Early Adoption of Minimally Invasive Surgery for Stage IA Endometrial Cancer: A Regional Multicenter Study in Japan.

AIM: The adoption of minimally invasive surgery (MIS) for endometrial cancer has progressed. This study aimed to evaluate the perioperative outcomes and early implementation of MIS in patients with preoperative International Federation of Gynecology and Obstetrics (FIGO) Stage IA endometrial cancer in a regional healthcare setting.

METHODS

This retrospective multicenter cohort study included consecutive patients who underwent surgery for presumed FIGO Stage IA endometrial cancer at three tertiary and cancer-specialized institutions in Gunma Prefecture, Japan, between 2018 and 2021. Patients were categorized into the MIS and open surgery groups according to the surgical approach. Perioperative outcomes, including operative time, estimated blood loss, hospital stay, blood transfusion, perioperative complications, and laboratory parameters, were compared between the groups.

RESULTS

This study included 365 patients, of whom 182 underwent MIS and 183 underwent open surgery. The proportion of MIS increased during the study period. Compared with open surgery, MIS was associated with significantly lower estimated blood loss (52 vs. 220 mL, p < 0.001) and a shorter postoperative hospital stay (5 vs. 9 days, p < 0.001), although operative time was longer (256 vs. 215 min, p < 0.001). Postoperative complication rates were comparable, and severe complications were rare. Postoperative Day 1 C-reactive protein and creatine kinase levels were significantly lower in the MIS group.

CONCLUSIONS

MIS for preoperative FIGO Stage IA endometrial cancer was introduced across major institutions in a regional healthcare system. MIS was associated with favorable perioperative outcomes without increased complications, supporting the feasibility and perioperative safety of regional implementation of MIS.