Real-world outcomes of robotic and non-robotic hysterectomy for endometrial cancer: insights from a national cohort

To compare perioperative outcomes, postoperative complications, and overall survival among patients with endometrial cancer (EC) undergoing open hysterectomy (OH), laparoscopic hysterectomy (LH), or robot-assisted hysterectomy (RAH) using nationwide real-world data. This was a retrospective, population-based study using 2018-2020 Taiwan Cancer Registry who underwent one of three surgical approaches (open, laparoscopic, or robot-assisted) and outcomes were evaluated using NHIRD with follow-up data available through 2021. From these linked datasets, we identified 5,360 women diagnosed with endometrial cancer who received hysterectomy, including 3,176 cases of OH, 1,760 LH, and 424 RAH. Inverse probability weighting (IPTW) methodology was utilized to harmonize baseline characteristics across the study arms. Compared with OH, RAH was associated with significantly fewer transfusions (15.5% vs. 29.7% (p < 0.0001)), shorter hospital stays (5.9 vs. 8.0 days, p < 0.0001), and reduced intensive care utilization. At one month postoperatively, overall complication rates were markedly lower in the RAH group (0.95%) than in OH (7.52%) and LH (6.07%) (both p < 0.0001). Specific complications, including vascular events, cardiac events, stroke, pneumonia, peritonitis, and wound disruption, were significantly reduced with RAH. Mortality analysis showed that OH was shown higher mortality hazard ratios compared with RAH (HR 1.39, 95% CI: 1.20-1.61 after IPTW), while survival outcomes were similar between RAH and LH (HR 0.97, 95% CI: 0.73-1.28). RAH for endometrial cancer demonstrated significant perioperative and postoperative advantages compared with OH, including lower complication rates and improved survival outcomes. RAH outcomes were largely comparable to laparoscopic hysterectomy. These findings support broader consideration of RAH as a safe and effective minimally invasive approach for EC management in real-world practice, although further long-term evaluation is warranted.