Does Minimally Invasive Robotic Surgery for Early-Stage Endometrial Cancer Decrease the Risk of Surgical Complications?


Key Points

  • Risk of severe complications was lower after nationwide introduction of minimally invasive robotic surgery.
  • Minimally invasive robotic surgery and minimally invasive laparoscopic surgery were associated with lower rates of severe complications vs open surgery.

In a Danish study reported in JAMA Surgery, Jørgensen et al found that the nationwide introduction of minimally invasive robotic surgery for early-stage endometrial cancer was associated with a reduction in the incidence of severe complications.

The nationwide prospective cohort study involved 5,654 women who underwent minimally invasive robotic surgery, minimally invasive laparoscopic surgery, or total abdominal hysterectomy between January 2005 and June 2015. The women were divided into 2 groups: group 1 underwent surgery before the introduction of minimally invasive robotic surgery in their region, and group 2 underwent surgery after the introduction of minimally invasive robotic surgery in their region. Rates of severe complications were assessed, consisting of death within 30 days after surgery and intraoperative and postoperative complications diagnosed within 90 days after surgery.

Risk of Severe Complications

A total of 3,091 women (mean age = 67 years) were included in group 1 and 2,563 (mean age = 68 years) were included in group 2. On multivariate analysis, group 1 had greater likelihood of severe complications vs group 2 (odds ratio [OR] = 1.39, 95% confidence interval [CI] = 1.11–1.74). Overall, 14.1% of women in group 1 and 22.2% in group 2 underwent minimally invasive laparoscopic surgery. A total of 50.0% of women in group 2 underwent minimally invasive robotic surgery.

On multivariate analysis among women in group 2, total abdominal hysterectomy was associated with increased risk of severe complications compared with minimally invasive laparoscopic surgery (OR = 2.58, 95% CI = 1.80–3.70) and compared with minimally invasive robotic surgery (OR = 3.87, 95% CI = 2.52–5.93), with no significant increase in risk found for minimally invasive laparoscopic surgery vs minimally invasive robotic surgery (OR = 1.50, 95% CI = 0.99–2.27).

The investigators concluded, “The national introduction of minimally invasive robotic surgery changed the surgical approach for early-stage endometrial cancer from open surgery to minimally invasive surgery. This change in surgical approach was associated with a significantly reduced risk of severe complications.”

Siv Lykke Jørgensen, MD, of the Department of Gynecology and Obstetrics, Odense University Hospital, Denmark, is the corresponding author for the JAMA Surgery article.

Disclosure: The project was funded by the region of Southern Denmark, the University of Southern Denmark, the Danish Cancer Society, and others. The study authors' full disclosures can be found at

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