbr\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eExclusion Criteria\u003c/span\u003e:\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e1. Advanced-stage (stage III and stage IV) Endometrial Cancer\u003c/span\u003e\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2. Surgery performed outside\u003c/span\u003e\u003cbr\u003e\u003c/span\u003e\u003cspan\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e3. Operated via\u003c/span\u003e a \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003elaparoscopic approach\u003c/span\u003e\u003cbr\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eInstitutional Protocol\u003c/span\u003e:\u003c/p\u003e\n\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eDa Vinci Xi Surgical System was used for all the robotic surgeries with precise four-site port placement. The\u003c/span\u003e surgeon carefully selected the surgical approach, taking \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003einto account the patient\u0026apos;s body type, health conditions, and personal preferences. The comprehensive procedure included peritoneal wash cytology, simple total hysterectomy with bilateral salpingo-oophorectomy, and sentinel lymph node biopsy (SLNB) or pelvic lymph node dissection (PLND) with adherence to the MSKCC algorithm (11) using indocyanine green dye (ICG) for SLNB. If there was no\u003c/span\u003e dye uptake \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ein the robotic surgery group, PLND was performed. However, PLND was more commonly conducted in the open surgery group. Adjuvant treatment decisions were based on the ESGO risk stratification (2020)\u003c/span\u003e [\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eVaginal brachytherapy was administered at a dosage of 21Gy in 3 fractions for those classified as Intermediate Risk (IR). High-Intermediate Risk (HIR) and High Risk (HR) patients received External Beam radiotherapy (EBRT) with or without VBT at a dose of 45Gy in 25 fractions. Patients with type 2 histologies (serous, carcinosarcoma, or clear cell) were treated with concurrent chemo-radiation (CTRT), consisting of EBRT with cisplatin on day 1 and day 25, followed by four cycles of chemotherapy (carboplatin\u0026thinsp;+\u0026thinsp;paclitaxel).\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eDefining comparative outcomes\u003c/span\u003e:\u003c/p\u003e\n\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eVarious demographic parameters\u003c/span\u003e, such as age, ASA (American Society of Anesthesiologists) classification, and Body Mass Index (BMI), were collected. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAdditionally, histological parameters including International Federation of Gynecology and Obstetrics (FIGO 2023) stage, histological type, grade, Lymphovascular Space Invasion (LVSI), Myometrial Invasion (MI), and the number of nodes harvested were documented.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003eRobotic surgery operative time was the duration from docking to closure of port-site incisions for robotic surgeries, while open surgery time was the period from skin incision to closure. The amount of blood lost during the surgery was calculated by subtracting the volume of irrigation fluid from the total fluid collected in the suction container and then adding the weight of the used sponges. The length of hospital stay referred to the number of nights spent in the hospital after surgery and did not include the 1\u0026ndash;2 days of pre-operative admission for patients who require optimisation before major surgery. We also documented any complications during and after the surgery. Postoperative complications were those that occurred within 30 days following the surgery. These complications were categorised as infections (wound infections or dehiscence), cardiopulmonary issues (atelectasis, pneumonia, pulmonary edema, heart failure, and coronary artery events), and renal problems (urinary retention, hematuria, and urinary tract infections). We followed up with our patients in person or via telephone to monitor any events, including death or recurrence.\u003c/p\u003e\n\u003ch2\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eStatistical Analysis\u003c/span\u003e:\u003c/h2\u003e\n\u003cp\u003eStatistical analyses were done using IBM SPSS Statistics 20 for Windows (SPSS Inc., Chicago, IL, USA). The results are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD for continuous variables and frequency (percentage) for categorical variables. RFS (recurrence-free survival) was the duration between the surgery date and the documented recurrence date, while OS (overall survival) was the time from the diagnosis date to the date of death from any cause. To compare the average OS time and RFS between groups, Kaplan-Meier curves and log-rank tests were used. Statistical significance was considered at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, and all tests for statistical significance were two-tailed.\u003c/p\u003e"},{"header":"RESULT","content":"\u003cp\u003e \u003cb\u003eClinicopathological\u003c/b\u003e \u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eoutcomes\u003c/span\u003e\u003c/p\u003e\u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eOut of 297 patients, 242 (81.5%) underwent robotic surgeries while 55 (18.5%) underwent open surgeries. The comparison of\u003c/span\u003e clinicopathological \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eparameters is highlighted in\u003c/span\u003e Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eBoth groups were similar\u003c/span\u003e regarding \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003emean age, mean BMI, grade, and histology type (\u003c/span\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e). In the robotic group, 32.4% (n = 77) patients had a BMI ≥ 30kg/m2, compared to 25% (n = 10) in the open group (p = 0.34). Endometrioid histology was found in 80.8% (n = 240) of the cohort, with 62.1% (n = 149) patients having Grade 1 and 7.5% (n = 18) having Grade 3 endometrioid histology. Stage I and Stage II were found in 209 (70.4%) and 88 (29.6%) patients, respectively. There was a significant difference in the stage-wise distribution (p = 0.02) between the groups, with\u003c/span\u003e most \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003estage II patients (n = 42; 41.8%) belonging to the open group.\u003c/span\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of clinicopathological features between robotic and open surgery groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCATEGORY\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSUB-CATEGORY\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTOTAL\u003c/p\u003e \u003cp\u003e(n = 297)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eROBOTIC\u003c/p\u003e \u003cp\u003e(n = 242)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOPEN\u003c/p\u003e \u003cp\u003e(n = 55)\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAGE (mean, SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.4 (11.2)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e59.3 (9.9)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI (mean, SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.7 (5.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28.3 (5.4)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eHISTOLOGY\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eType 1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e240 (80.8%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e197 (81.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43 (78.2%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eType 2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (19.2%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45 (18.6%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (21.8%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eENDOMETROID GRADE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e149 (62.1%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e125 (63.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24 (55.8%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73 (30.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 (30.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (30.2%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (7.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (6.1%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (14%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eMYOMETRIAL INVASION\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (6.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (7%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (3.6%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt; 50%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e180 (60.6%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e152 (62.8%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28 (51%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e≥ \u003cb\u003e50%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98 (33%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73 (30.1%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (45.4%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eLYMPHOVASCULAR SPACE INVASION (LVSI)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e227 (76.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e187 (77.3%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40 (72.7%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFocal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (23.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55 (22.7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 ( 27.3%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eLYMPH NODES EVALUATION\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSLNB\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e230 (95%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e213 (88%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17 (31%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePLND\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56 (18.8%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (10%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32 (58%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNot Done\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (3.7%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (2%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (11%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNUMBER OF LYMPH NODES HARVESTED\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eB/L\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (3–7)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (4–15)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0002\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eFIGO 2023 STAGE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eIA1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (4.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (4.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (3.6%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eIA2\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135 (45.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e117 (48.3%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (7%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eIB\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (19.2%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46 (19%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (20%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eIC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (1.3%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (1.2%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (1.8%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eIIA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (5.7%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (4.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (10.9%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eIIC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (23.9%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54 (22.3%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17 (30.9%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eRISK CATEGORIZATION\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eLow\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e151(50.8%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e129 (53.3%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22 (40%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eIntermediate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (19.8%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49 (20.2%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (18.1%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHigh Intermediate\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (5.7%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (4.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (11%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHigh\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (23.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53 (22%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17 (31%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eADJUVANT TREATMENT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eObservation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139 (46.8%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e120 (49.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19 (34.5%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003e0.04\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eVBT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108 (36.3%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83 (34.3%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (45.4%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eEBRT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (1%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (1.2%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eVBT + EBRT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (10.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (7.8%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (16.3%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eCTRT + CHEMOTHERAPY\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (15.8%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (14.4%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (21.8%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAll patients underwent standard staging surgery for endometrial cancer. Only one robotic case was converted into a laparotomy. SLNB procedure was\u003c/span\u003e done \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ein 95% of the patients, with 88% in the robotic surgery group and 31% in the open surgery group. PLND was performed in cases where SLNB mapping failed in 10% of patients in the robotic group, while it was done as a primary procedure in 58% of patients in the open group. Total lymph nodes (median) harvested was 5 (range 2–12) in the robotic group and 9 (range 4–29) in the open group (p = \u0026lt; 0.0001). Adjuvant treatments given were vaginal brachytherapy (VBT) in 108 (36.3%) cases, external beam radiation therapy (EBRT) plus VBT in 31 (10.4%) cases, and concurrent chemoradiotherapy (CTRT) plus chemotherapy in 47 (15.8%) cases. As patients in the open group mainly had stage II disease, more patients received VBT (45.4%) and CTRT (21.8%) compared to the robotic group where 34.3% patients\u003c/span\u003e received \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eVBT and only 14.4% patients\u003c/span\u003e received \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eCTRT followed by chemotherapy (p = 0.04).\u003c/span\u003e\u003c/p\u003e\u003cp\u003e \u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eShort-term Outcomes\u003c/span\u003e:\u003c/p\u003e\u003cp\u003eA comparison of the preoperative outcomes between the two groups is detailed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The robotic group exhibited significant advantages over the open group, with reduced operating time (p \u0026lt; 0.0001), minimal blood loss (p \u0026lt; 0.0001), and shorter hospital stays (p \u0026lt; 0.0001). Among the three patients who underwent standard laparotomy, over 500ml of blood loss was reported (p = 0.004), with one patient experiencing 1500ml of blood loss due to stage II endometrial cancer. In contrast, no patient in the robotic group experienced over 500ml of blood loss. The open group had significantly higher postoperative complication rates compared to the robotic group (47.3% vs. 4.1%; p \u0026lt; 0.0001). Patients in the open surgery group experienced a significantly higher incidence of postoperative complications, including blood transfusions (p = 0.02), paralytic ileus (p \u0026lt; 0.0001), surgical site wound infections (p \u0026lt; 0.0001), and fever (p \u0026lt; 0.0001). Two patients required wound resuturing due to wound dehiscence. Both groups had similar incidence of cardiopulmonary events (p = 0.41) and urinary tract infections (p = 0.06). Notably, urinary retention occurred in four patients in the robotic group (p = 0.75), while there were no cases of urinary retention in the open group.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of peri-operative, short-term and long-term outcomes between robotic and open surgery groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eSURGICAL OUTCOMES\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eUNIT\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eROBOTIC\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eOPEN\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eP VALUE\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eOperative Time\u003c/span\u003e\u003c/p\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e(min)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMean\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e150\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003e\u0026lt; 0.0001\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMedian\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e120\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e150\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMin-Max\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e60–239\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e81–279\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eEstimated Blood Loss (mL)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMean\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e140\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003e\u0026lt; 0.0001\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMedian\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e20\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e200\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMin-Max\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e10–70\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e30–590\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eDuration of Hospital Stay\u003c/span\u003e\u003c/p\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e(Days)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMean\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003e\u0026lt; 0.0001\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMedian\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e1\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e3\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMin-Max\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0–2\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e1–5\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eB\u003c/span\u003elood loss\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e\u0026gt; 500ML\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e3\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003e0.004\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eSHORT-TERM POSTOPERATIVE COMPLICATIONS\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eParalytic Ileus\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e7\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003e\u0026lt; 0.001\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eBlood Transfusion\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003e0.02\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eCardio-pulmonary (CAD)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.41\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eUrinary Retention\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e4\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.75\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eUrinary Tract Infection\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e3\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.06\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eElectrolyte Imbalance\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e1\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e1\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.81\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eVaginal Cuff Dehiscence\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e1\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e1.0\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eWound Infection\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e5\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003e\u0026lt; 0.001\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eFever\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e4\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003e0.011\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eICU STAY\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e1\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.41\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eReadmission\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e1\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.41\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eTotal Complications\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e10 (4.1%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e26 (47.3%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003e\u0026lt; 0.001\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eLONG-TERM OUTCOMES\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eLymphedema\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.32\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eIncisional Hernia\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e5\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003e\u0026lt; 0.001\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eRecurrences\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e15 (6.2%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e5 (9.1%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.63\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eDeath\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e9 (3.7%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0 (0%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.30\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e \u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eLong-term Outcomes\u003c/span\u003e:\u003c/p\u003e\u003cp\u003eTwo patients in both the robotic and open surgery groups developed lymphedema (p = 0.32). The patients in the open surgery group experienced lymphedema within a year. In contrast, incisional hernia did not occur in the robotic group, but seven patients in the open group developed this complication (p = \u0026lt; 0.001) after nearly a year. After a median follow-up period of 36 months (ranging from 10 to 36 months), the 3-year overall survival rate was 100% in the open surgery group and 95.4% in the robotic surgery group (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In the robotic surgery group, there were nine deaths recorded, while there were no deaths in the open surgery group (p = 0.30). Out of these 9 patients, 5 died from other causes, including sepsis (n = 1), renal failure (n = 2), acute myocardial infarction (n = 1), and secondary lung malignancy (n = 1). The other 4 patients experienced death due to disease recurrences in the lung (n = 3) and vault (n = 1).\u003c/p\u003e\u003cp\u003eRecurrences were observed in 20 patients (6.7%), with 15 in the robotic group and five in the open group (p = 0.63). The median time to recurrence was notably shorter in the open surgery cohort (29 months) compared to the robotic surgery cohort (38 months) (p = 0.01). The 3-year recurrence-free survival rates were 92.4% in the robotic group and 86.1% in the open surgery group, with no statistically significant difference found (p = 0.26; HR ratio 1.7, CI: 0.6–4.8) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Common sites for recurrences included the vaginal stump (n = 7, 35%), abdomen (n = 8, 40%), nodal areas (n = 4, 20%), and distant sites (n = 11, 55%). Local recurrences specifically occurred in 7 patients (2.9%) in the robotic group (p = 0.31), while regional, nodal, and distant recurrences were observed in both groups. Further details about patients who experienced recurrences can be found in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of clinicopathological features of recurrence cases between robotic and open surgery groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eCATEGORY\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eSUB-CATEGORY\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eROBOTIC (N = 15)\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eOPEN\u003c/span\u003e\u003c/p\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e(N = 5)\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eP VALUE\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eAGE\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMean Age (years)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e61.5\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e47.5\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eSTAGE\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eStage IA2\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e3 (20%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e1 (20%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e1.0\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eIB\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e4 (26.6%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2 (40%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eIIC\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e8 (\u003c/span\u003e53.3%)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2 (40\u003c/span\u003e%)\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eHISTOLOGY TYPE\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eType 1\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e10 (66.6%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e5 (100%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.37\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eType 2\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e5 (33.3%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eMI\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e\u0026lt; 50%\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e8 (53.3%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e1 (20%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.43\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e\u0026gt; 50%\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e7 (46.6%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e4 (80%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eLVSI\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eNo\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e7 (46.6%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2 (40%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e1.0\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eFocal\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e8 (53.3%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e3 (60%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cspan type=\"BoldSmallCaps\" class=\"BoldSmallCaps\" name=\"Emphasis\"\u003eRECURRENCE SITE\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eVaginal Stump\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e7 (\u003c/span\u003e46.6%\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.31\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAbdominal\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e7 (\u003c/span\u003e46.6%\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e1 (\u003c/span\u003e20\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.91\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eNodal\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2 (\u003c/span\u003e13.3\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2 (\u003c/span\u003e40\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.51\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eDistant\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e11 (\u003c/span\u003e73.3\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e2 (\u003c/span\u003e4\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e%)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e0.41\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eRobotic surgery was initially\u003c/span\u003e utilised \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003efor\u003c/span\u003e gynaecological \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003emalignancies in 2007\u003c/span\u003e [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eand was introduced to our institute in 2015. Since then, robotic surgery has\u003c/span\u003e significantly progressed \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eand has become a standard approach in many benign and malignant cases\u003c/span\u003e [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eDespite being used for\u003c/span\u003e over \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ea decade, the published literature still\u003c/span\u003e needs \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ea comparison of long-term outcomes with the conventional open approach.\u003c/span\u003e\u003c/p\u003e\u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eSeveral studies have compared the outcomes of different surgical methods for endometrial cancer. Current research suggests that laparoscopic surgery generally leads to better survival rates than open surgery\u003c/span\u003e [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eStudies comparing robotic and laparoscopic approaches for endometrial cancer found no significant differences in the survival rates.\u003c/span\u003e [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eHowever, only a few studies have looked at the long-term outcomes of robotic and open surgery approaches for endometrial cancer in all stages\u003c/span\u003e [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eIn a retrospective comparative analysis of 936 patients, Park et al. found similar survival outcomes between robotic and open surgeries. The estimated 3-year PFS rates were 90.87% for robotic surgery and 78.30% for open surgery. The estimated 5-year OS rates were 89.14% for robotic surgery and 79.47% for open surgery\u003c/span\u003e [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAnother study by Kilgore et al. focused on 499 patients who underwent robotic surgery at a single institution and reported a 5-year OS rate of 88.7% after a median follow-up of 23 months. When comparing these results to data from the Surveillance Epidemiology and End Results (SEER) database of patients with endometrial cancer between 1975–2008, similar 5-year OS rates of 79%−87% were reported, suggesting comparable outcomes\u003c/span\u003e [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe present study also found no significant difference in\u003c/span\u003e the \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e3-year OS rate (95.4% versus 100%) and\u003c/span\u003e the \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e3-year PFS rate (92.4% versus 86.1%, p = 0.6) after a median follow-up period of 36 months between the groups. This suggests that a robotic approach is as\u003c/span\u003e practical \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eas the traditional laparotomy approach for surgery in terms of survival outcomes in early-stage endometrial cancer.\u003c/span\u003e\u003c/p\u003e\u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eStudies evaluating long-term robotic surgery outcomes have reported a wide range of recurrence rates, from 1.2% with a relatively short 18-month follow-up period to 14.8%\u003c/span\u003e [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In a study by Song J et al., a statistically significant increase in recurrence rates was found in the robotic surgery group compared to the open surgery group (11.3% vs 0%). It's important to note that the study only included patients in the intermediate-risk category who were expected to have favourable outcomes. The increased recurrence rates in the robotic surgery group underscore the importance of meticulous surgical techniques and modern instruments [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. On the flip side, some research has shown that the open surgery group has higher recurrence rates in comparison to the robotic surgery group [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThese results were attributed to\u003c/span\u003e more \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003epatients with advanced stages, higher grades, and non-endometroid histology in the open surgery group. However, a study by Nayyar et al.\u003c/span\u003e [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003efound that similar recurrence rates were reported in both groups when compared in terms of stage and histological parameters.\u003c/span\u003e Our study \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003edid not include patients in the advanced stages, an\u003c/span\u003e essential \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003efactor contributing to recurrence. This exclusion makes the results more significant. Although\u003c/span\u003e more stage II patients were \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ein the open group, the recurrence rates were similar to the robotic group in our study (9% vs 6.2%).\u003c/span\u003e However, the open surgery group had a notably shorter median time to recurrence than the robotic surgery group (28 months versus 38 months, respectively, p = 0.01), possibly because the open group had more stage II patients. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eIn our study, the use of uterine manipulators during robotic surgery did not result in increased or earlier recurrences, which is consistent with the findings of other studies\u003c/span\u003e [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eSome studies have suggested that a longer median time to adjuvant treatment is directly linked to increased recurrences\u003c/span\u003e [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eHowever, in our study, both groups had a median time of 1 month to start adjuvant treatment, which did not influence the recurrence rates.\u003c/span\u003e\u003c/p\u003e\u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eData on the recurrence sites observed during the follow-up period have only been reported by a few studies, potentially due to the late adoption of robotic surgery for endometrial cancer\u003c/span\u003e [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eRecurrences in the vaginal stump have been reported in 1% of patients who underwent robotic surgery\u003c/span\u003e [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ecompared to 2.3% in patients who underwent laparotomy\u003c/span\u003e [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eSurprisingly, in our study, the most common recurrence site in the robotic group was the vaginal stump (n = 7, 2.9%), while no patients in the laparotomy group developed a recurrence in the vaginal stump. Out of the\u003c/span\u003e seven \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003epatients who developed vaginal stump recurrences, three patients had isolated vaginal stump recurrences. This may be attributed to the fact that all patients except one had endometrioid histology, which is more likely to recur in the vagina\u003c/span\u003e [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAlthough significant LVSI is a well-established marker for predicting recurrences in endometrial cancer\u003c/span\u003e [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ehigher\u003c/span\u003e recurrence rates have also been reported in cases of focal LVSI \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ecompared to no LVSI\u003c/span\u003e [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eRestaino et al. found a gradual increase in the risk of lymph node metastasis (5%, 15%, and 33%) and distant recurrences (6.6%, 14.7%, and 24.9%) in endometrial cancer patients with no LVSI, focal LVSI, and diffuse LVSI, respectively\u003c/span\u003e [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eOur study also observed that 11 (55%) out of 20 recurrences involved focal LVSI, which may have contributed to the risk of developing recurrences in early-stage endometrial cancer patients. However, none of the patients in our cohort exhibited diffuse LVSI. Therefore, focal LVSI should not be overlooked in the histopathology report, and these patients should be carefully monitored for recurrences.\u003c/span\u003e\u003c/p\u003e\u003cp\u003eOur study revealed that the robotic surgery group had better peri-operative outcomes than the open surgery group. The robotic group showed a reduced operating time, less estimated blood loss, and a shorter hospital stay compared to the open group. While some studies have reported a shorter operative time in the robotic group [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], most studies, including meta-analyses, have shown longer operative times with minimally invasive surgery [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Our study's median operative time was significantly shorter in the robotic group (120 vs. 150 min). These differences in operative time outcomes are primarily influenced by factors such as institution type, surgeon’s experience, and patient load. Our institute handles a high caseload of endometrial cancer cases.\u003c/p\u003e\u003cp\u003eRegarding postoperative complications, our study indicated a similar rate of postoperative complications (4.1%) in the robotic group as reported in other studies [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. This was significantly lower than the open surgery group (47.3%, p \u0026lt; 0.0001).\u003c/p\u003e\u003cp\u003eBased on previous studies [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], the number of lymph nodes (median) harvested are comparable in both groups. However, our research showed that the laparotomy group had significantly more lymph nodes retrieved compared to the robotic group. This variance could be attributed to the utilisation of SLNB mapping in the robotic group.Most patients in the open surgery group had stage II disease and underwent PLND, leading to a higher number of lymph nodes obtained in this group.\u003c/p\u003e\u003cp\u003eThis retrospective comparative analysis is one of the few studies that examines both short-term and long-term outcomes for early-stage endometrial cancer by comparing robotic and traditional laparotomy surgeries. We assessed perioperative and long-term consequences, including recurrence patterns and survival analysis. There is limited recent literature comparing robotic versus open surgery groups, making our study significant in contributing to important outcomes. However, it's important to note that the study is limited by its retrospective nature and the relatively small sample size.\u003c/p\u003e\u003cp\u003eIn conclusion, the findings indicate that robot-assisted surgery is a beneficial surgical method for treating endometrial cancer. It is both safe and less invasive than laparotomy, as demonstrated by improved perioperative results and significantly reduced short-term and long-term complications while achieving similar therapeutic outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eCompeting Interests: The authors have no relevant financial or non-financial interests to disclose\u003c/p\u003e\n\u003cp\u003eFunding: The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements of research support: \u0026nbsp;None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAuthors Contributions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study\u0026apos;s conception and design.\u003c/p\u003e\n\u003cp\u003eMaterial preparation, data collection and the manuscript was written by Monal Garg, Divya Panyam Vuppu and Priya Bhati\u003c/p\u003e\n\u003cp\u003eData analysis was done by Anjali S Nair and Sheejamol VS\u003c/p\u003e\n\u003cp\u003eA review of the manuscript was done by Priya Bhati and Divya Panyam Vuppu\u003c/p\u003e\n\u003cp\u003eAll authors commented on previous versions of the manuscript.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBray F, Laversanne M, Sung H et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024 May-Jun;74(3):229-263. https://doi.org/10.3322/caac.21834\u003c/li\u003e\n \u003cli\u003eSonkar D, Agarwal S, Melgandi W et al. Epidemiological characteristics of endometrial cancer patients treated at a tertiary health centre in National Capital Territory of India. J Cancer Res Ther. 2023 Jan-Mar;19(2):452-456. https://doi.org/10.4103/jcrt.jcrt_2029_21\u003c/li\u003e\n \u003cli\u003eKuhn TM, Dhanani S, Ahmad S. An Overview of Endometrial Cancer with Novel Therapeutic Strategies. Curr Oncol. 2023 Aug 27;30(9):7904-7919. https://doi.org/10.3390/curroncol30090574.\u003c/li\u003e\n \u003cli\u003eKalampokas E, Giannis G, Kalampokas T et al. Current Approaches to the Management of Patients with Endometrial Cancer. Cancers (Basel). 2022 Sep 16;14(18):4500. https://doi.org/10.3390/cancers14184500\u003c/li\u003e\n \u003cli\u003eWalker JL, Piedmonte MR, Spirtos NM et al. Recurrence and Survival After Random Assignment to Laparoscopy Versus Laparotomy for Comprehensive Surgical Staging of Uterine Cancer: Gynecologic Oncology Group LAP2 Study. J Clin Oncol. 2012 Mar 1;30(7):695-700. https://doi.org/10.1200/JCO.2011.38.8645\u003c/li\u003e\n \u003cli\u003eEoh KJ, Kim TJ, Park JY et al. Robot-assisted versus conventional laparoscopic surgery for endometrial cancer: long-term comparison of outcomes.Front Oncol. 2023 Sep 15;13:1219371. https://doi.org/10.3389/fonc.2023.1219371\u003c/li\u003e\n \u003cli\u003eSinha R, Jain V, Sp S et al. Multi-Institutional Trends in Gynecological Robotic Surgery in India: A Real-World Scenario. Cureus. 2023 Mar 23;15(3):e36564. https://doi.org/10.7759/cureus.36564\u003c/li\u003e\n \u003cli\u003ePark HK, Helenowski IB, Berry E et al. A Comparison of Survival and Recurrence Outcomes in Patients With Endometrial Cancer Undergoing Robotic Versus Open Surgery. J Minim Invasive Gynecol. 2015 Sep-Oct;22(6):961-7. https://doi.org/10.1016/j.jmig.2015.04.018\u003c/li\u003e\n \u003cli\u003eSong J, Le T, Hopkins L et al. A comparison of disease recurrence between robotic versus laparotomy approach in patients with intermediate-risk endometrial cancer. Int J Gynecol Cancer. 2020 Feb;30(2):160-166. 2019 Dec 22;30(2):160\u0026ndash;6. https://doi.org/10.1136/ijgc-2019-000838\u003c/li\u003e\n \u003cli\u003eInd T, Laios A, Hacking M et al. A comparison of operative outcomes between standard and robotic laparoscopic surgery for endometrial cancer: A systematic review and meta‐analysis. Int J Med Robot. 2017 Dec;13(4):e1851. https://doi.org/10.1002/rcs.1851\u003c/li\u003e\n \u003cli\u003eAbu-Rustum N, Yashar C, Arend R et al. Uterine Neoplasms, Version 1.2023, NCCN Clinical Practice Guidelines in Oncology. 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Does the use of a uterine manipulator in robotic surgery for early‐stage endometrial cancer affect oncological outcomes? Int J Med Robot. 2022 Aug 24;18(6). https://doi.org/10.1002/rcs.2443\u003c/li\u003e\n \u003cli\u003eMeng Y, Liu Y, Lin S et al. The effects of uterine manipulators in minimally invasive hysterectomy for endometrial cancer: A systematic review and meta-analysis. Eur J Surg Oncol. 2020 Jul;46(7):1225\u0026ndash;32. https://doi.org/10.1016/j.ejso.2020.03.213\u003c/li\u003e\n \u003cli\u003eCattaneo R II, Hanna RK, Jacobsen G et al. Interval Between Hysterectomy and Start of Radiation Treatment Is Predictive of Recurrence in Patients With Endometrial Carcinoma.Int J Radiat Oncol Biol Phys. 2014 Mar;88(4):866\u0026ndash;71. https://doi.org/10.1016/j.ijrobp.2013.11.247\u003c/li\u003e\n \u003cli\u003eGhanem AI, Modh A, Burmeister C et al. Does Interval between Hysterectomy and Start of Radiation Treatment Influence Survival in Early Stage Endometrial Carcinoma? A National Cancer Database Analysis.Int J Radiat Oncol Biol Phys. 2017 Oct;99(2):E292. https://doi.org/10.1097/COC.0000000000000713\u003c/li\u003e\n \u003cli\u003eAhmad NR, Lanciano RM, Corn BW et al. Postoperative radiation therapy for surgically staged endometrial cancer: Impact of time factors (overall treatment time and surgery-to-radiation interval) on outcome. Int J Radiat Oncol Biol Phys. 1995 Nov;33(4):837\u0026ndash;42. https://doi.org/10.1016/0360-3016(95)00197-0\u003c/li\u003e\n \u003cli\u003eTogami S, Fukuda M, Mizuno M et al. Efficacy and prognosis of robotic surgery with sentinel node navigation surgery in endometrial cancer. J Gynecol Oncol. 2023;34(6). https://doi.org/10.3802/jgo.2023.34.e68\u003c/li\u003e\n \u003cli\u003eHayashi S, Yamanaka Z, Kojima J et al. Retrospective comparative study of robot‐assisted surgery, laparoscopic surgery, and laparotomy for endometrial cancer in patients with a low risk of recurrence. J Obstet Gynaecol Res. 2023 Oct 17;50(1):103\u0026ndash;12. https://doi.org/10.1111/jog.15816\u003c/li\u003e\n \u003cli\u003e\u0026Aring;kesson \u0026Aring;, Adok C, Dahm-K\u0026auml;hler P. Increased survival in non-endometrioid endometrial cancer after introducing lymphadenectomy and tailoring radiotherapy \u0026ndash; A population-based cohort study. Eur J Cancer. 2022 Jul;169:54\u0026ndash;63. https://doi.org/10.1016/j.ejca.2022.04.002\u003c/li\u003e\n \u003cli\u003eIgnatov T, Eggemann H, Costa SD et al. Endometrial cancer subtypes are associated with different patterns of recurrence. J Cancer Res Clin Oncol. 2018 Jul 19;144(10):2011\u0026ndash;7. https://doi.org/10.1007/s00432-018-2711-8\u003c/li\u003e\n \u003cli\u003eBendifallah S, Ouldamer L, Lavoue V et al. Patterns of recurrence and outcomes in surgically treated women with endometrial cancer according to ESMO-ESGO-ESTRO Consensus Conference risk groups: Results from the FRANCOGYN Study Group. Gynecol Oncol. 2017 Jan;144(1):107\u0026ndash;12. https://doi.org/10.1016/j.ygyno.2016.10.025\u003c/li\u003e\n \u003cli\u003eRestaino S, Tortorella L, Dinoi G et al. Semiquantitative evaluation of lymph-vascular space invasion in patients affected by endometrial cancer: Prognostic and clinical implications. Eur J Cancer. 2021 Jan;142:29\u0026ndash;37. https://doi.org/10.1016/j.ejca.2020.10.011\u003c/li\u003e\n \u003cli\u003eSt\u0026aring;lberg K, Bjurberg M, Borgfeldt C et al. Lymphovascular space invasion as a predictive factor for lymph node metastases and survival in endometrioid endometrial cancer \u0026ndash; a Swedish Gynecologic Cancer Group (SweGCG) study. Acta Oncol. 2019 Aug 2;58(11):1628\u0026ndash;33. https://doi.org/10.1080/0284186X.2019.1643036\u003c/li\u003e\n \u003cli\u003edos Reis R, Burzawa JK, Tsunoda AT et al. Lymphovascular Space Invasion Portends Poor Prognosis in Low-Risk Endometrial Cancer. Int J Gynecol Cancer 2015 Sep;25(7):1292\u0026ndash;9. https://doi.org/10.1097/IGC.0000000000000490\u003c/li\u003e\n \u003cli\u003eIkebuchi A, Komatsu H, Yamamoto K et al. Outcome of robot-assisted surgery for stage IA endometrial cancer compared to open and laparoscopic surgeries: a retrospective study at a single institution. J Robot Surg. 2024 Mar 23;18(1). https://doi.org/10.1007/s11701-024-01897-8\u003c/li\u003e\n \u003cli\u003eJanda M, Gebski V, Davies LC et al. Effect of Total Laparoscopic Hysterectomy vs Total Abdominal Hysterectomy on Disease-Free Survival Among Women With Stage I Endometrial Cancer. JAMA. 2017 Mar 28;317(12):1224. https://doi.org/10.1001/jama.2017.2068\u003c/li\u003e\n \u003cli\u003eElSahwi KS, Hooper C, De Leon MC et al. Comparison between 155 cases of robotic vs. 150 cases of open surgical staging for endometrial cancer. Gynec. Oncol. 2012 Feb;124(2):260\u0026ndash;4. https://doi.org/10.1016/j.ygyno.2011.09.038\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Robotics, Postoperative complications, Survival, Endometrial Cancer, Early-stage","lastPublishedDoi":"10.21203/rs.3.rs-4759972/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4759972/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAIM:\u003c/h2\u003e \u003cp\u003eThis study aims to determine differences in surgical and survival outcomes for patients undergoing robotic surgeries versus laparotomies for early-stage endometrial cancer (EC).\u003c/p\u003e\u003ch2\u003eMETHODS:\u003c/h2\u003e \u003cp\u003eThis study was conducted retrospectively from 1st January 2015 to 30th June 2021 on all patients with stage I or stage II EC (FIGO 2023 Staging), irrespective of histology. Primary objective was to compare 3-year Overall Survival (OS) and Recurrence Free Survival (RFS) between robotic versus laparotomy group.\u003c/p\u003e\u003ch2\u003eRESULTS:\u003c/h2\u003e \u003cp\u003eIn a study of 297 patients, 81.5% underwent robotic surgeries and 18.5% underwent open surgeries. Median age was 47.5 years. Majority (81%) of the patients had Endometroid histology. Seventy percent of the cases had stage I, and 29.6% had stage II EC. Robotic group had significantly shorter hospital stay, blood loss and operative time (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). After a median follow-up period of 36 months, 9 deaths occured in robotic group and no deaths in laparotomy group leading to a 3-year OS of 95.4% in robotic group and 100% in laparotomy group. RFS rates of 92.5% and 86.1% in robotic and laparotomy groups, respectively (p\u0026thinsp;=\u0026thinsp;0.6). However, median time to recurrence was significantly shorter in open group than robotic group (28 versus 38 months respectively, p\u0026thinsp;=\u0026thinsp;0.01).\u003c/p\u003e\u003ch2\u003eCONCLUSION:\u003c/h2\u003e \u003cp\u003eNo statistically significant differences between both groups were found in RFS and OS. Robotic surgeries have better surgical and equivalent oncological outcomes than open surgeries in stage I and II EC.\u003c/p\u003e","manuscriptTitle":"Robotic Surgery versus Traditional Laparotomy: Surgical and Oncological Outcomes in Early-Stage Endometrial Cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-17 02:11:44","doi":"10.21203/rs.3.rs-4759972/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0b90178c-45f6-43f7-b6a0-5b83c9ed577b","owner":[],"postedDate":"August 17th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-17T02:11:46+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-17 02:11:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4759972","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4759972","identity":"rs-4759972","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}