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Minimally invasive surgery versus open surgery for uterine sarcomas - a retrospective study
Gabriel Levin1, Melica Nourmoussavi Brodeur2, Raanan Meyer3
1Division of Gynecologic Oncology, McGill University Health Center, Montreal, Quebec, Canada.
Objective:
To compare the oncologic outcomes of uterine sarcomas treated with minimally invasive surgery (MIS) versus open surgery.
Methods:
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).
Results:
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).
Conclusions:
Oncologic outcomes following MIS and open surgery for uterine sarcomas appear similar. Larger studies are needed to confirm these findings.
Insights
Minimally invasive surgery (MIS) and open surgery show similar oncologic outcomes for uterine sarcomas. Progression-free survival and overall survival rates did not significantly differ between the two surgical approaches in this study.
Area of Science:
- Gynecologic Oncology
- Surgical Oncology
- Cancer Research
Background:
- Uterine sarcomas are rare, aggressive gynecologic malignancies.
- Surgical management is the cornerstone of treatment.
- Minimally invasive surgery (MIS) offers potential benefits but oncologic outcomes compared to open surgery require evaluation.
Purpose of the Study:
- To compare the oncologic outcomes, specifically progression-free survival (PFS) and overall survival (OS), between minimally invasive surgery (MIS) and open surgery for uterine sarcomas.
- To evaluate the safety and efficacy of MIS in treating uterine sarcomas.
Main Methods:
- Retrospective analysis of 37 patients with high-grade endometrial stromal sarcoma and leiomyosarcoma undergoing surgery between 2003 and 2024.
- Patients were stratified into two groups: MIS and open surgery.
- Co-primary endpoints were PFS and OS, analyzed using log-rank tests and Cox regression.
Main Results:
- No significant difference in PFS (p=0.378) or OS (p=0.625) was observed between MIS and open surgery groups.
- Adjusted Cox regression analysis indicated MIS was not associated with differences in PFS (HR 0.44) or OS (HR 0.75).
- Baseline characteristics and disease stages were similar across both surgical approach groups.
Conclusions:
- Minimally invasive surgery (MIS) appears to provide comparable oncologic outcomes to open surgery for uterine sarcomas.
- Further investigation with larger patient cohorts is warranted to validate these findings and solidify MIS as a viable surgical option.
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