Objectives To compare oncological outcomes of women with high-grade endometrial carcinoma (HGEC) who underwent surgery by minimally invasive surgery (MIS) versus laparotomy.
Methods A retrospective cohort study performed in an academic multi-center setting. Consecutive women with HGEC cancer treated at 11 Israeli institutions between 2002 and 2017 were accrued in an assimilated database with a median follow-up of 52 months (range 12–120 months). Women with HGEC were stratified into two groups by route of surgery; MIS vs. laparotomy by an intention to treat. Clinical, pathological and outcome data were compared.
Results Six hundred and seventy-eight women met the inclusion criteria: 160 underwent MIS and 518 laparotomy. The two groups were comparable in demographic and clinical characteristics. Brachytherapy rate was similar in both groups (p=0.192). Disease progression and overall survival did not differ between groups (p=0.537, p=0.465, respectively). However, patients operated with MIS had almost 3 times risk to recur at their vaginal cuff or pelvis (Odds Ratio (OR) 95% Confidence Interval (CI) 2.80 (1.80–4.36)). In a multivariable analysis, including age, comorbidities, disease stage, CA-125 and lymph-vascular space invasion, MIS was associated with an increased risk for local (vaginal cuff or pelvic) recurrence (OR 95% CI 3.30 (1.69–6.48)).
Conclusions In women with HGEC, MIS was associated with higher rates of local recurrence as compared to laparotomy
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