Minimally Invasive Compared With Open Hysterectomy in High-Risk Endometrial Cancer. Issue 6 (December 2021)

• Record Type: Journal Article
• Authors: Segarra-Vidal, Blanca; Dinoi, Giorgia; Zorrilla-Vaca, Andres; Mariani, Andrea; Student, Vladimir; Garcia, Nuria Agustí; Llueca Abella, Antonio; Ramirez, Pedro T.
• Is Part Of: Obstetrics and gynecology. Volume 138:Issue 6(2021)
• Publication Date: 2021-12
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/AOG.0000000000004606
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : OBJECTIVE: To compare disease-free survival between minimally invasive surgery and open surgery in patients with high-risk endometrial cancer. METHODS: We conducted a multicentric, propensity-matched study of patients with high-risk endometrial cancer who underwent hysterectomy, bilateral salpingo-oophorectomy, and staging between January 1999 and June 2016 at two centers. High-risk endometrial cancer included grade 3 endometrioid, serous, clear cell, undifferentiated carcinoma or carcinosarcoma with any myometrial invasion. Patients were categorized a priori into two groups based on surgical approach, propensity scores were calculated based on potential confounders and groups were matched 1:1 using nearest neighbor technique. Cox hazard regression analysis and Kaplan-Meier curves evaluated the association of surgical technique with survival. RESULTS: Of 626 eligible patients, 263 (42%) underwent minimally invasive surgery and 363 (58%) underwent open surgery. In the matched cohort, there were no differences in disease-free survival rates at 5 years between open (53.4% [95% CI 45.6–60.5%]) and minimally invasive surgery (54.6% [95% CI 46.6–61.8]; P =.82). Minimally invasive surgery was not associated with worse disease-free survival (hazard ratio [HR] 0.85, 95% CI 0.63–1.16; P =.30), overall survival (HR 1.04, 95% CI 0.73–1.48, P =.81), or recurrence rate (HR 0.99; 95% CI 0.69–1.44; P =.99) compared with open surgery. Use of uterine manipulator was not associated with worse disease-free survival (HR 1.01, 95% CI 0.65–1.58, P =.96), overall survival (HR 1.18, 95% CI 0.71–1.96, P =.53), or recurrence rate (HR 1.12, 95% CI 0.67–1.87; P =.66). CONCLUSION: There was no difference in oncologic outcomes comparing minimally invasive and open surgery among patients with high-risk endometrial cancer. Abstract : There was no difference in disease-free survival, overall survival, and recurrence rate when comparing minimally invasive and open surgery among patients with high-risk endometrial cancer.