The application value of the Da Vinci robot-assisted surgery in lymphadenectomy for endometrial cancer: a retrospective cohort study

Abstract

Purpose To investigate whether there is any difference in the safety, feasibility and intraoperative lymph node clearance of the Da Vinci robot-assisted surgery in endometrial cancer lymph node dissection compared to conventional laparoscopic surgery. Methods A retrospective analysis was made on the clinical data of 83 patients with endometrial cancer enrolled in the Affiliated Hospital of Jining Medical University from January 2018 to March 2022. 41 patients received Da Vinci robot-assisted surgery (RAS group) and 42 received conventional laparoscopic surgery (CLS group). To collect and compare the general condition, operation time, intraoperative bleeding, presence of intraoperative injury, postoperative exhaustion time, application of antibiotics, duration of pelvic drainage tube retention, duration of indwelling catheter, whether postoperative pain medication was applied, whether postoperative abdominal distension was present, number of intraoperative lymph nodes cleared and positive, and LNR between the two groups. Results There was a statistically significant difference (P < 0.05) between the two groups in terms of operative time. There was no statistically significant difference (P > 0.05) in terms of intraoperative bleeding, postoperative time to exhaustion, time to apply antibiotics, time to leave a pelvic drain in place, time to leave a catheter in place, length of hospital stay, whether pain medication was applied postoperatively, and whether there was postoperative abdominal distension. When comparing the number of lymph nodes cleared intraoperatively, the number of positives and LNR between the two groups, the differences were statistically significant (P < 0.05). When the surgical approach, number of intraoperatively cleared lymph nodes, maximum diameter of the mass, tissue grading, type of postoperative pathology, myxomatous infiltration, cervical interstitial involvement and vascular infiltration were compared with the number of positive intraoperative cleared lymph nodes and LNR in each of the 83 patients in a univariate analysis, the differences between the number of intraoperative cleared lymph nodes, maximum diameter of the mass, tissue grading, type of postoperative pathology and cervical interstitial involvement were The differences were not statistically significant (P > 0.05), while the differences were statistically significant (P < 0.05) when comparing the surgical approach, tumour myxomatous infiltration and choroidal infiltration. The number of positive intraoperative lymph node dissection (P = 0.0498) and LNR (P = 0.0455) were compared between the two groups after multiple regression analysis of tumour myofibrotic infiltration and choroidal infiltration, and the differences were statistically significant (P < 0.05). Conclusion This may be related to the 360o wrist rotation of the instrument arm of the Da Vinci robot-assisted surgery, which allows for the smooth removal of deep pelvic lymph nodes with clear exposure, thus allowing more lymph nodes to be cleared, but the relationship remains to be investigated.