Minimally invasive versus abdominal hysterectomy for endometrial carcinoma with glandular or stromal invasion of cervix

Abstract

<h3>Objectives:</h3> To evaluate the feasibility of laparoscopic approach in endometrial cancer that extends to the cervix in the form of glandular extension and/or stromal invasion and compare with laparotomy. <h3>Methods:</h3> A retrospective, single-center cohort study was conducted using data between January 1, 2002 and December 31, 2017 at an urban tertiary academic medical center. We identified patients who were diagnosed with endometrial cancer FIGO stage I with endocervical glandular extension and FIGO stage II on final pathology. Operative and oncologic outcomes were compared between the patients who underwent minimally-invasive surgery (MIS) and those who underwent laparotomy. <h3>Results:</h3> Eighty-five patients with endometrial cancer were reviewed for the study. Among these patients, 25 patients underwent hysterectomy and surgical staging via MIS. There was no conversion from MIS to laparotomy. In the MIS group, shorter hospital stay (4.4 ± 2.3 days for MIS group vs. 7.1 ± 4.7 days for laparotomy group; <i>p</i>-value = 0.002) and less blood loss during the operations (200 mL vs. 400 mL, <i>p</i>-value < 0.001) were observed compared with the laparotomy group. In terms of pathological findings, there was no statistical difference in FIGO stage (IB and II), the rate of endometrioid histology, grade, tumor size, depth of myometrial invasion and lymph-vascular space invasion (LVSI) between the MIS and laparotomy groups. For the treatment, types of hysterectomy (Type 1 vs. 2 vs. 3) and the rate of adjuvant radiotherapy or chemotherapy were similar in both groups. In univariate analyses, no difference in disease-free and overall survival was observed between the two groups and these findings were reproduced in multivariate analysis. <h3>Conclusions:</h3> Among the women with endometrial cancer that involved the cervix without evidence of extrauterine disease, surgical treatment via MIS compared with laparotomy showed no difference in overall survival but better perioperative outcomes. These findings support the use of MIS for these patient group.