MIRaGE (Minimally Invasive suRGery in recurrent Endometrial cancer)

Area of Science:

• Gynecologic Oncology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Endometrial cancer recurrence affects 10-70% of cases, necessitating effective secondary cytoreductive surgery.
• Complete gross resection is crucial for successful outcomes in recurrent endometrial cancer.
• Minimally invasive surgery (MIS) shows potential perioperative benefits, but patient selection and oncologic outcomes require further investigation.

Purpose of the Study:

• To evaluate the feasibility and outcomes of secondary cytoreductive surgery for recurrent endometrial cancer using minimally invasive surgery (MIS) versus open surgery.
• To identify preoperative predictors of successful MIS in patients undergoing secondary cytoreductive surgery for recurrent endometrial cancer.
• To compare perioperative and survival outcomes between MIS and open surgery for recurrent endometrial cancer.

Main Methods:

• Retrospective analysis of 192 patients with first abdominal recurrence of endometrial cancer undergoing secondary cytoreductive surgery (2010-2023).
• Patients were categorized by surgical approach: minimally invasive surgery (MIS) versus open surgery.
• Primary endpoint: predictors of successful MIS (complete gross resection). Secondary endpoints: perioperative and survival outcomes.

Main Results:

• Complete gross resection was achieved in 97.3% of MIS cases and 94.9% of open surgery cases (p = .42).
• MIS was associated with significantly lower blood loss, fewer transfusions, shorter operative times, and reduced hospital stays.
• Independent predictors for successful MIS included BMI ≥30, early-stage disease, single-site relapse, and loco-regional or lymph-node recurrence.

Conclusions:

• Minimally invasive surgery (MIS) is a feasible approach for selected patients with recurrent endometrial cancer, offering significant perioperative advantages.
• Survival outcomes (overall survival and progression-free survival) were comparable between MIS and open surgery groups.
• Further prospective multicenter studies are essential to confirm oncologic safety and refine patient selection criteria for MIS in recurrent endometrial cancer.