Introduction/Background*Randomized trials have shown comparable oncologic outcomes between open versus minimally invasive surgery for endometrial cancer. Limited data is available specifically in patients with high-risk disease. The aim of this study was to compare disease-free survival, overall survival, and recurrence rates between minimally invasive surgery versus open surgery in patients with high-risk endometrial cancer.
Methodology This was a multicentric, propensity score matched study of patients with high-risk endometrial cancer who underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy and staging between January 1999 and June 2016 at two referral cancer centers. High-risk endometrial cancer included uterine grade 3 endometrioid, serous carcinoma, clear cell carcinoma, and undifferentiated carcinoma or carcinosarcoma with any degree of myometrial invasion. Patients were categorized a priori into two groups based on the surgical approach, propensity scores were calculated based on potential confounders and then both groups were matched in a 1:1 fashion using the nearest neighbor technique. Cox hazard regression analysis was used to evaluate effect of surgical technique on survival.
Result(s)*A total of 626 patients were eligible, of which 263 patients underwent minimally invasive surgery and 363 open surgery. The median age was 67 years (IQR 60-74), and the median body mass index was 30.5 kg/m2 (IQR 25.5-35.8). After matching, both groups had 185 matched pairs with comparable demographics and clinical characteristics. In the matched cohort, there were no differences in disease-free survival rates at 5-years between open surgery (53.4% [95%CI 45.6-60.5%]) and minimally invasive surgery (54.6% [95%CI 95% 46.6-61.8]; P=0.82). Minimally invasive surgery was not associated with worse disease-free survival (HR 0.85, 95% CI 0.63 to 1.16; P=0.30), overall survival (HR 1.04, 95% CI 0.73 to 1.48, P=0.81), or recurrence rate (HR 0.99; CI 95% 0.69-1.44; P=0.99) compared to open surgery. Use of uterine manipulator was not associated with worse disease-free survival (HR 1.01, 95% CI 0.65 to 1.58, P=0.96), overall survival (HR 1.18, 95% CI 0.71 to 1.96, P=0.53), or recurrence rate (HR,1.12; CI 95% 0.67 to1.87; P=0.66).
Conclusion*There was no difference in oncologic outcomes when comparing minimally invasive and open surgery among high-risk endometrial cancer patients
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