{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T09:11:43Z","timestamp":1790154703781,"version":"4.0.1"},"reference-count":28,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:00:00Z","timestamp":1790121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Robot-assisted laparoscopic surgery (RALS) for endometrial cancer achieves outcomes comparable to those of conventional laparoscopy (Lap) but often requires a longer operative time, which may increase the early postoperative inflammatory response. We compared the postoperative day 1 (POD1) C-reactive protein (CRP) elevation between RALS and Lap and examined whether it was associated with the surgical platform or with patient- and procedure-related factors. Methods: This retrospective single-center study included 301 patients who underwent minimally invasive hysterectomy for endometrial cancer (Lap, n = 202; RALS, n = 99; 2018\u20132025). The primary outcome was CRP rise (POD1 minus the preoperative CRP level). Propensity score matching using preoperative covariates only (1:2, caliper 0.15 SD), multivariable regression, a formal mediation analysis with operative time as the mediator, and a test of the interaction between body mass index (BMI) category and surgical approach were performed. Results: RALS was associated with a greater CRP rise (2.88 vs. 2.13 mg\/dL; p = 0.001) and a longer operative time (271.0 vs. 210.5 min; p &lt; 0.001). In the matched cohort the median CRP rise was 2.91 mg\/dL after RALS and 2.22 mg\/dL after Lap, and the association persisted in a weighted model that accounted for the matched sets (\u03b2 = 0.131; p = 0.023). On multivariable analysis, operative time (\u03b2 = 0.0026 per minute; p &lt; 0.001) and BMI (\u03b2 = 0.0090 per kg\/m2; p = 0.033) were associated with the CRP rise, whereas the surgical approach was not (\u03b2 = \u22120.029; p = 0.623). Mediation analysis showed an indirect effect through operative time of +0.192 (95% CI, 0.120 to 0.278). The interaction between BMI category and surgical approach was not statistically significant (p = 0.750). Conclusions: The greater POD1 CRP rise after RALS was attenuated after accounting for operative time, and the mediation analysis was consistent with an indirect pathway through operative duration. This pathway cannot be established causally, because operative time could not be separated from surgeon experience, the learning curve and the era of each platform. A difference of this magnitude has no established clinical correlate, and no BMI-specific effect was demonstrated. Whether improving operative efficiency reduces the early postoperative inflammatory response should be evaluated prospectively.<\/jats:p>","DOI":"10.3390\/jcm15197376","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T08:14:39Z","timestamp":1790151279000},"page":"7376","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Postoperative C-Reactive Protein as a Marker of the Early Inflammatory Response in Robotic Versus Laparoscopic Minimally Invasive Surgery for Endometrial Cancer: A Propensity Score-Matched Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0926-1015","authenticated-orcid":false,"given":"Masahiro","family":"Kagabu","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"}]},{"given":"Takayuki","family":"Nagasawa","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Rina","family":"Shibata","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Shunsuke","family":"Tatsuki","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Nanako","family":"Jonai","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Shun","family":"Takagi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Sho","family":"Sato","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Eriko","family":"Takatori","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Yoshitaka","family":"Kaido","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9022-3333","authenticated-orcid":false,"given":"Tadahiro","family":"Shoji","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0066-3747","authenticated-orcid":false,"given":"Tsukasa","family":"Baba","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba, Iwate 028-3695, Japan"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e119","DOI":"10.3802\/jgo.2025.36.e119","article-title":"Japan Society of Gynecologic Oncology 2023 guidelines for treatment of uterine body neoplasm","volume":"36","author":"Morisada","year":"2025","journal-title":"J. Gynecol. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1097\/GCO.0000000000000606","article-title":"Endometrial cancer in the morbidly obese: A review","volume":"32","author":"Liu","year":"2020","journal-title":"Curr. Opin. Obstet. Gynecol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/j.ajog.2019.05.004","article-title":"Laparoscopic and robotic hysterectomy in endometrial cancer patients with obesity: A systematic review and meta-analysis of conversions and complications","volume":"221","author":"Cusimano","year":"2019","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e372","DOI":"10.1016\/j.clon.2021.05.001","article-title":"Laparoscopic and robotic surgery for endometrial and cervical cancer","volume":"33","author":"Uwins","year":"2021","journal-title":"Clin. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"588.E1","DOI":"10.1016\/j.ajog.2016.06.005","article-title":"Robotic-assisted vs traditional laparoscopic surgery for endometrial cancer: A randomized controlled trial","volume":"215","author":"Maenpaa","year":"2016","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e1851","DOI":"10.1002\/rcs.1851","article-title":"A comparison of operative outcomes between standard and robotic laparoscopic surgery for endometrial cancer: A systematic review and meta-analysis","volume":"13","author":"Ind","year":"2017","journal-title":"Int. J. Med. Robot. Comput. Assist. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1935","DOI":"10.1016\/j.ejso.2018.08.021","article-title":"Laparoscopic versus robotic hysterectomy in obese and extremely obese patients with endometrial cancer: A multi-institutional analysis","volume":"44","author":"Corrado","year":"2018","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_8","first-page":"2909","article-title":"Systemic inflammatory response after open, laparoscopic and robotic surgery in endometrial cancer patients","volume":"36","author":"Pilka","year":"2016","journal-title":"Anticancer Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"7226","DOI":"10.1038\/s41598-020-64016-1","article-title":"Markers of tissue damage and inflammation after robotic and abdominal hysterectomy in early endometrial cancer: A randomised controlled trial","volume":"10","author":"Lundin","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Meng, S., Cao, Y., Shen, Q., Dong, L., and Wang, N. (2024). Comparison of tissue damage and inflammation for robotic laparoscopy and conventional laparoscopy in early endometrial cancer. Front. Med., 11.","DOI":"10.3389\/fmed.2024.1492469"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e2024.00005","DOI":"10.4293\/JSLS.2024.00005","article-title":"Factors influencing CRP levels in laparoscopic and robotic total hysterectomy","volume":"28","author":"Tanabe","year":"2024","journal-title":"J. Soc. Laparosc. Robot. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"eaan3464","DOI":"10.1126\/scitranslmed.aan3464","article-title":"The systemic response to surgery triggers the outgrowth of distant immune-controlled tumors in mouse models of dormancy","volume":"10","author":"Krall","year":"2018","journal-title":"Sci. Transl. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1158\/0008-5472.CAN-15-1591","article-title":"Neutrophil extracellular traps promote the development and progression of liver metastases after surgical stress","volume":"76","author":"Tohme","year":"2016","journal-title":"Cancer Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1007\/s10147-019-01580-1","article-title":"The impact of postoperative inflammation on recurrence in patients with colorectal cancer","volume":"25","author":"Matsubara","year":"2020","journal-title":"Int. J. Clin. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1038\/bmt.2012.244","article-title":"Investigation of the freely available easy-to-use software \u2018EZR\u2019 for medical statistics","volume":"48","author":"Kanda","year":"2013","journal-title":"Bone Marrow Transplant."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1200\/JCO.2011.36.7508","article-title":"Comparative effectiveness of robotic versus laparoscopic hysterectomy for endometrial cancer","volume":"30","author":"Wright","year":"2012","journal-title":"J. Clin. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1016\/j.ejso.2015.04.020","article-title":"Surgical and oncological outcome of robotic surgery compared to laparoscopic and abdominal surgery in the management of endometrial cancer","volume":"41","author":"Corrado","year":"2015","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.surg.2014.09.009","article-title":"Routine clinical markers of the magnitude of the systemic inflammatory response after elective operation: A systematic review","volume":"157","author":"Watt","year":"2015","journal-title":"Surgery"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3243","DOI":"10.1007\/s00464-018-06611-y","article-title":"Comparison of inflammatory stress response between laparoscopic and open approach for pediatric inguinal hernia repair in children","volume":"33","year":"2019","journal-title":"Surg. Endosc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"4163","DOI":"10.21873\/anticanres.15220","article-title":"Laparoscopic versus robotic hysterectomy in obese patients with early-stage endometrial cancer: A single-centre analysis","volume":"41","author":"Yoshida","year":"2021","journal-title":"Anticancer Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.ygyno.2023.02.014","article-title":"Robotic-assisted surgery for endometrial cancer is safe in morbidly and extremely morbidly obese patients","volume":"172","author":"Lechartier","year":"2023","journal-title":"Gynecol. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1097\/CCO.0000000000001156","article-title":"Advantages of robotic surgery in obese patients with endometrial cancer","volume":"37","author":"Zaccarini","year":"2025","journal-title":"Curr. Opin. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.ygyno.2024.01.051","article-title":"The impact of body mass index on robotic surgery outcomes in endometrial cancer","volume":"185","author":"Kadoch","year":"2024","journal-title":"Gynecol. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1080\/13645706.2024.2407845","article-title":"Robotic-assisted, laparoscopic, and vaginal hysterectomy in morbidly obese patients with endometrial hyperplasia and endometrial cancer","volume":"33","author":"Giannini","year":"2024","journal-title":"Minim. Invasive Ther. Allied Technol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1002\/bjs.9756","article-title":"Meta-analysis of the predictive value of C-reactive protein for infectious complications in abdominal surgery","volume":"102","author":"Adamina","year":"2015","journal-title":"Br. J. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1007\/s00384-015-2205-y","article-title":"Diagnostic value of C-reactive protein to rule out infectious complications after major abdominal surgery: A systematic review and meta-analysis","volume":"30","author":"Gans","year":"2015","journal-title":"Int. J. Colorectal Dis."},{"key":"ref_27","first-page":"397","article-title":"C-reactive protein kinetics and its predictive value in orthopedic (trauma) surgery: A systematic review","volume":"84","author":"Kruidenier","year":"2018","journal-title":"Acta Orthop. Belg."},{"key":"ref_28","first-page":"e31067","article-title":"Role of procalcitonin and C-reactive protein as predictors of sepsis and in managing sepsis in postoperative patients: A systematic review","volume":"14","author":"Hassan","year":"2022","journal-title":"Cureus"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7376\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T08:55:52Z","timestamp":1790153752000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7376"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,23]]},"references-count":28,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["jcm15197376"],"URL":"https:\/\/doi.org\/10.3390\/jcm15197376","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,23]]}}}