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. 2025 Oct 10:15:1665803.
doi: 10.3389/fonc.2025.1665803. eCollection 2025.

Minimally invasive versus open surgery in uterine serous carcinoma: impact on recurrence and survival in a multicenter cohort

Yi Fang #  1 , Jian Chen #  1 , Lin Yang  1 , Yingtao Lin  2 , Yao Lin  3 , Rong Lin  4 , Xingfa Chen  5
Affiliations

Minimally invasive versus open surgery in uterine serous carcinoma: impact on recurrence and survival in a multicenter cohort

Yi Fang et al. Front Oncol. .

Abstract

Background: Uterine serous carcinoma (USC) is a highly aggressive subtype of endometrial cancer, characterized by high recurrence rates and poor prognosis. While minimally invasive surgery (MIS) is commonly used in endometrial cancer treatment, its oncologic safety in high-risk USC remains unclear. This study aimed to compare survival outcomes between MIS and open surgery in patients with USC.

Methods: In this multicenter retrospective cohort study, 176 patients with USC who underwent primary surgical treatment were included (MIS: 53 [30.1%], open: 123 [69.9%]). Kaplan-Meier analysis was used to estimate overall survival (OS) and progression-free survival (PFS), while Cox regression identified independent prognostic factors.

Results: The median follow-up was 78 months (95% CI: 68.3-87.7). Patients in the MIS group experienced a higher recurrence rate (49.1% vs. 31.7%) and lower 5-year PFS (49.7% vs. 68.3%, P = 0.017), although 5-year OS was comparable between groups (69.7% vs. 77.4%, P = 0.219). Multivariate analysis confirmed that MIS as an independent predictor of poorer PFS (HR = 2.29, 95% CI: 1.31-4.01, P = 0.004). In contrast, adjuvant therapy significantly improved PFS (HR = 0.28, 95% CI: 0.13-0.60, P = 0.001). Hypertension was also associated with decreased OS (HR = 2.06, 95% CI: 1.11-3.81, P = 0.022).

Conclusions: MIS may be associated with an increased risk of recurrence and reduced PFS in USC patients, while adjuvant therapy remains critical for improving survival outcomes.

Keywords: minimally invasive surgery; open surgery; overall survival; progression-free survival; surgical outcomes; uterine serous carcinoma.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier survival curves in patients with uterine serous carcinoma (USC). (A, B) Comparison of progression-free survival (PFS) and overall survival (OS) between minimally invasive surgery (MIS) and open surgery groups. (C, D) PFS and OS stratified by receipt of adjuvant therapy. (E, F) PFS and OS according to hypertension status. Statistical differences were assessed using the log-rank test.
See this image and copyright information in PMC

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