Revisiting the role of the Pfannenstiel incision in early-stage endometrial cancer

Introduction: Endometrial cancer is the most common gynecologic malignancy in developed countries, and the optimal surgical approach in early-stage cases remains a subject of ongoing clinical debate. Objective: This study aims to compare laparoscopy and Pfannenstiel incision in early-stage, low-grade endometrial cancer (EC) surgery. Methods: A retrospective study was conducted on the records of 224 patients diagnosed with EC between April 2010 and April 2024. Only patients with stage I and grade I-II endometrioid type EC were included in the study. After excluding 94 patients with non-endometrioid histology, stage II-IV disease, grade 3 tumors, and synchronous tumors, 130 patients were included in the final analysis. Participants were categorized into two groups: Group 1 (63 patients who underwent surgery through Pfannenstiel incision) and Group 2 (67 patients who underwent laparoscopic surgery). Results: The median overall survival (OS) was 48 months (range: 12 – 168) and the median disease-free survival (DFS) was 47 months (range: 8 – 168). During the follow-up period, 20 patients died and 8 patients experienced disease recurrence. The overall OS rate was 84.6%, and the DFS was 93.8%. When comparing groups, the OS was 85.7% in Group 1 and 83.6% in Group 2 (p=0.12). The DFS rate was significantly higher in Group 1 compared to Group 2 (96.8% vs. 91%; p=0.037). Conclusion: This study highlights the continued relevance of staging surgery with the Pfannenstiel incision in early-stage EC patients with vaginal stenosis, morbid obesity unsuitable for trocar insertion, a history of multiple abdominal surgeries, inability to insert a manipulator, an enlarged normal uterus, or suspected pelvic adhesions.