title: Long-term oncological safety of minimally invasive surgery in high-risk endometrial cancer.
abstract: Several studies showed that women with low-risk endometrial cancers staged by minimally invasive surgery (MIS) experience fewer postoperative complications compared to those staged by laparotomy with similar disease-free survival (DFS) and overall survival (OS). However, high-risk patients were poorly represented. In this study, we compared DFS and OS in high-risk endometrial cancer patients who underwent surgical staging via MIS versus laparotomy.
  
  
  
  Using a multicentric database, we compared DFS and OS between 114 patients with high-risk histology who underwent surgical staging via MIS and 114 patients who underwent laparotomy. Patients were matched for age, tumour type, FIGO stage and management criteria.
  
  
  
  Among the 114 patients who underwent MIS, 93 underwent laparoscopy and 21 robotic surgery. Groups were comparable for stage, body mass index, histology and adjuvant therapies. However, patients in the MIS group underwent paraaortic lymphadenectomy less frequently (13% versus 29%; p = 0.01), had less lymph nodes removed (19.0 versus 28.6; p < 0.01) and had lower mean tumour size (30 versus 40 mm; p < 0.01). With a median follow-up time of 49 months, DFS and OS were not significantly different between the surgical cohorts. In multivariable analysis, both higher stage (hazard ratio [HR] = 2.2) and histology (HR = 4.9) were associated with DFS in contrast to surgical procedure (HR = 0.9).
  
  
  
  Beyond the benefit of MIS on immediate surgical outcome, our results show that fear for a poor long-term outcome should not be the reason to refrain from MIS in patients with high-risk endometrial cancer.
authors: Gynecologic Oncology, Bichat University Hospital, Paris Diderot University, Paris, France; Gynecologic Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium. Electronic address: martin.koskas@wanadoo.fr.
authors: Martin
authors: M
authors: Koskas
authors: Center for Gynecologic Oncology Amsterdam (CGOA), Antoni Van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors: Marta
authors: M
authors: Jozwiak
authors: Gynecologic Oncology, Bichat University Hospital, Paris Diderot University, Paris, France.
authors: Marie
authors: M
authors: Fournier
authors: Gynecologic Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium.
authors: Ignace
authors: I
authors: Vergote
authors: Center for Gynecologic Oncology Amsterdam (CGOA), Antoni Van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors: Hans
authors: H
authors: Trum
authors: Center for Gynecologic Oncology Amsterdam (CGOA), Antoni Van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors: Christianne
authors: C
authors: Lok
authors: Gynecologic Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium; Center for Gynecologic Oncology Amsterdam (CGOA), Antoni Van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors: Frédéric
authors: F
authors: Amant
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007813:Laparotomy / Q000706:statistics & numerical data*; D008197:Lymph Node Excision / Q000379:methods; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000706:statistics & numerical data; D016019:Survival Analysis; D055815:Young Adult
keywords: Endometrial cancer; Laparoscopy; Laparotomy; Minimally invasive surgery; Staging; Survival