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2022-RA-1181-ESGO Survival outcomes and recurrence patterns of laparotomy versus minimal invasive surgery in women with intermediate- and high-risk uterine cancer at a tertiary referral center
  1. Pernille Bjerre Trent1,2,
  2. Milada Småstuen3,
  3. Yun Wang1,
  4. Gunn Fallås Dahl1,
  5. Brynhildur Eyjólfsdóttir1,
  6. Anne Cathrine Staff2,4 and
  7. Anne Gerda Zahl Eriksson1
  1. 1Dept of gynecological oncology, Oslo University Hospital, Oslo, Norway
  2. 2Faculty of Medicine, University of Oslo, Oslo, Norway
  3. 3Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
  4. 4Division of Obstetrics and Gyneacology, Oslo University Hospital, Oslo, Norway


Introduction/Background Minimal invasive surgery (MIS) has emerged as the gold standard for surgical staging of women with assumed early-stage endometrial cancer (EC). In cervical cancer the use of MIS has decreased after publication of the LACC-trail in 2018. We sought to compare women treated by laparotomy versus MIS for EC in respect to survival outcomes and recurrence.

Methodology Women with assumed uterine-confined endometrioid grade 3 and non-endometrioid EC from 2006 to 2021 were identified in our institutional database. Risks of recurrence and cancer-specific death were estimated, stratified by surgical approach. Appropriate statistical tests were applied.

Results 786 women were identified, 463(58.9%) laparotomy and 323(41.1%) MIS (82/323 laparoscopy, 241/323 robotic), see figure 1 for distribution over time. Patient and tumor characteristics are described in table1.There was no difference between groups regarding age, BMI, smoking, ASA, histology, presence of LVIS, or adjuvant therapy. Significantly more women in the laparotomy group were stage III (29% vs 21%) and IV (7% vs 2%), respectively (p<0.0001). Nodal assessment and anatomic distribution of recurrences varied between groups, see table1. There were more women in the laparotomy group with isolated vaginal recurrences and multiple site recurrences, p=0.04 and p=0.02, respectively. More women in the laparotomy group underwent comprehensive lymphadenectomy and more women in the MIS group underwent sentinel lymph node biopsy. Acknowledging the small number of isolated nodal recurrences, there was no significant difference in rate of these recurrences (p=0.25). When adjusted for age, histology, stage and LVSI, risk of recurrence and cancer-specific death was not significantly different between groups, HR=1.28 (95%CI, 0.94 – 1.74) and HR=1.19 (95%CI, 0.82 – 1.74), respectively.

Abstract 2022-RA-1181-ESGO Table 1

Patient and tumor characteristics

Abstract 2022-RA-1181-ESGO Figure 1

Conclusion In this retrospective comparison of laparotomy versus MIS in women with high-risk EC having mainly received adjuvant chemotherapy, distribution of recurrences varied. However, risk of recurrence and death was the same.



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