Background Endometrial carcinoma (EC) is one of the most common malignant tumor of the female reproductive system, which is closely related to endocrine and metabolic disorders such as hypertension, diabetes and obesity. Although a large number of literatures have reported that Da Vinci robotic surgery is characterized by shorter operation time, less blood loss and better survival prognosis than traditional laparoscopic surgery and laparotomy, however, the perioperative results and long-term survival prognosis of a large number of patients with endometrial cancer treated with Da Vinci robotic system are currently lacking.
Objective To analyze the perioperative conditions, clinical and pathological characteristics and prognosis of 333 EC cases undergoing robotic-assisted surgery, discuss the feature and application advantages of Da Vinci robotic surgery and provide reference for clinical application.
Methods From February 2012 to June 2020, 333 patients with endometrial cancer in the First Medical Center of Chinese PLA General Hospital were selected, and they all underwent Da Vinci robotic surgery. The basic information, data of operation index, tumor pathological characteristics and postoperative survival outcome of all cases were collected and analyzed.
Results Of the 333 EC patients with average age of (53.03±9.05) years and BMI of (26.04±4.00) kg/m2, 92 cases (27.63%) were obesity. Nullipara accounted for 9% and postmenopausal accounted for 63%, 43.84% of cases had metabolic syndrome. The average time of robotic-assisted surgery was (184.91±49.78) min, the average blood loss was (113.57±122.90) mL and the number of lymph nodes removed was (28.00±11.47). Moreover, 38 cases (11.41%) had intraoperative complications, including 23 cases of lymphorrhagia, 7 cases of infection, 4 cases of deep vein thrombosis in the lower extremity, 2 cases of intestinal obstruction, 1 case of intraperitoneal hemorrhage and 1 case of ureterovaginal fistula, and they were cured after active treatment. The average length of hospital stay and anal exhaust time after operation was (9.59±4.04) d and (1.90±0.63) d, respectively. However, the tumor pathological feature showed Type I and Type II EC accounted for 92.19% and 7.81%, respectively. The proportion of patients with tumor stage I, II, III, IV was 78.08%, 10.51%, 10.81%, 0.60%, respectively. The proportion of well-differentiated tumors was 41.19% and the rate of middle-low differentiated tumor was 58.81%. Age (age＞53 years) or obese (BMI＞28) had no significant influence on perioperative conditions (P＜0.05, respectively). The 3-year and 5-year cumulative survival rate of EC treated by robotic-assisted system in our hospital was 96.5% and 95.8%, respectively.
Conclusion Da Vinci robot-assisted surgery shows strong stability and efficiency. The surgical outcome of Da Vinci robot-assisted is not affected by comorbidity, old age or obesity. In conclusion, Da Vinci robot-assisted surgery have the value of popularization and application.
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