A comparison of laparoscopic and open surgery for early stage endometrial cancer with analysis of prognostic factors: a propensity score matching study

Objective: We aimed to compare the short- and long-term outcomes of a laparoscopic approach with those of laparotomy for early stage endometrial cancer and attempted to identify factors predicting survival. Methods: Between 2007 and 2014, patients with clinical early stage endometrial cancer and a uterine size less than 10 cm receiving surgical treatment were reviewed. Kaplan-Meier and multivariate Cox regression model were used for survival analysis. Short- and long-term outcomes were compared between the two groups before and after 1 : 1 propensity score matching (PSM). Results: Finally 255 patients were enrolled, 177 received laparotomy and 78 received laparoscopic surgery. The patients receiving laparoscopic surgery had significant less blood loss and shorter hospital stay, but longer operative time. Before PSM, the 5-year disease-free survival (DFS) and overall survival (OS) rates were in favor of laparoscopic group (94.4 vs. 84.1%, p = 0.022; 97 vs. 90.5%, p = 0.060). Cox regression analysis showed that high-grade lesion (HR 11.35, 95% CI 4.06–31.07), non-endometrioid histology (HR 3.99, 95% CI 1.52–10.44), and age $>$60 (HR 3.35, 95% CI 1.60–7.00) were independent factors predicting recurrence while high-grade lesion (HR 10.38, 95% CI 2.44–44.15) and CA125 $>$35 (HR 3.02, 95% CI 1.07–8.55) were independent factors predicting death. After PSM, two comparable groups of 59 patients each were obtained. There were no significant differences in 5-year DFS and OS between the two groups. Conclusion: Our results showed that compared with laparotomy, laparoscopic surgery improved short-term outcomes, with similar survival results. Factors predicting survival were high-grade tumor, non-endometrioid histology, age $>$60, and CA125 $>$35.

Endometrial cancer; Laparoscopy; Laparotomy

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