Objectives To compare survival outcomes between women with stages II-IV endometrial carcinoma (EC) with lower uterine segment involvement (LUSI), staged by minimally invasive surgery (MIS) and those staged by laparotomy.

Methods A retrospective multi-center cohort study of nine gynecologic-oncology centers. Univariate analysis, Kaplan-Meier survival and Cox proportional hazard models analysis were performed to compare women surgically staged by MIS and those operated by laparotomy in different stages and histology of EC.

Results Over a median follow-up period of 3 years (interquartile range, 1.5–6 years) 212 women were included, 68 (32.1%) were surgically staged by MIS. Stages of disease among the study cohort were stages II, III and IV, 32.1%, 51.9%, and 16.0%, respectively. Stage distribution did not vary between MIS and laparotomy groups (p=0.144). High-grade histology was less common in MIS group (44.1% vs. 67.4%, p<0.001). Adjuvant radiation and chemotherapy rates were comparable. Recurrence (local and distal) rate did not differ between groups (44.1% MIS vs. 31.9% laparotomy, p=0.084). Local recurrence rate was higher in MIS group (32.4% vs. 18.1%, p=0.023). Overall survival and local recurrence-free survival were similar in both groups (log rank test p=0.08, p=0.33, respectively). In Cox regression model adjusting for age, comorbidities, tumor grade, disease stage and adjuvant therapy, route of surgery (MIS vs. laparotomy) was not associated with overall survival (p=0.169) or local recurrence (p=0.296).

Conclusions In women with stage II-IV EC with LUSI, MIS was associated with higher local recurrence rate, yet overall survival was comparable between patients with MIS and laparotomy, regardless of adjuvant therapy.