Minimally Invasive Approach in Type II Endometrial Cancer: Is It Wise and Safe?

STUDY OBJECTIVE: To compare perioperative and survival outcomes in patients with type II endometrial cancer surgically staged by a minimally invasive surgery (MIS) approach and those surgically staged by laparotomy.

DESIGN: Retrospective cohort study (Canadian Task Force classification II-2).

SETTING: Catholic University of the Sacred Heart of Rome, University of Insubria, Varese and "Regina Elena" National Cancer Institute of Rome.

PATIENTS: A total of 283 patients with type II endometrial cancer in clinical International Federation of Gynecology and Obstetrics stage I-II and pathological stage III with apparent early-stage disease detected on preoperative instrumental examination.

INTERVENTIONS: Baseline features and perioperative data were evaluated in 142 patients who underwent hysterectomy via open surgery (laparotomy [LPT] group) and 141 patients who did so via a minimally invasive approach (MIS group).

MEASUREMENTS AND MAIN RESULTS: The 2 groups were comparable in terms of baseline features and perioperative data except for operative time, which was longer in the LPT group (p < .001) and hospital stay, which was shorter in the MIS group. There were no between-group differences in pathological features, except for myometrial invasion and the rate of positive pelvic lymph nodes. Therefore, we obtained a higher number of early stages in the MIS group (p < .001). In the overall population, significant differences were observed in the recurrence rate, number, and site of relapses, with a higher recurrence rate and number in the LPT group (p < .001). Progression-free and overall survival were not significantly different in the 2 groups.

CONCLUSION: Women with type II endometrial cancer submitted to MIS for hysterectomy experienced fewer complications and similar survival outcomes compared with those who underwent open surgery. When managed by an expert surgeon, a high-risk histological subtype should not be considered a contraindication for MIS. Further prospectively randomized studies are needed to definitively evaluate the safety and feasibility of MIS in early-stage type II endometrial cancer.