Could the Long-Term Oncological Safety of Laparoscopic Surgery in Low-Risk Endometrial Cancer also Be Valid for the High–Intermediate- and High-Risk Patients? A Multi-Center Turkish Gynecologic Oncology Group Study Conducted with 2745 Endometrial Cancer Cases. (TRSGO-End-001)

Mehmet Ali Vardar ,Samet Topuz,Ümran Küçükgöz Güleç ,K Yuce ,Ivan Đunđer ,Fuat Demirkıran ,Mehmet Köse ,Nejat Özgül ,Mete Güngör ,Özgüç Takmaz ,Aydın Özsaran ,Tayup Şimşek ,Ahmet Göçmen ,Selen Taşkın ,Derya Gümürdülü ,Ghanim Khatib ,Ç Taşkiran ,Coşkun Salman ,Gülşah Şeydaoğlu ,A Onan ,Ahmet Barış Güzel ,Gökçen Çoban ,Fırat Ortaç ,Coşan Terek ,Ali̇ Ayhan

doi:10.3390/curroncol28060368

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

Introduction

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

Methods

Results

Discussion

Conclusion