OBJECTIVES:

To evaluate the role played by the introduction of robotic-assisted surgery for endometrial cancer(EC) treatment in the United States in terms of 30-day morbidity and costs over time. Also, to compare the clinical and economic outcomes that followed the change in surgical treatment.

METHODS:

The Premier Hospital Perspective Database was reviewed for adult patients who underwent elective total hysterectomy for EC(2008/01-2015/09). Trend analyses for the proportions of surgical approaches, surgical and economics outcomes were performed. Outcomes were compared among surgical approaches after 1:1 Greedy propensity score matching.

RESULTS:

Overall, 35,224 EC patients were included. An increase in the use of Robotic-assisted hysterectomy(RH)(9.48% in 2008 to 56.82% in 2015) and a concomitant decrease in the use of Open hysterectomy(OH)(70.45% in 2008 to 28.08% in 2015) were observed over time. As a consequence, the rate of minimally invasive surgery increased from 27.59% to 70.65%. During the study period, the median length of stay(LOS) in US EC patients decreased from 4 to 3 days and 30-day readmission rates from 6.29% to 4.26%. The rate of any major complications decreased from 10.5% to 8,01%, p-for-trend=0.01; any minor complications went from 16.5% to 13.7%, urinary tract infections from 2.21% to 1.40%, and superficial surgical site infections from 2.94% to 1.50%(all P-for-trend< 0.05). A reduction of overall 30-day complications was registered (from 19.9% to 16.10%, P-value-for-trend: 0.05).Perioperative 30-day total cost from US$11048.17 slightly decreased to US$10322.76(all P-Values-for-trend<0.05).

After propensity score matching, RH was associated with shorter hospitalization(Median(Q1,Q3) days: RH=2(2,3)vs.OH=4(3,6), P-Value<0,001) and less 30-day complications(Overall 30-day complications RH=20.3%vs.OH=33.8%, P-value<0.001); Comparable perioperative total costs between approaches(Median(Q1,Q3): RH$12210(9457,16371) vs.OH$12017(8940, 17106), P-value=0.23) was registered.

CONCLUSIONS:

The implementation of minimally invasive surgery, thanks to the introduction of RH, led to a reduction of 30-day complications at a national level in the US without increasing treatment-related costs. More investigations are needed to demonstrate the causality.