The objective of this study is to compare the overall survival (OS) and surgical outcomes between conventional laparoscopy and robot-assisted laparoscopy (RAL) in women with type II endometrial cancer. We identified a large cohort of women who underwent hysterectomy for type II endometrial cancer between January 2010 and December 2014 using the National Cancer Database (NCDB). The primary outcome was to compare the OS of conventional laparoscopy versus RAL. Secondary outcomes included the length of hospital stay, 30-day readmission rate, 90-day mortality, rates of lymph node retrieval, rates of node positivity, and rates of conversion to laparotomy. Cohorts were compared and multivariable logistic regression was used to determine characteristics with statistically significant predictors of outcome. We identified 7168 patients with stage I–III type II endometrial cancer who had minimally invasive surgery as primary treatment between 2010 and 2014. A total of 5074 patients underwent RAL. Women who underwent RAL were less likely to have stage III disease (26.4% vs. 29.9%,p= 0.008) and had smaller primary tumors (4.6 vs. 4.1 cm,p< 0.001). In a multivariable model, there was no difference in OS between conventional laparoscopy and RAL. With regard to postoperative outcomes, RAL was associated with a decreased risk for conversion to laparotomy (2.7% vs. 12%,p< 0.001), a shorter hospital stay (1 vs. 2 days,p< 0.001), a decreased 90-day mortality (1.3% vs. 2.2%,p= 0.004), and an increased number of lymph nodes sampled (14 vs. 12,p< 0.001). In multivariable analysis, the use of RAL was independently associated with a reduced rate of conversion to laparotomy. In conclusion, there was no difference in OS between conventional laparoscopy and RAL in type II endometrial cancer in a large retrospective cohort of patients from the NCDB. RAL was associated with a decreased risk of conversion to laparotomy.
本研究旨在比较传统腹腔镜手术与机器人辅助腹腔镜手术（RAL）在II型子宫内膜癌女性患者中的总生存期（OS）及手术结局。我们通过美国国家癌症数据库（NCDB）识别了2010年1月至2014年12月期间因II型子宫内膜癌接受子宫切除术的大型患者队列。主要结局指标为比较传统腹腔镜手术与RAL的OS。次要结局指标包括住院时长、30天再入院率、90天死亡率、淋巴结清扫数量、淋巴结阳性率以及中转开腹手术率。通过队列比较并采用多变量逻辑回归分析确定具有统计学显著性的结局预测因素。 我们共识别出7168例在2010年至2014年间接受微创手术作为初始治疗的I-III期II型子宫内膜癌患者，其中5074例接受了RAL治疗。接受RAL治疗的患者中III期疾病比例较低（26.4% vs. 29.9%，p=0.008），且原发肿瘤体积更小（4.6 vs. 4.1 cm，p<0.001）。在多变量模型中，传统腹腔镜手术与RAL的OS无显著差异。在术后结局方面，RAL与中转开腹手术风险降低（2.7% vs. 12%，p<0.001）、住院时间缩短（1天 vs. 2天，p<0.001）、90天死亡率下降（1.3% vs. 2.2%，p=0.004）以及淋巴结采样数量增加（14枚 vs. 12枚，p<0.001）显著相关。多变量分析显示，RAL的使用与降低中转开腹手术率独立相关。 结论：基于NCDB大型回顾性队列研究，传统腹腔镜手术与RAL在II型子宫内膜癌患者中的OS无显著差异。RAL与降低中转开腹手术风险相关。
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