OBJECTIVES: This study aims to evaluate the safety and effectiveness of robotic-assisted surgery (RAS) in endometrial cancer (EC) compared with open surgery (OS).

METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE via Ovid, on 12 April 2022. The study involved randomized controlled trials (RCTs). Two authors independently assessed studies for inclusion, risk of bias, and extracted study data. We extracted complication, incidence of readmission, conversion to OS, operative time (OT), length of stay (LOS), bleeding loss (BL), total resection lymph nodes(LNs), quality of life (QOL), and survival outcomes.

RESULTS: A total of three RCTs were included. There was no difference in complications related to surgery and the incidence of readmission between RAS and OS. The conversion to OS did not occur in RAS.

In two RCTs with meta-analysis, OT in RAS were significantly longer (p < 0.001) but LOS in RAS were significantly shorter (p < 0.00001). And the other one RCT OT in RAS were significantly longer (p < 0.001) but LOS in RAS were significantly shorter(p<0.001).

In two RCTs with meta-analysis, BL were not different between two groups (p = 0.2) but their heterogeneities was high, but in one RCT BT in RAS were significantly lower(p<0.001).Two RCTs reported the total resection LNs but the results were inconsistent. At 5-42 days after the surgery in one RCT, the results of the EQ-5D index reported better QOL in the RAS(p<0.01). There is no study that reported survival outcomes.

CONCLUSIONS: RAS could be a viable alternative to OS for EC on the basis of current evidence with complication, readmission and conversion. However, more rigorous studies focus on inconclusive aspects are required to support the benefit of RAS.