Oncological Safety of Laparoscopic Surgery for Women with Apparent Early-stage Uterine Clear Cell Carcinoma: A Multicenter Retrospective Cohort Study

Study Objective: To study the effect of different surgical approaches (laparoscopy and laparotomy) on the oncological outcomes of patients with apparent early-stage uterine clear cell carcinoma (UCCC). Design: Retrospective cohort study. Setting: Four Chinese teaching hospitals. Patients: A total of 273 women with apparent early-stage UCCC. Interventions: All included patients were surgically staged by laparoscopy or laparotomy. Measurements and Main Results: The eligible patients were divided into the laparotomy group and the laparoscopy group. Disease-free survival (DFS) and overall survival (OS) were evaluated by the Kaplan-Meier method and compared by the log-rank test. The Cox proportional hazards regression model was used to estimate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the effect of surgical approach on DFS and OS. With a median follow-up of 31.0 months, the 3-year DFS rates were 68.82% and 64.27% in the laparotomy group and the laparoscopy group, respectively. The difference in DFS between the 2 groups was not statistically significant (HR, 1.06; 95% CI, 0.72- 1.58; p =.758). In addition, the 3-year OS rate (72.76% vs 73.46%; HR, 1.06; 95% CI, 0.65- 1.72; p =.823) was not different between the 2 groups. Furthermore, multivariable analysis showed that for patients with apparent earlystage UCCC, the approach of surgical staging was not an independent prognostic factor for OS (adjusted HR, 1.29; 95% CI, 0.78- 2.12; p =.321) and DFS (adjusted HR, 1.11; 95% CI, 0.73- 1.68; p =.621). Conclusion: For clinical early-stage clear cell carcinoma of the uterus, staging by laparoscopy is oncologically safe. This needs to be justified by further prospective studies. Journal of Minimally Invasive Gynecology (2022) 29, 968- 975. (c) 2022 AAGL. All rights reserved.