PT  - JOURNAL ARTICLE
AU  - Koek, Ruben C G
AU  - Wenzel, Hans
AU  - Jonges, Geertruida N
AU  - Lok, Christianne A R
AU  - Zweemer, Ronald
AU  - Gerestein, Cornelis G
TI  - Oncological outcomes after laparotomic, laparoscopic, and robot-assisted laparoscopic staging for early-stage high–intermediate or high-risk endometrial cancer
AID  - 10.1136/ijgc-2024-005510
DP  - 2024 Jul 16
TA  - International Journal of Gynecologic Cancer
PG  - ijgc-2024-005510
4099  - http://ijgc.bmj.com/content/early/2024/07/23/ijgc-2024-005510.short
4100  - http://ijgc.bmj.com/content/early/2024/07/23/ijgc-2024-005510.full
AB  - 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.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).