AccScience Publishing / EJMO / Online First / DOI: 10.36922/EJMO025150106
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ORIGINAL RESEARCH ARTICLE

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

Cem Yagmur Ozdemir1,2* ,  Hasan Eroğlu3 ,  Necat Cağatay Sezer3 ,  Nayif Çicekli2,4 ,  Derya Yeğin Aksu5 ,  Dağıstan Tolga Arioz2
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1 Department of Gynecological Oncology, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey
2 Department of Gynecological Oncology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
3 Department of Gynecology and Obstetrics, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
4 Department of Gynecological Oncology, Erzurum City Hospital, Erzurum, Turkey
5 Department of Pathology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
EJMO, 025150106 https://doi.org/10.36922/EJMO025150106
Received: 11 April 2025 | Revised: 7 May 2025 | Accepted: 27 May 2025 | Published online: 19 June 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

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.

Keywords
Endometrial cancer
Laparoscopy
Pfannenstiel incision
Funding
None.
Conflict of interest
The authors declare no competing interests.
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Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing
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