Comparison of Single-Port Laparoscopy with Other Surgical Approaches in Endometrial Cancer Surgical Staging: Propensity-Score-Matched Analysis

Abstract

This single-institution, retrospective study aimed to compare the surgical outcomes of single-port, multi-port, and robot-assisted laparoscopy, as well as laparotomy, in patients with endometrial cancer who underwent surgical staging between January 2006 and December 2017. This study evaluated various parameters, including disease-free survival (DFS), overall survival (OS), recurrence rate (RR), recurrence site, and intra- and postoperative complications. Propensity score matching was performed to account for baseline characteristics, and a total of 881 patients were included in the analysis. The 3-year DFS of single-port laparoscopy was similar to that of the other groups, but laparotomy exhibited a lower 3-year DFS compared to multi-port (p = 0.001) and robot-assisted (p = 0.031) laparoscopy. Single-port laparoscopy resulted in a significantly higher 3-year OS than laparotomy (p = 0.013). After propensity score matching, the four groups demonstrated similar survival outcomes (3-year DFS: p = 0.533; 3-year OS: p = 0.328) and recurrence rates (10.3%, 12.1%, 10.3%, and 15.9% in the single-port, multi-port, and robot-assisted laparoscopy and laparotomy groups, respectively, p = 0.552). Recurrence most commonly occurred in distant organs. The single-port laparoscopy group had the longest operative time (205.1 ± 76.9 min) but the least blood loss (69.5 ± 90.8 mL) and the shortest postoperative hospital stay (5.2 ± 2.3 days). In contrast, the laparotomy group had the shortest operative time (163.4 ± 51.0 min) but the highest blood loss (368.3 ± 326.4 mL) and the longest postoperative hospital stay (10.3 ± 4.6 days). The transfusion rate was 0% in the single-port laparoscopy group and 3.7% in the laparotomy group. Notably, the laparotomy group had the highest wound complication rate (p = 0.001), whereas no wound hernias were observed in the three minimally invasive approaches. In conclusion, the survival outcomes were comparable between the methods, with the benefit of lower blood loss and shorter hospital stay observed in the single-port laparoscopy group. This study suggests that single-port laparoscopy is a feasible approach for endometrial cancer surgical staging.

Keywords: endometrial cancer; propensity score matching; single-port laparoscopy; staging surgery.

Figure 1

Kaplan–Meier curves of survival outcomes according to the surgical methods in endometrial cancer. (A) Overall survival curves before matching, (B) disease-free survival curves before matching, (C) overall survival curves after matching, and (D) disease-free survival curves after matching. Abbreviations: LT, laparotomy; MPL, multi-port laparoscopy; RAL, robot-assisted laparoscopy; SPL, single-port laparoscopy; PSM, propensity score matching.

Figure 2

Kaplan–Meier curves of survival outcomes according to the FIGO stage. (A) Overall survival curves of patients with FIGO stage I endometrial cancer, (B) disease-free survival of patients with FIGO stage I endometrial cancer, (C) overall survival of patients with FIGO stage II endometrial cancer, (D) disease-free survival of patients with FIGO stage II endometrial cancer, (E) overall survival of patients with FIGO stages III and IV endometrial cancer, and (F) disease-free survival of patients with FIGO stages III and IV endometrial cancer. Abbreviations: FIGO, International Federation of Gynecology and Obstetrics; LT, laparotomy; MPL, multi-port laparoscopy; RAL, robot-assisted laparoscopy; SPL, single-port laparoscopy.