Objectives Objective: Minimally invasive surgery (MIS) is a common approach in endometrial cancer care. Recent studies have shown increased recurrence rates for women undergoing MIS versus laparotomy. Our goal was to assess endometrial cancer recurrence rates for MIS versus laparotomy.

Methods A multi-centre retrospective study was conducted for patients with intermediate-risk (ESGO) stage 1 endometrioid endometrial cancer treated surgically between January 1/2010-December 31/2019. Surgical and pathology data were collected and oncology outcomes were assessed using Kaplan-Meier and multivariate COX regression analysis.

Results A total of 282 risk-stratified patients were reviewed from two major cancer centers. Median age of diagnosis was 64 and median follow up 60 months. A minimally invasive approach was completed for 65% of patients; 35% of patients underwent laparotomy. Adjuvant therapy with EBRT was completed in 21% of patients, brachytherapy in 48% and 31% had no adjuvant therapy. There was no difference in type of radiation between the two groups. In the MIS group 9.2% had any recurrence; 4.3% of these were extrapelvic (p=0.154). In the laparotomy group 4.1% had any recurrence; 1% of these were extrapelvic (p=0.169). Although no observed difference in overall survival, mean progression free survival was 106 months in the MIS group versus 117 months in the laparotomy group (p=0.031). There was a significantly greater risk of extrapelvic relapse with MIS (p=0.019).

Conclusion Among women with intermediate risk endometrial cancer, we observed a higher recurrence rate and risk of extrapelvic recurrence with MIS surgery. This finding is concerning and consistent with other published data.