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Original research
Oncological outcomes after laparotomic, laparoscopic, and robot-assisted laparoscopic staging for early high–intermediate or high-risk endometrial cancer
  1. Ruben C G Koek1,
  2. Hans Wenzel2,
  3. Geertruida N Jonges3,
  4. Christianne A R Lok4,
  5. Ronald Zweemer1 and
  6. Cornelis G Gerestein1
    1. 1Department of Gynaecological Oncology, UMC Utrecht, Utrecht, The Netherlands
    2. 2Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
    3. 3Department of Pathology, UMC Utrecht, Utrecht, The Netherlands
    4. 4Department of Gynaecologic Oncology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
    1. Correspondence to Dr Cornelis G Gerestein, Department of Gynecologic Oncology, Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht 3508 GA, The Netherlands; c.g.gerestein-2{at}umcutrecht.nl

    Abstract

    Objectives To compare oncological outcomes in patients with early-stage high–intermediate or high-risk endometrial cancer undergoing surgical staging by laparotomy, conventional laparoscopy, or robot-assisted laparoscopy.

    Methods Patients diagnosed between 2015 and 2021 with stage I–II (International Federation of Gynecology and Obstetrics 2009), high–intermediate or high-risk endometrial cancer who underwent staging surgery, were identified in the Netherlands Cancer Registry. Five-year disease-free survival and overall survival were calculated using the Kaplan-Meier method, and differences between groups were evaluated using log-rank testing. Additionally, survival analyses were stratified by histological subtype. The effect of surgical modality on risk of recurrence and all-cause death was assessed by performing Cox regression analysis with inverse probability treatment weighting.

    Results In total 941 patients met the inclusion criteria, of whom 399 (42.4%) underwent staging surgery by laparotomy, 273 (29.0%) by laparoscopy, and 269 (28.6%) by robot-assisted laparoscopy. Baseline characteristics were comparable between the three groups. No difference in disease-free survival (75.0% vs 71.2% vs 79.0% p=0.35) or overall survival (72.7% vs 72.3% vs 71.2% p=0.98) was observed between patients after laparotomy, laparoscopy, or robot-assisted laparoscopy, respectively. Subanalyses based on histological subtype showed comparable disease-free survival and overall survival between surgical approaches. After correcting for possible confounders by means of inverse probability treatment weighting, there was no significantly increased risk of recurrence or risk of all-cause death after laparoscopy or robot-assisted laparoscopy.

    Conclusion Laparoscopic and robot-assisted laparoscopic staging surgery in women with early-stage high–intermediate or high-risk endometrial cancer are safe alternatives to laparotomic staging surgery.

    • Laparotomy
    • Surgery
    • Robotic Surgical Procedures
    • Uterine Cancer
    • Laparoscopes

    Data availability statement

    Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. Data were requested from the Netherland Cancer Registry and the Dutch national pathology database (PALGA).

    https://doi.org/10.1136/ijgc-2024-005510

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      Data availability statement

      Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. Data were requested from the Netherland Cancer Registry and the Dutch national pathology database (PALGA).

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      Footnotes

      • Contributors RCGK: formal analysis, investigation, methodology, project administration, manuscript writing; HW: data curation, methodology, supervision, manuscript writing/reviewing; GNJ: data curation, manuscript reviewing; CARL: methodology, supervision, manuscript reviewing; RZ: supervision, manuscript reviewing; CGG: conceptualization, methodology, project administration, resources, supervision, manuscript writing/reviewing, guarantor.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests RZ is a proctor for robot-assisted surgery in gynaecological oncology on behalf of Intuitive Surgical.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.