Laparotomic versus robotic surgery in elderly patients with endometrial cancer: A systematic review and meta-analysis

Background: Although robotics has been shown to improve outcomes in some high-difficulty surgical category patients, it is unclear if such an approach may improve outcomes in elderly patients with endometrial carcinoma (EC). Objective: To compare robotic and laparotomic surgery in the treatment and staging of elderly EC patients. Materials and methods: A systematic review and meta-analysis was performed assessing the risk of overall, intra-operative, and peri-operative complications associated with the surgical approach (laparotomic vs robotic) for elderly patients with EC by relative risk (RR). Pooled means ± standard deviation of length of stay were compared with the unpaired t test. Subgroup analyses for overall complications were performed based on different age cut-offs (>70, >65, and >75 years) and severity of complications (minor and major). A value of P less than 0.05 was considered significant. Results: Five studies with 7629 EC patients were included. Pooled RR for robotic compared with laparotomic surgery was 0.40 (P < 0.001) for overall, 0.46 (P = 0.18) for intra-operative, and 0.43 (P < 0.001) for peri-operative complications. Pooled difference between means ± standard deviation of length of stay for robotic versus laparotomic surgery was −3.34 (P < 0.001). At subgroup analyses, pooled RR of overall complications for robotic surgery versus laparotomic surgery was 0.34 (P < 0.001) in the >70 years, 0.51 (P < 0.01) in the >65 years, 0.20 (P = 0.12) in the >75 years groups. Pooled RR was 0.50 (P = 0.1) in the minor complications subgroup, and 0.42 (P = 0.002) in the major complications subgroup. Conclusion: Robotics might be a viable alternative to the laparotomic approach for EC in elderly patients because it significantly decreases the risk of overall and peri-operative complications (mainly major complications), and the length of stay when compared with laparotomy. The decrease in risk of overall complications is greater with increasing patient age.