High-risk endometrial cancer outcomes not compromised with minimally invasive vs open surgery

In the treatment of endometrial cancer patients with high-risk histology, minimally invasive surgery neither worsens cancer prognosis nor contributes to a significant increase in the risks of recurrence and mortality as compared with open surgery, according to a systematic review and meta-analysis.

Researchers searched multiple online databases for studies that compared the effects of minimally invasive surgery and open surgery on outcomes, including recurrence and mortality, in patients with endometrial cancer of high-risk histology (grade 3 endometrioid adenocarcinoma, papillary serous carcinoma, clear cell carcinoma, and carcinosarcoma).

The search yielded nine observational studies (eight retrospective and one prospective) for inclusion in the meta-analysis. The researchers evaluated study design features that might have affected participant selection, recurrence/death detection, and manuscript publication. They used the random- or fixed-effects meta-analytical models after assessing the cross-study heterogeneity.

The studies included 8,877 patients who underwent minimally invasive surgery and 5,751 patients who received open surgery. Pooled data revealed that compared with open surgery, minimally invasive surgery conferred no significant increase in the risks of recurrence (hazard ratio [HR], 0.86, 95% confidence interval [CI], 0.71–1.05; p=0.13) and mortality (HR, 0.86, 95 percent CI, 0.79–0.93; p<0.001).

The observed associations were consistent in subgroups defined by the disease stage (early vs all stage), histology (papillary serous and clear cell carcinomas), and minimally invasive surgery type (laparoscopy vs robotic).

There was no evidence of publication bias.

More well-designed randomized controlled trials are needed to establish the role of minimally invasive surgery in endometrial cancer patients with high-risk histology.