Robotic vs Laparoscopic and Open Surgery for Abdominopelvic Cancers

Robotic surgery has become an increasingly common option for treating cancers in the abdomen and pelvis. However, whether robotic surgery leads to better cancer-related outcomes than laparoscopic (keyhole) surgery or open surgery is still uncertain. Results may differ across cancer types, and factors such as how complex the surgery is and how experienced the surgeon is may also influence the outcome. This retrospective cohort study examined adults who underwent curative-intent surgery for one of seven abdominopelvic cancers (pancreatic, gastric, rectal, cervical, endometrial, kidney, or prostate cancer) at a large tertiary hospital in Seoul, South Korea, between January 2012 and December 2021. Patients were classified into three groups according to the surgical approach they received: open, laparoscopic, or robotic surgery. The main outcome was 1-year disease-free survival, defined as the time from surgery to the first occurrence of cancer recurrence, distant metastasis, or death from any cause. Additional outcomes included 1-year mortality, overall mortality during follow-up, major postoperative complications, acute kidney injury, and length of hospital stay. To reduce differences between groups that might affect the comparison, the study used a statistical method called propensity score overlap weighting. Additional analyses adjusted for surgical complexity, surgeon experience including robotic learning curve, and pathological cancer stage to isolate the effect of the surgical platform itself. The purpose of this study was to evaluate whether the association between surgical approach and early oncologic and perioperative outcomes differed across the seven cancer types, and whether any observed advantage of the robotic platform remained after accounting for these factors.

Inclusion Criteria: * Age 18 years or older * Underwent curative-intent abdominopelvic surgery for a nonmetastatic malignant solid tumor of one of the following types: pancreatic, gastric, rectal, cervical, endometrial, kidney, or prostate cancer * Surgery performed between January 1, 2012, and December 31, 2021 * Available postoperative surveillance data Exclusion Criteria: * Presence of distant metastasis before surgery * Presentation with recurrent disease from previously treated cancer * Incomplete or missing key demographic, comorbidity, operative, or outcome data required for analysis