Retrospective Cohort Study Comparing Different Hysterectomy Approaches for the Treatment of Endometrial Cancer

Background: Endometrial cancer is the most common gynecologic malignancy in North America, with over 8000 new diagnoses in 2022 alone. Surgical management is the mainstay of treatment, with a shift towards the use of minimally invasive surgery, including laparoscopic and robotic techniques. Therefore, our study aims to compare the surgical and oncologic outcomes of hysterectomy approaches for patients with endometrial cancer. Methods: We have used a retrospective design to review all the endometrial cancer cases from Kingston Health Sciences Centre between January 2017 and November 2022. Variables were collected and categorized. Surgical outcomes were compared based on the route of surgery. Kaplan-Meier and Cox proportional hazard models were used to compare recurrence-free and overall survival. Results: A total of 341 cases were included in this review. One-hundred-fifty-two (44.6%) of these cases were minimally invasive surgeries (total laparoscopic, laparoscopic-assisted vaginal and robotic-assisted hysterectomies) and 189 (55.4%) were open hysterectomies. The early complication rates (p < 0.001) and length of stay (p < 0.001) were lower in the laparoscopic group. Despite the abdominal group including more advanced cases, there were no differences in recurrence-free and overall survival between the groups (p = 0.39; p = 0.85). Conclusions: Minimally invasive hysterectomy approaches result in improved surgical outcomes, while oncologic outcomes remain similar across techniques.