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Updated: Oct 14, 2025
Author Spotlight: A Reproductive Hysteroscopy Approach for Complete Endometrial Polyp Removal and Enhanced Endometrial Receptivity
Published on: August 2, 2024
Minimally Invasive Compared With Open Hysterectomy in High-Risk Endometrial Cancer
Blanca Segarra-Vidal1, Giorgia Dinoi, Andres Zorrilla-Vaca
1Department of Gynecologic Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain; the Gynecology Oncology Department, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; the Department of Anesthesiology and Perioperative Medicine and the Department of Gynecologic Oncology and Reproductive Medicine, the University of Texas MD Anderson Cancer Center, Houston, Texas; the Department of Gynecology and Obstetrics, Mayo Clinic, Rochester, Minnesota; the Gynecology Oncology Unit, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Barcelona, Spain; and the Department of Medicine, University Jaume I (UJI), Castellón, Spain.
Objective:
To compare disease-free survival between minimally invasive surgery and open surgery in patients with high-risk endometrial cancer.
Methods:
We conducted a multicentric, propensity-matched study of patients with high-risk endometrial cancer who underwent hysterectomy, bilateral salpingo-oophorectomy, and staging between January 1999 and June 2016 at two centers. High-risk endometrial cancer included grade 3 endometrioid, serous, clear cell, undifferentiated carcinoma or carcinosarcoma with any myometrial invasion. Patients were categorized a priori into two groups based on surgical approach, propensity scores were calculated based on potential confounders and groups were matched 1:1 using nearest neighbor technique. Cox hazard regression analysis and Kaplan-Meier curves evaluated the association of surgical technique with survival.
Results:
Of 626 eligible patients, 263 (42%) underwent minimally invasive surgery and 363 (58%) underwent open surgery. In the matched cohort, there were no differences in disease-free survival rates at 5 years between open (53.4% [95% CI 45.6-60.5%]) and minimally invasive surgery (54.6% [95% CI 46.6-61.8]; P=.82). Minimally invasive surgery was not associated with worse disease-free survival (hazard ratio [HR] 0.85, 95% CI 0.63-1.16; P=.30), overall survival (HR 1.04, 95% CI 0.73-1.48, P=.81), or recurrence rate (HR 0.99; 95% CI 0.69-1.44; P=.99) compared with open surgery. Use of uterine manipulator was not associated with worse disease-free survival (HR 1.01, 95% CI 0.65-1.58, P=.96), overall survival (HR 1.18, 95% CI 0.71-1.96, P=.53), or recurrence rate (HR 1.12, 95% CI 0.67-1.87; P=.66).
Conclusion:
There was no difference in oncologic outcomes comparing minimally invasive and open surgery among patients with high-risk endometrial cancer.
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