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O006/#340 Minimally invasive surgery in advanced endometrial carcinoma is associated with an increased risk for local recurrence
  1. L Kogan1,
  2. G Levin2,
  3. L Helpman3,
  4. R Eitan4,
  5. Z Vaknin5,
  6. O Lavie6,
  7. A Ben Arie7,
  8. A Amit8,
  9. T Levy9,
  10. A Namazov10,
  11. I Ben Shachar11,
  12. I Atlas12,
  13. I Bruchim13,
  14. B Brandt1 and
  15. O Gemer14
  1. 1Hadassah, Gynecologic Oncology, Jerusalem, Israel
  2. 2hadassah medical center, Gynecologic Oncology, jerusalem, Israel
  3. 3Cheba medical center, Gynecologic Oncology, Ramat Gan, Israel
  4. 4Rabin Medical Center, Gynecology, Petah Tikva, Israel
  5. 5Assaf Haroffe Medical Center, Sackler School of Medicine, Gynecology, Zrifin, Israel
  6. 6Carmel Medical Center, Obstetrics and Gynecology, Haifa, Israel
  7. 72. Kaplan Medical Center, Hebrew University, Gynecology, Rehovot, Israel
  8. 8Rambam, Gymecologic Oncology, Haifa, Israel
  9. 98. Wolfson Medical Center, Holon, Sackler Faculty of Medicine, Tel Aviv University, Gynecology, Tel Aviv, Israel
  10. 10Ahmet, Gynecology, Ashkelon, Israel
  11. 11ZIv, Gynecologic Oncology, Zefat, Israel
  12. 12Poriah, Gynecologic Oncology, Tiberia, Israel
  13. 13Hillel Yafe, Gynecology, Hadera, Israel
  14. 14Barzilai Medical Center, Gynecology, Ashkelon, Israel


Objectives To compare oncological outcomes of women with stage II -IIIc endometrial cancer (EC) who underwent minimally invasive surgery (MIS) versus laparotomy.

Methods A retrospective cohort study in an academic multi-center setting. Consecutive women with EC treated at 11 Israeli institutions between 2002 and 2017 were recorded in an assimilated database with a median follow-up of 52 months (range 12–120 months). Women with stage II -IIIc were stratified into groups by intentional route of surgery; MIS vs. laparotomy. Clinical, pathological and outcome data were compared.

Results Three hundred and four women met criteria: 200 underwent laparotomy and 104 MIS. Women in the MIS group were younger, had lower rate of diabetes and lower CA-125 level. Women who underwent laparotomy had higher grade EC and more advanced stage disease; Odds Ratio (OR) and 95% Confidence Interval (CI) 0.34 (0.21–0.56) and 0.56 (0.34–0.92), respectively. Brachytherapy rate was comparable between groups (p=0.715). In a multivariable analysis, including age, comorbidities, disease stage, tumor grade and lymph-vascular space invasion, MIS was not associated with an increased risk for recurrence, progression or decreased overall survival. However, patients operated by MIS had higher risk to recur locally (vaginal cuff or pelvic) (26.9% vs. 16.5%, p=0.032, OR, 1.86, 95% CI 1.05–3.30). MIS was the only independent factor associated with local recurrence, adjusted OR, 2.09, 95% CI 1.12–3.90.

Conclusions In women with stage II-IIIc EC, MIS was associated with an increased risk for local recurrence compared to laparotomy.

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