Robotic versus conventional laparoscopic total hysterectomy in patients with endometrial cancer and frailty: analysis of the National Readmission Database, 2016–2020

Objective: To compare perioperative outcomes after robotic-assisted vs. conventional laparoscopic total hysterectomy in frail women with endometrial cancer.Methods: This retrospective study included female patients aged ≥50 years with endometrial cancer and frailty who received either robotic-assisted or conventional laparoscopic total hysterectomy, extracting data from the Nationwide Readmissions Database from 2016 to 2020.Frailty was defined using the Hospital Frailty Risk Score.Patients with lymph node invasion, metastatic disease, missing key variables, or sample weight were excluded.Outcomes included perioperative complications, length of stay (LOS), and 30-and 90-day readmission.Logistic and linear regression analyses were performed to compare outcomes between surgical approaches.Results: In total, 1,212 patients with endometrial cancer and frailty were included.Roboticassisted surgery was associated with significantly shorter LOS (adjusted beta=-0.34;95% confidence interval [CI]=-0.46,-0.21; p<0.001), lower odds of sepsis (adjusted odds ratio [aOR]=0.57;95% CI=0.34, 0.94; p=0.027) and surgical site infection (p=0.025),but higher odds of pneumonia (aOR=2.01;95% CI=1.06, 3.84; p=0.033).Conclusion: Robotic-assisted hysterectomy in frail patients was associated with shorter LOS and fewer infection-related complications but a higher risk of pneumonia.Further studies are needed to optimize surgical decision-making in this population.