Evolving trends in the surgical staging of endometrial cancer patients in Germany: Analysis of a nationwide registry with special emphasis on perioperative outcomes

Abstract Purpose The present study compared the use and outcomes of open surgical staging, laparoscopic surgical staging and robotic-assisted surgical staging in all patients suffering from endometrial carcinoma undergoing surgery in Germany between 2007 and 2018. Methods All patients with the diagnosis of endometrial carcinoma undergoing open surgical staging, laparoscopic surgical staging and robotic-assisted surgical staging were identified by international classification of diseases (ICD) or specific operational codes (OPS) within the database of the German federal bureau of statistics. Results Between 2007 and 2018, a total of 85,204 patients underwent surgery for endometrial carcinoma. Since 2013 laparoscopy was the leading approach in the surgical staging. The use of robotic-assisted laparoscopy increased steadily since 2011 with a share of 3% in 2018. Open surgical staging was associated with a higher risk of in-hospital mortality than laparoscopic surgical staging (1.3% vs. 0.2%, p < 0.001), of prolonged mechanical ventilation (1.3% vs. 0.2%, p < 0.001), and of prolonged hospital stay (13.7 ± 10.2 vs. 7.2 ± 5.3, p < 0.001). 0.04% patients undergoing laparoscopy were converted to laparotomy. The perioperative outcomes of surgical staging by laparotomy compared with robotic-assisted were comparable. None of the robotic-assisted treated patients died or was converted into laparotomy. Costs were highest in the open laparotomy staging group, followed by robotic assisted. Conventional laparoscopic approach caused lowest costs (8286 ± 7533€ vs. 7083 ± 3893€ vs. 6047 ± 3509€). Conclusion The present analysis shows that conventional laparoscopy is the standard therapy of endometrial carcinoma with excellent in-hospital outcomes in clinical practice. Robotic-assisted laparoscopy is an emerging technology with convincing results similar to