Long-term prognostic value of staging surgery for high-intermediate-risk and high-risk endometrial cancer

The prognostic relevance of surgical staging in patients with high-intermediate-risk and high-risk endometrial cancer remains uncertain. In this cohort study, we investigated the prognostic role of robot-assisted laparoscopic staging surgery among patients with clinically early-stage endometrial carcinoma at a high-intermediate-risk or high-risk for recurrence. Clinical data of women with clinically International Federation of Gynaecology and Obstetrics (FIGO) 2009 stage I–II, grade 3 endometrioid or non-endometrioid EC who were intended to undergo robot-assisted laparoscopic staging surgery were retrospectively collected from a single tertiary referral center. The procedure consisted of total hysterectomy with bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and, when feasible, para-aortic lymphadenectomy, with additional omentectomy and peritoneal biopsies performed in a subset of cases. Survival outcomes were assessed using Kaplan–Meier analysis, with additional subgroup analyses by histological subtype. A total of 166 patients, of which 154 patients (92.8%) with FIGO 2009 stage I and 12 patients (7.2%) with FIGO 2009 stage II were included, comprising various histological subtypes, including 64 (38.6%) with endometrioid carcinoma, 52 (31.3%) with serous carcinoma, 11 (6.6%) with clear cell carcinoma, and 27 (16.3%) with carcinosarcoma. Thirty-two patients (19.3%) were reclassified as having FIGO stage disease III–IV based on final pathology. The 5-year disease-specific survival was 25.5% for upstaged patients compared with 73.1% for those who were not upstaged. Robot-assisted laparoscopic staging provides valuable prognostic information in clinically early-stage endometrial cancer with a high-intermediate-risk or high-risk of recurrence. These findings underscore the value of surgical staging in informing prognosis and guiding adjuvant treatment decisions.