Minimally invasive surgical treatment of recurrent endometrial carcinoma: A systematic review

Background: While the role minimally invasive surgery (MIS) is established for primary endometrial carcinoma (EC), its feasibility in recurrent cases remains underexplored. Objective: To systematically review the literature about MIS for EC recurrence. Search Strategy: A systematic literature search was conducted across six electronic databases, targeting studies published until October 31, 2024. Selection Criteria: Inclusion criteria encompassed all peer-reviewed studies reporting MIS for recurrent EC. Data Collection and Analysis: Data extraction focused on surgical outcomes and survival metrics, following PRISMA guidelines. Main Results: Out of 9652 results, 15 studies with 17 cases of patients with EC recurrence met the inclusion criteria. All patients underwent successful MIS, with no intraoperative complications reported. Complete resection (when reported) was achieved in 100% of cases, and adjuvant treatment was administered in 64.7% of patients. The mean follow-up duration was 23.6 months, with a disease-free survival rate of 63.6%. Risk of bias assessment indicated a predominance of low to medium risk of bias within studies. Conclusion: MIS might be feasible and safe in cases of abdominal recurrence of EC when the number of recurrence localizations is less than three. MIS might be a management option independently from EC histology, grade and stage (except for stage IV), previous adjuvant therapy and group of risk. The endoscopic approach could be both laparoscopic and robotic, without any apparent difference in terms of feasibility, safety and survival outcomes. However, data on this topic are limited and our findings need to be confirmed by additional studies.