Comparative Effectiveness of Robotic Versus Laparoscopic Hysterectomy for Endometrial Cancer

PURPOSE: Use of robotics in oncologic surgery is increasing; however, reports of safety and efficacy are from highly experienced surgeons and centers. We performed a population-based analysis to compare laparoscopic hysterectomy and robotic hysterectomy for endometrial cancer. PATIENTS AND METHODS: The Perspective database was used to identify women who underwent a minimally invasive hysterectomy for endometrial cancer from 2008 to 2010. Morbidity, mortality, and cost were evaluated using multivariable logistic and linear regression models. RESULTS: We identified 2, 464 women, including 1, 027 (41. 7%) who underwent laparoscopic hysterectomy and 1, 437 (58. 3%) who underwent robotic hysterectomy. Women treated at larger hospitals, nonteaching hospitals, and centers outside of the northeast were more likely to undergo a robotic hysterectomy procedure, whereas black women, those without insurance, and women in rural areas were less likely to undergo a robotic hysterectomy procedure (P <. 05 for all). The overall complication rate was 9. 8% for laparoscopic hysterectomy versus 8. 1% for robotic hysterectomy (P =. 13). The adjusted odds ratio (OR) for any morbidity for robotic hysterectomy was 0. 76 (95% CI, 0. 56 to 1. 03). After adjusting for patient, surgeon, and hospital characteristics, there were no significant differences in the rates of intraoperative complications (OR, 0. 68; 95% CI, 0. 42 to 1. 08), surgical site complications (OR, 1. 49; 95% CI, 0. 81 to 2. 73), medical complications (OR, 0. 64; 95% CI, 0. 40 to 1. 01), or prolonged hospitalization (OR, 0. 85; 95% CI, 0. 64 to 1. 14) between the procedures. The mean cost for robotic hysterectomy was 10, 618 versus 8, 996 for laparoscopic hysterectomy (P <. 001). In a multivariable model, robotic hysterectomy was significantly more costly (1, 291; 95% CI, 985 to 1, 597). CONCLUSION: Despite claims of decreased complications with robotic hysterectomy, we found similar morbidity but increased cost compared with laparoscopic hysterectomy. Comparative long-term efficacy data are needed to justify its widespread use.