Comparison of minimally invasive surgery with laparotomic approach in the treatment of high risk endometrial cancer: A systematic review G. Scaletta a , G. Dinoi a , V. Capozzi a , S. Cianci a, * , S. Pelligra a , R. Ergasti a , A. Fagotti a, b , G. Scambia a, b , F. Fanfani a, b a Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universit a Cattolica del Sacro Cuore, Rome, Italy b Catholic University of the Sacred Heart, Italy article info Article history: Received 19 September 2019 Received in revised form 24 November 2019 Accepted 30 November 2019 Available online xxx Keywords: Minimally invasive surgery Endometrial cancer High-risk endometrial cancer Laparoscopy abstract Objective: To analyze all published studies comparing minimally invasive surgery (MIS) with laparotomic one in the surgical treatment of high-risk endometrial cancer (EC) in term of operative, peri-operative and oncological outcomes. Data sources: We conducted a systematic literature search in PubMed between January 1995eMarch 2019. Methods of study selection: Titles and abstracts were analyzed by two reviewers. A set of explicit criteria was used for selection of literature: 1) randomized controlled trials (RCT), prospective or retrospective cohort studies, given the rarity of this tumor and the concomitant lack of data in the form of large trials, all reviewed original report publications with an appropriate number of subjects were considered and included; 2) participants of interest being patients who have suffered from high risk EC 3) the outcome measures including overall survival (OS), disease-free survival (DFS) and recurrence, (4) English lan- guage, (5) abstract available. Results: Thirty relevant articles were selected for full reading. For final analysis 20 studies were selected. Then, as second step, the full articles were evaluated to determine whether full inclusion criteria were met. In total, 9 papers were identified and included. Conclusion: MIS appears to be safe in the management of high-risk EC patients, showing better peri- operative and postoperative outcomes and comparable oncological outcomes than open surgery. Pro- spective randomized trial would be needed to confirm this data. © 2019 Published by Elsevier Ltd. Introduction Endometrial cancer (EC) is the most common female repro- ductive organs cancer [1,2]. While most uterine corpus cancers are early-stage with low- grade Type I tumors with an excellent prognosis, grade 3 endo- metrioid adenocarcinoma, uterine serous carcinoma (USC), clear cell carcinoma (CCC) and carcinosarcoma, have been identified as distinct, high-risk variants, with a poorer prognosis [3e5]. Although these high-grade subtypes account for fewer than 25% of all uterine cancers, they collectively account for more than 50% of uterine cancer deaths [6,7]. All over the world, it is now established that minimally invasive surgery (MIS) is the gold standard for early-stage EC patients with a lower comorbidity rate and superimposable clinical outcomes respect to laparotomy (LPT) [8e12]. Despite this, few studies still mention the oncological safety of this surgical approach in high- risk endometrial tumors [13e15]. The aim of this review was to analyze all published studies comparing minimally invasive approach (laparoscopic or robotic) with laparotomic one in the surgical treatment of high-risk EC (high grade or type II endometrial cancer) in term of operative, peri- operative and oncological outcomes. * Corresponding author. Gynecologic Oncology Unit, Women Wealth Area, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, Rome, Italy. E-mail address: stefanoc85@hotmail.it (S. Cianci). Contents lists available at ScienceDirect European Journal of Surgical Oncology journal homepage: www.ejso.com https://doi.org/10.1016/j.ejso.2019.11.519 0748-7983/© 2019 Published by Elsevier Ltd. European Journal of Surgical Oncology xxx (xxxx) xxx Please cite this article as: Scaletta G et al., Comparison of minimally invasive surgery with laparotomic approach in the treatment of high risk endometrial cancer: A systematic review, European Journal of Surgical Oncology, https://doi.org/10.1016/j.ejso.2019.11.519