To investigate the efficacy, safety and benefit groups of different surgical approaches based on propensity score inverse probability treatment weighting method (IPTW) comparing robotic and open and traditional laparoscopic surgery in patients with endometrial cancer (EC).

Data of 387 patients with EC who underwent different surgical approaches between Jun. 2014 and Jun. 2019 from the First Medical Center of PLA General Hospital were retrospectively reviewed, and after adjusting for confounding factors by the IPTW method, surgery related indicators and some prognostic index such as overall survival (OS) and disease-free survival (DFS) were compared.

There was a significant difference in operative length among the three surgical approaches (P< 0.001), with less blood loss in the robotic group (P= 0.013) than in the laparoscopic (P= 0.001) and open groups (P< 0.001); There was a significant difference in the number of lymph nodes resection (P< 0.001), with the robotic group (18.88±17.32) being superior to laparoscopic (8.50 ± 12.18) and open (6.86±12.38) surgeries (P< 0.001), the odds of delayed flatus were lower than open surgery(1.3% vs 12.1%, P= 0.001), and the postoperative drainage volume was higher in the robotic group compared to laparoscopic (P= 0.01) and open surgeons (P= 0.003). In the survival analysis, there was no significant difference in the prognosis of patients with typeⅠ EC (OS, P= 0.999; DFS, P= 0.9), early stage EC (OS, P= 0.3; DFS, P= 0.08), and there was significant difference among type Ⅱ EC among the three surgical approaches (P= 0.003) and OS (P= 0.001).

The application of robotics can reduce blood loss, better dissection of lymph nodes, and improve the prognosis of type Ⅱ EC in endometrial cancer surgery; however, it might have related to a longer surgery time and an greater amount of total postoperative drainage.