Clinical effectiveness of laparoscopic versus open surgery for apparently early-stage endometrial cancer: Application of a treatment effect model

Objective: While the advantages of laparoscopic surgery (LPS) over open surgery (OPS) for endometrial cancer (EC) have been reported, most evidence comes from high-income countries with limited follow-up periods.To emulate a clinical trial using real-world cohort data to compare the clinical effectiveness, specifically recurrence and mortality rate, between LPS and OPS in patients with apparently early-stage EC.Methods: A retrospective cohort study was conducted at a tertiary care hospital in Thailand.Treatment effect models with inverse-probability-weighted regression adjustment were employed to balance patient characteristics between the LPS and OPS groups, and subsequently estimated the treatment effect of LPS relative to OPS.Results: From January 2011 to December 2022, 939 patients underwent surgery for EC.With a median follow-up time of 6.0 years (interquartile range=3.7-8.7),LPS significantly reduced the risk of recurrence and death compared to OPS, with a hazard ratio of 0.21 (95% confidence interval [CI]=0.09,0.50) for recurrence and 0.42 (95% CI=0.24, 0.75) for death.LPS was significantly associated with longer operative time than OPS (mean difference [MD]=79.37 minutes; 95% CI=63.77-94.98)but showed clear advantages in other surgical outcomes, including reduced blood loss ) and shorter hospital stays .Conclusion: Real-world data from an upper-middle-income country indicated that LPS may provide superior oncologic outcomes, such as reduced recurrence and mortality rates, as well as improve surgical outcomes, including less blood loss and shorter hospital stays, despite a longer operative time.