Minimally invasive surgery versus open surgery for uterine sarcomas - a retrospective study

To compare the oncologic outcomes of uterine sarcomas treated with minimally invasive surgery (MIS) versus open surgery.

We conducted a retrospective analysis of patients with uterine sarcomas (high-grade endometrial stromal sarcoma and leiomyosarcoma) who underwent surgery between 2003 and 2024. Patients were grouped according to surgical approach: (1) MIS or (2) open surgery. The co-primary endpoints were progression-free survival (PFS) and overall survival (OS).

A total of 37 patients were included: 23 (62%) underwent open surgery, and 14 (38%) underwent MIS. Baseline characteristics were similar between groups. Disease stages at diagnosis were: stage I in 24 patients (65%), stage II in 5 (13%), stage III in 2 (5%), and stage IV in 6 (17%). PFS did not differ significantly between MIS and open surgery (median 43 months [IQR 11-75] vs. 13 months [IQR 2-25], log-rank p = .378). Median OS was also comparable (70 months [IQR 39-100] for MIS vs. 56 months [IQR 24-88] for open surgery, log-rank p = .625). In Cox regression adjusted for tumor size, stage (I vs. II-IV), and surgical approach, MIS was not associated with differences in PFS (HR 0.44, 95% CI 0.14-1.43) or OS (HR 0.75, 95% CI 0.17-3.13).

Oncologic outcomes following MIS and open surgery for uterine sarcomas appear similar. Larger studies are needed to confirm these findings.