Endometrial Cancer Recurrence Risk Following Robotic Hysterectomy

Background: Minimally invasive surgery is widely used in endometrial cancer management, but recurrence remains a concern. Methods: A retrospective review of 1201 patients treated from 2012 to 2019 with robotic laparoscopy was conducted. Recurrence-free survival and hazard ratios were calculated using multivariate Cox models. Results: Of 1278 patients, 155 cases of recurrent disease were identified. Age (HR 1.01, p = 0.045), LVSI (HR 3.54, p < 0.001), stage and high-grade histology (HR 3.39, p < 0.001) were associated with increased risk of recurrence. Hazard ratios for stages IB, II and III/IV were 1.92 (p = 0.007), 2.67 (p = 0.001), and 3.23 (p < 0.001) respectively. The use of a uterine manipulator was an independent risk factor on multivariate analysis (HR 2.12, p < 0.001). Adjuvant chemotherapy (HR 0.67, p = 0.239) and radiotherapy (HR 0.64, p = 0.056) trends favored reduced risk but were not significant. Chemoradiotherapy was found to have a reduction in recurrence with a HR 0.44 (p = 0.002). Conclusions: Traditional prognostic factors remain important for patients with endometrial cancer having undergone robotic laparoscopic hysterectomy. Uterine manipulator use should be carefully reconsidered in endometrial cancer surgery.