816P - Laparoscopic versus open-surgery in FIGO stage II endometrioid endometrium cancers: Is there a prognostic effect?

Background

Based on two randomized trials (LACE and LAP2) minimal invasive surgery has turned into surgical standard in early stage endometrial cancer (EC) including “high-risk” patients. These recommendations are predominately based on “low-risk” cancers, which were mainly represented in both trial collectives. We herein provide a retrospective study focusing on potential differences in clinical outcome in early stage endometrioid ECs treated by laparoscopy or open surgery.

Methods

420 early stage ECs were retrospectively dichotomized according to the surgical approach and correlated to recurrence rate and clinical outcome. In addition, subgroup analyses were performed according relevant clinical risk parameters, namely FIGO stage, grading and LVSI.

Results

The analyzed collective consisted of 73.8% stage IA, 19.5% stage IB, and 6.7% stage II cases. 23% of patients exhibit G3 tumors and LVSI was detected in 12.4%. Minimal invasive surgery was performed in 54.5% of study patients. During a median follow-up of 5.0 years, recurrence or death were observed in 8.3% and 6.7%, respectively. Recurrences were located in the vaginal cuff (60.0%), in locoregional lymph nodes (31.4%), and in 8.6% in both sides. No distant metastases were observed. Under consideration of the mentioned clinicopathologic parameters, surgical approach in FIGO stage I did not influence recurrence rate and survival. However, in stage II disease, a laparoscopic approach was clearly associated with a higher recurrence rate (85.7% vs. 14.3%; p = 0.013). All recurrences were located in the vaginal cuff, and in one case, additional relapse was found in loco-regional lymph nodes. Moreover, laparoscopy in stage II disease was associated with impaired progression-free and overall survival (HR 8.86 (1.01 – 20.85) and HR 6.36 (1.10 – 28.61)).

Conclusions

We herein demonstrate that a laparoscopic approach in stage II endometrial cancer is associated with higher recurrence rates and impaired clinical outcome. These data could be interpreted in line with results of the LACC trial in cervical cancer. Although, grounded on a retrospective analysis, these hypothesis-generating results warrants a confirmatory trial, which is ongoing.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Innsbruck Medical University.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.