{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T04:30:09Z","timestamp":1783917009759,"version":"3.55.0"},"reference-count":35,"publisher":"Georg Thieme Verlag KG","issue":"07","license":[{"start":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T00:00:00Z","timestamp":1747612800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Geburtshilfe Frauenheilkd"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Minimally invasive surgery (MIS) to treat endometrial cancer offers advantages over laparotomy, although concerns about its oncological safety for high-risk tumors and feasibility in patients with significant comorbidities remain. This study evaluates perioperative and long-term outcomes of MIS versus open surgery in a tertiary referral center cohort, using FIGO 2010 and 2023 classifications.<\/jats:p><jats:p>This is a retrospective analysis of perioperative outcomes, recurrence rates, and survival after endometrial cancer surgery (2000\u20132021) at an ESGO training center and tertiary referral center in Germany. 760 patients underwent hysterectomy, and adequate data for risk classification (without molecular diagnostics) was available for 330 of them.<\/jats:p><jats:p>More than one third of the patients were aged 70 years or older and approximately half of the patients were obese. A high proportion presented with comorbidities such as hypertension or diabetes. MIS demonstrated favorable perioperative results in both low-risk and high-risk patients. Survival analysis showed a superior outcome with MIS for low-risk (5-year RFS rate: 79.8% vs. 59.2%, p\u00a0=\u00a00.035; OS rate: 83.8% vs. 58.0%, p\u00a0=\u00a00.010) and FIGO 2023 stage I disease (OS: p\u00a0=\u00a00.014). The oncological safety of MIS was equivalent to that of open surgery for high-risk tumors (5-year RFS rate: 60.5% vs. 54.3%, p\u00a0=\u00a00.506; OS rate: 67.5% vs. 58.3%, p\u00a0=\u00a00.416) and FIGO 2023 stages II (RFS, p\u00a0=\u00a00.453; OS, p\u00a0=\u00a00.378) and III (RFS, p\u00a0=\u00a00.419; OS, p\u00a0=\u00a00.850).<\/jats:p><jats:p>MIS was found to have superior outcomes for low-risk endometrial cancer and a comparable safety for high-risk patients, including those with older age or significant comorbidities. These findings support the use of MIS approaches as viable options across diverse risk groups, in line with FIGO 2023.<\/jats:p>","DOI":"10.1055\/a-2589-0498","type":"journal-article","created":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T23:42:37Z","timestamp":1747698157000},"page":"724-735","source":"Crossref","is-referenced-by-count":2,"title":["Minimally Invasive Surgery in Endometrial Cancer: Superior for Low-Risk and Comparable for High-Risk Cases in a 20-Year Cohort Study"],"prefix":"10.1055","volume":"85","author":[{"given":"Valentina","family":"Auletta","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya Ehab","family":"Hassan","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7652-698X","authenticated-orcid":false,"given":"Angela","family":"Kather","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany"},{"name":"Zentrum f\u00fcr Alternsforschung Jena \u2013 Aging Research Center Jena, Friedrich-Schiller-University Jena, Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaus","family":"Ga\u00dfler","sequence":"additional","affiliation":[{"name":"Section Pathology of the Institute of Forensic Medicine, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davit","family":"Bokhua","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingo B.","family":"Runnebaum","sequence":"additional","affiliation":[{"name":"Department of gynecology and reproductive medicine, Jena University Hospital, Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,5,19]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries","volume":"71","author":"H Sung","year":"2021","journal-title":"CA Cancer J Clin"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1093\/jnci\/djx214","article-title":"International Patterns and Trends in Endometrial Cancer Incidence, 1978\u20132013","volume":"110","author":"J Lortet-Tieulent","year":"2018","journal-title":"J Natl Cancer Inst"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1440","DOI":"10.3389\/fonc.2019.01440","article-title":"Global, Regional, and National Burden of Endometrial Cancer, 1990\u20132017: Results From the Global Burden of Disease Study, 2017","volume":"9","author":"S Zhang","year":"2019","journal-title":"Front Oncol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"2204","DOI":"10.7150\/ijms.55026","article-title":"Survival rates of patients who undergo minimally invasive surgery for endometrial cancer with cervical involvement","volume":"18","author":"SI Kim","year":"2021","journal-title":"Int J Med Sci"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1055\/a-2066-2051","article-title":"Endometrial Cancer. Guideline of the DGGG, DKG and DKH (S3-Level, AWMF Registry Number 032\/034-OL, September 2022). Part 1 with Recommendations on the Epidemiology, Screening, Diagnosis and Hereditary Factors of Endometrial Cancer, Geriatric Assessment and Supply Structures","volume":"83","author":"G Emons","year":"2023","journal-title":"Geburtshilfe Frauenheilkd"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.ygyno.2020.04.684","article-title":"Survival of microsatellite-stable endometrioid endometrial cancer patients after minimally invasive surgery: An analysis of the Cancer Genome Atlas data","volume":"158","author":"Y Dai","year":"2020","journal-title":"Gynecol Oncol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1016\/j.ygyno.2020.12.003","article-title":"Effect of surgical approach on risk of recurrence after vaginal brachytherapy in early-stage high-intermediate risk endometrial cancer","volume":"160","author":"L Philp","year":"2021","journal-title":"Gynecol Oncol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1055\/a-0715-2964","article-title":"Interdisciplinary Diagnosis, Therapy and Follow-up of Patients with Endometrial Cancer. Guideline (S3-Level, AWMF Registry Number 032\/034-OL, April 2018) \u2013 Part 2 with Recommendations on the Therapy and Follow-up of Endometrial Cancer, Palliative Care, Psycho-oncological\/Psychosocial Care\/Rehabilitation\/Patient Information and Healthcare Facilities","volume":"78","author":"G Emons","year":"2018","journal-title":"Geburtshilfe Frauenheilkd"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"952","DOI":"10.1111\/j.1525-1438.2005.00159.x","article-title":"Association of p53 mutations and a codon 72 single nucleotide polymorphism with lower overall survival and responsiveness to adjuvant radiotherapy in endometrioid endometrial carcinomas","volume":"15","author":"B Saffari","year":"2005","journal-title":"Int J Gynecol Cancer"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1038\/ng.3562","article-title":"Five endometrial cancer risk loci identified through genome-wide association analysis","volume":"48","author":"TH Cheng","year":"2016","journal-title":"Nat Genet"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1002\/ijgo.14923","article-title":"FIGO staging of endometrial cancer: 2023","volume":"162","author":"JS Berek","year":"2023","journal-title":"Int J Gynaecol Obstet"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1374","DOI":"10.1002\/ijgo.15193","article-title":"Correction to \u201cFIGO staging of endometrial cancer\u201d","volume":"166","author":"JS Berek","year":"2024","journal-title":"Int J Gynaecol Obstet"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1136\/ijgc-2020-002230","article-title":"ESGO\/ESTRO\/ESP guidelines for the management of patients with endometrial carcinoma","volume":"31","author":"N Concin","year":"2021","journal-title":"Int J Gynecol Cancer"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"D Dindo","year":"2004","journal-title":"Ann Surg"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"32","DOI":"10.3802\/jgo.2015.26.1.32","article-title":"Risk group criteria for tailoring adjuvant treatment in patients with endometrial cancer: a validation study of the Gynecologic Oncology Group criteria","volume":"26","author":"TW Kong","year":"2015","journal-title":"J Gynecol Oncol"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1016\/j.gore.2023.101147","article-title":"Minimally invasive surgery versus laparotomy in women with high risk endometrial cancer: A multi-center study performed in Argentina","volume":"46","author":"D Odetto","year":"2023","journal-title":"Gynecol Oncol Rep"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"549","DOI":"10.4143\/crt.2020.802","article-title":"Nationwide Comparison of Surgical and Oncologic Outcomes in Endometrial Cancer Patients Undergoing Robotic, Laparoscopic, and Open Surgery: A Population-Based Cohort Study","volume":"53","author":"KJ Eoh","year":"2021","journal-title":"Cancer Res Treat"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"5331","DOI":"10.1200\/JCO.2009.22.3248","article-title":"Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2","volume":"27","author":"JL Walker","year":"2009","journal-title":"J Clin Oncol"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0108361","article-title":"Comparison of robotic surgery with laparoscopy and laparotomy for treatment of endometrial cancer: a meta-analysis","volume":"9","author":"L Ran","year":"2014","journal-title":"PLoS One"},{"issue":"10","key":"ref20","doi-asserted-by":"publisher","first-page":"CD006655","DOI":"10.1002\/14651858.CD006655.pub3","article-title":"Laparoscopy versus laparotomy for the management of early stage endometrial cancer","author":"K Galaal","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1055\/a-1869-2060","article-title":"Endometrial Cancer \u2013 Long-Term Survival in Certified Cancer Centers and Non-Certified Hospitals: Comparative Analysis Based on a Large German Retrospective Cohort Study (WiZen)","volume":"84","author":"J Hansinger","year":"2024","journal-title":"Geburtshilfe Frauenheilkd"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ejca.2018.12.004","article-title":"Survival after a nationwide introduction of robotic surgery in women with early-stage endometrial cancer: a population-based prospective cohort study","volume":"109","author":"SL J\u00f8rgensen","year":"2019","journal-title":"Eur J Cancer"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1007\/s00432-019-03122-8","article-title":"Long-term outcome of patients with intermediate- and high-risk endometrial cancer after pelvic and paraaortic lymph node dissection: a comparison of laparoscopic vs. open procedure","volume":"146","author":"T Papathemelis","year":"2020","journal-title":"J Cancer Res Clin Oncol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"5605","DOI":"10.1200\/JCO.2023.41.16_suppl.5605","article-title":"Laparoscopic versus open-surgery in FIGO stage II endometrioid endometrium cancers: Is there a prognostic effect?","volume":"41","author":"DU Reimer","year":"2023","journal-title":"JCO"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"4328","DOI":"10.3390\/curroncol28060368","article-title":"Could the Long-Term Oncological Safety of Laparoscopic Surgery in Low-Risk Endometrial Cancer also Be Valid for the High-Intermediate- and High-Risk Patients? A Multi-Center Turkish Gynecologic Oncology Group Study Conducted with 2745 Endometrial Cancer Cases. (TRSGO-End-001)","volume":"28","author":"MA Vardar","year":"2021","journal-title":"Curr Oncol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1016\/j.ygyno.2012.04.028","article-title":"Minimally invasive surgery versus laparotomy in women with high grade endometrial cancer: a multi-site study performed at high volume cancer centers","volume":"126","author":"AN Fader","year":"2012","journal-title":"Gynecol Oncol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1673","DOI":"10.1097\/IGC.0000000000000803","article-title":"Oncologic Safety of Laparoscopy in the Surgical Treatment of Type II Endometrial Cancer","volume":"26","author":"G Favero","year":"2016","journal-title":"Int J Gynecol Cancer"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"e24","DOI":"10.3802\/jgo.2019.30.e24","article-title":"Laparoscopic surgery for low, intermediate and high-risk endometrial cancer","volume":"30","author":"MA Vardar","year":"2019","journal-title":"J Gynecol Oncol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"782","DOI":"10.1016\/j.ejso.2019.11.519","article-title":"Comparison of minimally invasive surgery with laparotomic approach in the treatment of high risk endometrial cancer: A systematic review","volume":"46","author":"G Scaletta","year":"2020","journal-title":"Eur J Surg Oncol"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1136\/ijgc-2024-005510","article-title":"Oncological outcomes after laparotomic, laparoscopic, and robot-assisted laparoscopic staging for early-stage high-intermediate or high-risk endometrial cancer","author":"RCG Koek","year":"2024","journal-title":"Int J Gynecol Cancer"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1002\/rcs.1580","article-title":"Robotic surgery for staging of serous papillary and clear cell carcinoma of the endometrium","volume":"10","author":"GA Feuer","year":"2014","journal-title":"Int J Med Robot"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2024.108584","article-title":"Comparison of survival and complications between minimally invasive and open staging surgeries in non-endometrioid endometrial cancer","volume":"50","author":"DW Hwang","year":"2024","journal-title":"Eur J Surg Oncol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1186\/s12885-023-10746-0","article-title":"Increased incidence and improved survival in endometrial cancer in Sweden 1960\u20132014: a population-based registry survey","volume":"23","author":"F Herbst","year":"2023","journal-title":"BMC Cancer"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1016\/j.ejca.2017.03.010","article-title":"Less-favourable prognosis for low-risk endometrial cancer patients with a discordant pre- versus post-operative risk stratification","volume":"78","author":"FA Eggink","year":"2017","journal-title":"Eur J Cancer"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"265","DOI":"10.3389\/fonc.2019.00265","article-title":"A Novel Approach to Preoperative Risk Stratification in Endometrial Cancer: The Added Value of Immunohistochemical Markers","volume":"9","author":"V Weinberger","year":"2019","journal-title":"Front Oncol"}],"container-title":["Geburtshilfe und Frauenheilkunde"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2589-0498.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T22:30:40Z","timestamp":1751322640000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2589-0498"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,19]]},"references-count":35,"journal-issue":{"issue":"07","published-online":{"date-parts":[[2025,6,30]]},"published-print":{"date-parts":[[2025,7]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2589-0498","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0016-5751","1438-8804"],"issn-type":[{"value":"0016-5751","type":"print"},{"value":"1438-8804","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,19]]}}}