| Objective:To compare robotics surgery with laparoscopy and abdominal surgery in order to explore the clinical value of robotic surgery in the treatment of endometrial carcinoma. Materials and methods:All patients selected in our hospital during the period of September 2010 to September 2015 who underwent robotic hysterectomy, bilateral salpingo-oophorectomy and lymphadenectomy were identified. Traditional laparoscopy and abdominal surgery cases of endometrial carcinoma during the same period were retrospectively analyzed.Indicators were compared with patients included by general information, operation index and postoperative index. General information included age, body mass index(BMI), FIGO staging. Operation index included operative time, blood loss, pelvic lymph nodes, aortic lymph nodes, total lymph nodes, intraoperative complications, conversion to laparotomy, conversion to laparoscopy and median hospital stay. Postoperative index included early postoperative complications, late postoperative complication, the rate of recurrence and death from disease.Results:A total of 363 patients underwent endometrial cancer staging between September 2010 and September 2015 at our Institute:71 cases of laparotomy group (GroupA),218 cases of laparoscopic group (GroupB) and 74 cases of robot group (GroupC) were performed.1. Results of general information:There were no statistically significant differences between three groups in terms of age, BMI and FIGO stage.2. Results of operation indexes(1) The median operation time was 212.94±35.64min,179.67±60.11 min and 185.14±61.02 min in Groups A, B and C, and it was shortest in GroupB(P=0.009). By pairwise comparison, the median operation time was shorter in GroupB and GroupC rather than GroupA, this difference was statistically significant.(2) The median blood loss was 576.64±302.71ml,201.75± 124.52 ml and 127.65±51.70 ml in three groups, and it was lowest in GroupC(P< 0.001). By pairwise comparison, the median blood loss were equivalent in GroupB and GroupC(p=0.055), while both of them were lower than GroupA, the difference was statistically significant.(3) The median pelvic lymph nodes was 21.13±8.25,21.90±9.56 and 29.83±9.36 in Groups A, B and C, and it was heighest in GroupC. Compared with the other 2 groups, the difference was statistically significant(p<0.001).(4)The median aortic lymph nodes was 2.35±1.84,2.75±1.92 and 3.73±2.03 in three groups. No significant differences were detected in three groups(p=0.084), while it was higher in GroupC than GroupA(p=0.026) by pairwise comparison.(5)The median total lymph nodes was 23.82±9.17,24.90±10.79 and 33.23±10.51 in Groups A, B and C. It was higher in GroupC than both GroupA and GroupB. This difference was statistically significant.(6) The median hospital stay was 21.33±6.76 days,17.06±5.60 days and 17.96±6.06 days in three groups and it was shortest in GroupB(P<0.001). By pairwise comparison, they were similar in GroupB and C(p=0.682), while both of them were shorter than GroupA, this difference was statistically significant.3.Results of postoperative indexesThe early postoperative complication rates of GroupA,B and C are 7.0%,3.7% and 2.7% respectively; The long-term complication rates were 4.2%,3.2% and 1.4% in three groups. The early postoperative complication rate of GroupA was higher than the other two groups, and the long-term complication rate of GroupC is lower than the other two. The recurrence rates of Group A, B, C are 8.6%,6.9% and 8.6% respectively; the total survival rates of three groups were 93.1%,94.1% and 98.5%. No significant differences were detected in three groups of the recurrence and mortality in the management of endometrial cancer (p> 0.05).4. ConclusionMinimally invasive surgery (robotic surgery and laparoscopic surgery) have more advantages than laparotomy surgery in the treatment of endometrial cancer. Robotic surgery is safe and reliable and can overcome some of the challenges posed by the use of laparoscopies without affecting survival nor recurrence rates in women with endometrial cancer. |
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