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. 2025 Jul 7;17(13):2261.
doi: 10.3390/cancers17132261.

Impact of a Surgical Approach on Endometrial Cancer Survival According to ESMO/ESGO Risk Classification: A Retrospective Multicenter Study in the Northern Italian Region

Vincenzo Dario Mandato  1 , Anna Myriam Perrone  2   3 , Debora Pirillo  1 , Gino Ciarlini  1 , Gianluca Annunziata  1 , Alessandro Arena  3   4 , Carlo Alboni  5 , Ilaria Di Monte  5 , Vito Andrea Capozzi  6 , Andrea Amadori  7 , Ruby Martinello  8 , Federica Rosati  9 , Marco Stefanetti  9 , Andrea Palicelli  10 , Giacomo Santandrea  10 , Renato Seracchioli  3   4 , Roberto Berretta  6 , Lorenzo Aguzzoli  1 , Federica Torricelli  11 , Pierandrea De Iaco  2   3
Affiliations

Impact of a Surgical Approach on Endometrial Cancer Survival According to ESMO/ESGO Risk Classification: A Retrospective Multicenter Study in the Northern Italian Region

Vincenzo Dario Mandato et al. Cancers (Basel). .

Abstract

Background: Following the results of the Laparoscopic Approach to Carcinoma of the Cervix (LACC) trial, doubts have arisen about the safety of laparoscopy in the treatment of endometrial cancer. Methods: A retrospective multicenter cohort study which included all endometrial cancer (EC) patients who underwent a hysterectomy in Emilia Romagna hospitals from 2000 to 2019. All cases were revised and classified according to the 2009 International Federation of Gynaecology and Obstetrics (FIGO) staging system. The different impacts of the surgical approach on survival were stratified according to the recurrence risk from the 2016 European Society for Medical Oncology (ESMO)-European Society of Gynaecological Oncology (ESGO) classification system. The clinical characteristics and oncological outcome of patients treated by laparoscopy were compared with those treated by laparotomy. Results: A total of 2402 EC patients were included in the study. The use of laparoscopy has increased over the years, reaching 81% of procedures in 2019. Laparoscopy reduced complications and hospital stay. Laparoscopy was preferred to treat low, intermediate, and intermediate/high-risk patients. Laparoscopy showed no adverse effects on overall survival (OS) in any recurrence risk class. Particularly in high-risk EC patients, laparoscopy was associated with an increased OS in comparison with women treated by laparotomy regardless of the use of adjuvant therapy. Conclusions: Laparoscopy should always be chosen to treat EC of any risk class. The goal is to ensure correct treatment and oncological safety regardless of the surgical approach.

Keywords: ESMO-ESGO classification system; adjuvant therapy; endometrial cancers; high-risk endometrial cancer; laparoscopy; laparotomy; lymphadenectomy; sentinel lymph node biopsy; survival.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Histograms showing the frequency distribution of surgical approaches over the years.
Figure 2
Figure 2
(A) Histograms of the percentage of patients with different clinical characteristics treated with laparoscopy or laparotomy. (B) Histograms of the percentage of patients with different pathological characteristics treated with laparoscopy or laparotomy. ** p < 0.01, *** p ≤ 0.001.
Figure 3
Figure 3
(A) Boxplots representing the duration of surgery in patients treated with laparoscopy or laparotomy. (B) Histograms illustrating the percentage of patients who had a fever higher than 38° for more than 24h after laparoscopy or laparotomy. (C) Boxplots representing the hemoglobin variation after surgery in patients treated with laparoscopy or laparotomy. (D) Histograms illustrating the percentage of patients who needed a transfusion after laparoscopy or laparotomy. (E) Boxplots summarizing the hospital length of stay required after a laparoscopy or laparotomy. ** p < 0.01, *** p ≤ 0.001.
Figure 4
Figure 4
(A) Histograms representing the percentage of patients treated with laparoscopy or laparotomy who received pelvic, paraaortic lymph node dissection, or sentinel lymph node biopsy. (B) Pie chart of the percentages of laparoscopies and laparotomies performed in patients who needed pelvic lymph node dissection. (C) Pie chart of the percentages of laparoscopies and laparotomies performed in patients who needed paraaortic lymph node dissection. (D) Pie chart of the percentages of laparoscopies and laparotomies performed in patients who needed sentinel lymph node biopsy. *** p ≤ 0.001.
Figure 5
Figure 5
Kaplan–Meier curves comparing the effect of surgical procedures on overall survival in the total cohort of EC patients (A) and in high-risk (B) and metastatic/advanced (C) groups.
Figure 6
Figure 6
(A–E) Kaplan–Meier curves showing: (A) The combinatory effect of surgical treatment and adjuvant therapy on the overall survival of high-risk EC patients. (B) The effect of adjuvant therapy on the overall survival of high-risk EC patients treated with laparoscopy. (C) The effect of adjuvant therapy on the overall survival of high-risk EC patients treated with laparotomy. (D) The effect of surgical treatment on the overall survival of high-risk EC patients who received adjuvant therapy. (E) The effect of surgical treatment on the overall survival of high-risk EC patients who did not receive adjuvant therapy.
Figure 7
Figure 7
(A) Histograms showing the distribution of FIGO stages in EC patients treated with laparoscopy or laparotomy. (B) Histograms showing the distribution of IA stages in non-endometrioid EC patients treated with laparoscopy or laparotomy.
Figure 8
Figure 8
Kaplan–Meier curves showing the effect of surgical treatment in advanced/metastatic EC patients treated with adjuvant therapy.
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