Minimally Invasive Surgery in High-Grade Endometrial Carcinoma and Risk for Local Recurrence: An Israeli Gynecology Oncology Group Study

Study Objective To compare oncological outcomes of women with high-grade endometrial carcinoma (HGEC) who underwent surgery by minimally invasive surgery (MIS) versus laparotomy. Design A retrospective cohort study. Setting Academic multi-center. Patients or Participants Consecutive women with HGEC cancer treated at 11 Israeli institutions between 2002 and 2017 were accrued in an assimilated database with a median follow-up of 52 months (range 12-120 months). Women with HGEC were stratified into two groups by route of surgery; MIS vs. laparotomy by an intention to treat. Clinical, pathological and outcome data were compared. Interventions MIS and laparotomy. Measurements and Main Results Six hundred and seventy-eight women met the inclusion criteria: 160 underwent MIS and 518 laparotomy. The two groups were comparable in demographic and clinical characteristics. Local recurrence was more common in the MIS group, Odds Ratio (OR) 95% Confidence Interval (CI) 2.80 (1.80-4.36). Disease progression rates were comparable (p=0.537). In a multivariable analysis, including age, comorbidities, disease stage, CA-125 and lymph-vascular space invasion, MIS was not associated with an increased risk for either overall recurrence rate, disease progression, or overall survival. Independent risk factors for local recurrence were diabetes, stage III-IV, LVSI and MIS, adjusted OR 95% CI 3.30 (1.69-6.48). Conclusion In women with HGEC, MIS is associated with higher rates of local recurrence as compared to laparotomy. To compare oncological outcomes of women with high-grade endometrial carcinoma (HGEC) who underwent surgery by minimally invasive surgery (MIS) versus laparotomy. A retrospective cohort study. Academic multi-center. Consecutive women with HGEC cancer treated at 11 Israeli institutions between 2002 and 2017 were accrued in an assimilated database with a median follow-up of 52 months (range 12-120 months). Women with HGEC were stratified into two groups by route of surgery; MIS vs. laparotomy by an intention to treat. Clinical, pathological and outcome data were compared. MIS and laparotomy. Six hundred and seventy-eight women met the inclusion criteria: 160 underwent MIS and 518 laparotomy. The two groups were comparable in demographic and clinical characteristics. Local recurrence was more common in the MIS group, Odds Ratio (OR) 95% Confidence Interval (CI) 2.80 (1.80-4.36). Disease progression rates were comparable (p=0.537). In a multivariable analysis, including age, comorbidities, disease stage, CA-125 and lymph-vascular space invasion, MIS was not associated with an increased risk for either overall recurrence rate, disease progression, or overall survival. Independent risk factors for local recurrence were diabetes, stage III-IV, LVSI and MIS, adjusted OR 95% CI 3.30 (1.69-6.48). In women with HGEC, MIS is associated with higher rates of local recurrence as compared to laparotomy.