Design: Patients with early-stage endometrial cancer who underwent LESS\CLS\LS during 2018-2022 at Sun Yat-sen Cancer Centre was included, parameters of surgical quality and treatment outcomes were analyzed using statistical methods.

Setting: Only one 2-2.5cm umbilical incision was required for LESS. A 1.0-1.2 cm umbilical and three 0.5 cm abdominal incisions were made for CLS. A 15-20 cm vertical midline incision was required for LS.

Patients or Participants: 327 patients staged IA-IIC were divided into 3 groups: LESS (n=100), CLS (n=103), and LS (n=72). Surgical procedure is total hysterectomy with salpingo-oophorectomy (all in 3 groups) ± pelvic/para-aortic lymphadenectomy (LESS: 23/100; CLS: 60/103; LS:24/72, respectively).

Interventions: LESS\CLS\LS.

Measurements and Main Results: CLS group had the lowest estimated blood loss (59.3 ± 37.7 ml, p<0.05). LESS group had the longest operative time (142.8 ± 64.2 min, p<0.05) but the shortest postoperative hospital stays (5.8 ± 1.6 days, p>0.05). Conversely, the LS group had the shortest operative time (135.9 ± 47.0 min, p<0.05) while the highest estimated blood loss (116 ± 68.8 ml, p<0.0001), the longest postoperative hospital stay (7.0 ± 2.4 days, p>0.05), and the highest postoperative complications(3/72 cases). Both CLS and LESS had 1 case converted into laparotomy due to large vein injury. As for the treatment outcomes,3-year disease-free survival (LESS:98.0%; CLS:98.0%; LS:98.6%, median follow-up 40.9 months ,) and recurrence rate (LESS:0.03%; CLS:0.02%; LS:0.03%) demonstrate no significant statistical differences among 3 groups (all, p>0.05).

Conclusion: With the observed benefits of less surgical incision, faster recovery, and similar survival outcomes in LESS group, this real-world data-based study shows that LESS is a feasible alternative for early-stage endometrial cancer.