EPV133/#555 Minimally invasive approach in endometrial cancer with lower uterine segment involvement in ≥ stage ii: is it safe?

Abstract

<h3>Objectives</h3> To compare survival outcomes between women with stages II-IV endometrial carcinoma (EC) with lower uterine segment involvement (LUSI), staged by minimally invasive surgery (MIS) and those staged by laparotomy. <h3>Methods</h3> A retrospective multi-center cohort study of nine gynecologic-oncology centers. Univariate analysis, Kaplan-Meier survival and Cox proportional hazard models analysis were performed to compare women surgically staged by MIS and those operated by laparotomy in different stages and histology of EC. <h3>Results</h3> Over a median follow-up period of 3 years (interquartile range, 1.5–6 years) 212 women were included, 68 (32.1%) were surgically staged by MIS. Stages of disease among the study cohort were stages II, III and IV, 32.1%, 51.9%, and 16.0%, respectively. Stage distribution did not vary between MIS and laparotomy groups (p=0.144). High-grade histology was less common in MIS group (44.1% vs. 67.4%, p&lt;0.001). Adjuvant radiation and chemotherapy rates were comparable. Recurrence (local and distal) rate did not differ between groups (44.1% MIS vs. 31.9% laparotomy, p=0.084). Local recurrence rate was higher in MIS group (32.4% vs. 18.1%, p=0.023). Overall survival and local recurrence-free survival were similar in both groups (log rank test p=0.08, p=0.33, respectively). In Cox regression model adjusting for age, comorbidities, tumor grade, disease stage and adjuvant therapy, route of surgery (MIS vs. laparotomy) was not associated with overall survival (p=0.169) or local recurrence (p=0.296). <h3>Conclusions</h3> In women with stage II-IV EC with LUSI, MIS was associated with higher local recurrence rate, yet overall survival was comparable between patients with MIS and laparotomy, regardless of adjuvant therapy.