Article Text

Download PDFPDF

864 Minimally invasive versus open hysterectomy in high-risk endometrial cancer: a propensity score matching analysis
  1. B Segarra Vidal1,
  2. A Zorrills-Vaca2,
  3. G Dinoi3,
  4. V Študent4,
  5. N Agustí5,
  6. A Llueca6;7,
  7. A Mariani8 and
  8. P Ramirez9
  1. 1Hospital Universitario y Politécnico de La Fe, Gynecologic Oncology, València, Spain
  2. 2MD Anderson Main Building, Houston, USA
  3. 3Gemelli, Roma, Italy
  4. 4Mayo Clinic, Rochester, USA
  5. 5Hospital Clínic de Barcelona, Barcelona, Spain
  6. 6Hospital General Universitari de Castelló, Castelló de la Plana, Spain
  7. 7Gynecology Oncology Unit Hospital General Universitario de Castellon. Departamento de Medicina. Universitat Jaume I (UJI). , Spain
  8. 8Mayo Clinic Rochester MN, Rochester, USA
  9. 9The University of Texas MD Anderson Cancer Center, Houston, USA


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

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.