Introduction/Background Minimally invasive surgery (MIS) has become the approach of choice for staging endometrial cancers. Recent reports have demonstrated its non-inferiority to laparotomy especially in early-stage disease across many endometrial histologies, but have not specifically evaluated MIS for UCC. Our objective was to compare oncologic outcomes for patients undergoing MIS versus laparotomy for uterine-confined UCC.

Methodology Patients who underwent surgical management of newly diagnosed UCC between 6/1997 and 10/2021 were retrospectively identified and allocated to MIS or laparotomy groups. Patients with conversion to laparotomy were analyzed as MIS in an intention to treat manner. Appropriate statistical tests were used.

Results Ninety-three patients met inclusion criteria:

62 (67%) underwent MIS (34% non-robotic and 66% robotic-assisted laparoscopy) and 31 (33%) laparotomy. Four (6%) patients had conversion to laparotomy. Seventy-one (77%) patients had FIGO-stage-I/II, 17 (18%) FIGO-stage-III, and 5 (5%) FIGO-stage-IV. Age, BMI, FIGO-stage, depth of myoinvasion, and washing status did not differ between groups. Patients undergoing MIS were less likely to have lymph-vascular invasion (20 vs 43%), (P=0.03). The rate of perioperative complications was 13% in the MIS and 65% in laparotomy (P<0.001). The median number of nodes was 8 (range, 1–40) in MIS and 21 (range, 1–59) in laparotomy (P<0.01). Para-aortic nodes were removed in 36% of MIS compared to 72% in laparotomy (P<0.001). Rates of adjuvant treatment did not differ between groups.

Median follow-up time was 53 months (range, 2–235) and did not differ between groups. Three-year PFS was 68% (SE ± 7%) for MIS and 67% (SE ± 10%) for laparotomy (P=0.9). Three-year OS was 81% (SE ± 6%) for MIS and 87% (SE ± 6%) for laparotomy (P=0.8). On multivariate analysis, only FIGO-stage was associated with decrease in both PFS and OS.

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Abstract #275 Figure 1

Kaplan-Meier Curve comparing overall survival for MIS vs laparotomy

Conclusion MIS does not compromise oncologic outcomes in patients with uterine-confined UCC. MIS should be considered to minimize surgical morbidity.

Disclosures Dr. Abu-Rustum reports grant funding from GRAIL paid to the institution. Dr. Leitao is an ad hoc speaker for Intuitive Surgical, Inc., has consulted for Medtronic, and has served on the advisory boards of Ethicon/Johnson & Johnson and Immunogen.