EP103/#355 Comparison of minimally invasive versus open surgery in treatment of endometrial cancer with high risk of recurrence – retrospective cohort study in Korea and Taiwan

Objectives

The aim of this study was to compare oncologic outcomes between minimally invasive surgery (MIS) and open surgery in the treatment of endometrial cancer with high risk of recurrence.

Methods

This retrospective study included patients with endometrial cancer with high risk factor who underwent primary surgery in two tertiary centers in Korea and Taiwan. Stage III-IVA endometrial cancer with grade 1–2 endometrioid type, stage I-IVA endometrial cancer with grade 3 endometrioid type or non-endometrioid type were considered as factors of high risk of recurrence. We conducted 1:1 propensity score matching between MIS and open surgery group to adjust the baseline characteristics. Oncologic outcomes were compared according to surgical approach.

Results

A total of 284 patients were included after propensity score matching. Among them, 32 (11.3%) cases were patients with low grade endometrioid carcinoma with advanced stage, 109 (38.4%) patients were grade 3 endometrioid carcinoma, and 143 (50.3%) were patients with non-endometrioid carcinoma. Compared to patients who underwent open surgery, MIS did not show difference in disease-free survival (HR 1.09, 95% CI 0.67–1.77, P=0.717) and overall survival (HR 0.67, 95% CI 0.36–1.24, P=0.198). In multivariate analysis, non-endometrioid histology, tumor size, tumor in cytology, depth of invasion, and lympho-vascular space invasion were risk factors for recurrence. There was no association between surgical approach in either recurrence or mortality in subgroup analysis according to stage and histologic type.

Conclusions

Minimally invasive surgery did not compromise survival outcomes for endometrial cancer with high risk of recurrence when compared to open surgery.