Abstract
This study was conducted to compare the long-term oncological outcomes of laparotomy and laparoscopic surgeries in endometrial cancer under the light of the 2016 ESMO-ESGO-ESTRO risk classification system, with particular focus on the high–intermediate- and high-risk categories. Using multicentric databases between January 2005 and January 2016, disease-free and overall survivals of 2745 endometrial cancer cases were compared according to the surgery route (laparotomy vs. laparoscopy). The high–intermediate- and high-risk patients were defined with respect to the 2016 ESMO-ESGO-ESTRO risk classification system, and they were analyzed with respect to differences in survival rates. Of the 2745 patients, 1743 (63.5%) were operated by laparotomy, and the remaining were operated with laparoscopy. The total numbers of high–intermediate- and high-risk endometrial cancer cases were 734 (45%) patients in the laparotomy group and 307 (30.7%) patients in the laparoscopy group. Disease-free and overall survivals were not statistically different when compared between laparoscopy and laparotomy groups in terms of low-, intermediate-, high–intermediate- and high-risk endometrial cancer. In conclusion, regardless of the endometrial cancer risk category, long-term oncological outcomes of the laparoscopic approach were found to be comparable to those treated with laparotomy. Our results are encouraging to consider laparoscopic surgery for high–intermediate- and high-risk endometrial cancer cases.
Highlights
Endometrial cancer is the most common gynecological cancer among women in the developed world [1]
The similar long-term oncological outcomes of LS in low-risk endometrial cancer patients have been demonstrated in the literature to be comparable to open surgery [3,11,13,14,15]
As a reflection of this reality, the European guidelines’ recommendation for the management of low- and intermediate-risk endometrial cancer with minimally invasive surgery (MIS) was level of evidence–I and strength of recommendation–A, whereas it was considered as level of evidence–IV and strength of recommendation–C- for the management of highrisk endometrial cancer [4]
Summary
Endometrial cancer is the most common gynecological cancer among women in the developed world [1]. Numerous studies, including the abovementioned landmark studies, have found comparable safety and oncological outcomes between laparotomy and laparoscopic modalities in low-risk endometrial cancer [3,11,12,13,14,15,16,17]. Such studies on high-risk patients are scarce [18,19,20,21,22]. As the Turkish Society of Gynecologic Oncology (TRSGO), we designed this multi-centric retrospective study to compare the oncologic outcomes of laparotomy and laparoscopic surgeries in endometrial cancer, focusing on the high–intermediate- and high-risk categories
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