Robotic Versus Laparoscopic Staging for Endometrial Cancer: Does Robotic Surgery Attenuate the Early Systemic Inflammatory Response?

Background/Objectives: Robotic and laparoscopic staging for endometrial cancer (EC) yield comparable oncologic outcomes, but whether robotic surgery attenuates the early systemic inflammatory response is unknown. Methods: This retrospective cohort study at a European Society of Gynaecological Oncology-accredited center included 110 consecutive women (49 laparoscopic, 61 robotic) with apparently uterine-confined, non-aggressive EC who underwent sentinel lymph node-based staging by the same surgeons within an Enhanced Recovery After Surgery protocol. Complete blood counts were obtained in routine care preoperatively and 6, 24, and 48 h postoperatively; C-reactive protein and procalcitonin were measured routinely at 48 h but only selectively at intermediate time points, and albumin only preoperatively and at 48 h. The trajectories of five blood count-derived indices (systemic immune-inflammation index [SII], systemic inflammation response index, and neutrophil-, platelet-, and monocyte-to-lymphocyte ratios) were compared with mixed-effects models adjusted for baseline imbalances. Results: All five indices reached their highest observed values at 6 h and declined by 48 h, with no detectable between-group difference in trajectory (group × time p = 0.54–0.85; 6-h SII ratio, robotic/laparoscopic, 0.93, 95% confidence interval 0.71–1.23). Robotic surgery took longer (median 180 vs. 155 min; p = 0.012) and was followed by a greater 6-h hemoglobin decline (0.93 vs. 0.55 g/dL; p = 0.020) but a similar hemoglobin trajectory (p = 0.17). Complications, length of stay, and 30-day readmission did not differ detectably, although vaginal cuff complications were more frequent after robotic surgery (7/61 vs. 1/49). Conclusions: Early inflammatory trajectories did not differ detectably between robotic and laparoscopic staging, although moderate differences cannot be excluded. Sampling time for these indices should be standardized.