Acute outcomes with robotic versus laparoscopic and open hysterectomy for endometrial cancer: a retrospective cohort study from Alberta, Canada
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Huong Luu1, Karen J B Martins1, Jeanelle Sabourin1
1From the Real World Evidence Unit, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Luu, Martins, Klarenbach); the Department of Obstetrics and Gynaecology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Sabourin); the Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Jago); the Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Lester); the Centre for Health Informatics Cumming School of Medicine, University of Calgary, Calgary, Alta. (Nguyen, Williamson); the Alberta Children's Hospital Research Institute, Libin Cardiovascular Institute, O'Brien Institute for Public Health, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alta. (Williamson); the Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Klarenbach).
Background:
We sought to compare real-world outcomes of robotic hysterectomy (RH) with laparoscopic (LH) and open (OH) hysterectomy among adults living with endometrial cancer in Alberta, Canada.
Methods:
We used administrative data to identify adults living with endometrial cancer who underwent a total hysterectomy (2012 to 2022) in Alberta. We applied generalized linear regression models and adjusted for confounders using propensity score overlap weighting. We presented predicted means and estimated probabilities with 95% confidence intervals (CIs).
Results:
We included 4555 patients. In adjusted analyses, patients who underwent RH had a shorter length of hospital stay (1.2 [95% CI 1.2 to 1.3] d) than those who underwent LH (2.0 [95% CI 1.9 to 2.1] d) or OH (3.7 [95% CI 3.6 to 3.8] d). Duration of surgery for RH was shorter than LH (172 [95% CI 169 to 174] min v. 186 [95% CI 183 to 189] min), and longer than OH (173 [95% CI 171 to 175] min v. 169 [95% CI 167 to 171] min). Compared with patients who underwent OH, those who underwent RH had reduced probabilities of blood transfusions (2.2% [95% CI 1.3% to 3.9%] v. 6.6% [95% CI 4.8% to 9.0%]), perioperative complications (12.7% [95% CI 10.2% to 15.8%] v. 20.5% [95% CI 17.3% to 24.0%]), infections (16.5% [95% CI 13.6% to 19.8%] v. 33.8% [95% CI 30.0% to 37.9%]), and 30-day acute care readmissions (11.7% [95% CI 9.2% to 14.6%] v. 17.9% [95% CI 14.9% to 21.3]); no differences were observed in comparisons with LH.
Conclusion:
Among adults living with endometrial cancer in Alberta, RH was associated with a shorter length of hospital stay than LH and OH; we also noted fewer blood transfusions, complications, infections, and readmissions for RH compared with OH but not LH. Findings can be used in the context of surgical volumes and outcomes, along with other considerations, to guide decisions.
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