Introduction/Background The aim of this study is to compare disease-free survival (DFS) and overall survival (OS) in patients with endometrial cancer according to the surgical approach.

Methodology Retrospective review of 434 endometrial cancer cases treated between 1996–2017, with follow-up until 2019.

Results The most used surgical approach was laparoscopy with 337 (77.6%) cases followed by laparotomy in 77 (17.7%) patients. Vaginal approach was performed in 20 (4.6%) cases that were excluded from the analysis. There were 71 recurrences (16.4%) with a mean follow-up estimated by Kaplan Meier of 220.1 months (95% confidence interval (CI) 208.0–232.3). 92 patients (21.19%) died with a mean follow-up estimated by Kaplan Meier of 202.6 months (95% CI 198.38–215.90). Cox regression model showed that surgical approach was not associated with DFS (p=0.518) (Hazard ratio (HR)1.20 95% CI 0.688–2.100). We found differences according to the surgical approach for OS (p<0.043) with an HR of 1.63 (95% CI: 1.104–1.63). There is 1.63 times more risk of death in the laparotomy approach. 38 (49.35%) of the laparotomies were performed in the first 5 years of the series, patients died from other causes not due to cancer (18 (60%) versus 22 (37.9%) in the laparoscopy group p=0.049). We have compared OS with cancer-specific death in both groups, this difference was not significant (p=0.673) (HR 1.15 95% CI 0.587–2.28). We have not found differences in local and distant recurrence (p=0.491), or recurrence above vaginal vault (p=0.534) in both groups.

Conclusion Surgical approach had no impact on DFS or OS in our series. Corresponding to the first years of the series, OS is lower in the LPM group, but when analyzing OS with cancer-specific death, this difference was not significant.