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, conversion to OS, incidence of readmission, operative time (OT), bleeding loss (BL), length of stay (LOS), 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 between RAS and OS. The conversion to OS did not occur in RAS. The incidence of readmission occurred less in the RAS than in the OS after surgery, but the difference disappeared one year after surgery.

In two RCTs with meta-analysis, OT, BL and LOS were not different between two groups (p > 0.5) but their heterogeneities were high. In the other RCT, however, OT in RAS were significantly longer (p < 0.001), BL and LOS in RAS were significantly less than OS (p < 0.001). Two RCTs reported the total resection LNs but the results were inconsistent. At 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, conversion and readmission. However, more rigorous studies focus on inconclusive aspects are required to support the benefit of RAS.