Comparison of Laparoscopy without Use of Uterine Manipulator and Laparatomy for Staging Surgery for High Grade and Serous Endometrial Carcinoma Running Title: Laparoscopy and Laparatomy for Endometrial Carcinoma

Introduction: To Evaluate perioperative and oncological outcomes of laparoscopy without the use of uterine manipulators and laparatomy in high-grade and serous endometrial cancer Material and Methods: The patients with grade III endometrioid adenocancer and serous carcinoma between 2018 and 2022 were included to the study. A preoperative staging with PET/CT or thoracoabdominal CT was performed. All patients underwent staging surgery including hysterectomy, bilateral salpingoopherectomy,peritoneal washing, omentectomy pelvic and paraaortic lymphadenectomy up to renal vein. Laparoscopic paraaortic lymphadenectomy was perofmed by extraperitoneal approach. No uterine manipulator was used for laparoscopic hysterectomy. Age, CA 125 level, BMI, accompanying diseases, pathologic data including stage, lymphovascular invasion, number of pelvic and paraaortic lymph nodes and surgical data including operative time, surgical complications and ajuvant therapies were collected from hospital database. Results: Eighty-nine patients were included in the study: 34 underwent laparotomy and 55 underwent laparoscopy. Operation time were similar between groups. Mean pelvic lymph node count in LT and LS groups were 33 and 34 respectively. Mean paraaortic lymph node count was 23 and 22 respectively. Red blood cell transfusion, hemorrhage, urinary tract infection, postoperative fever, bladder atony, bladder injury, and chylous leakage showed no significant differences. However, ileus, intestinal injury and eviscerations were significantly higher in the LT group. Hospital stay was significantly loonger in LT compared to LS. Overall and recurrence-free survival were similar between the groups Conclusion: Our study concluded that laparoscopic surgery, performed without manipulators, provides comparable oncological outcomes to open surgery in the treatment of high-grade endometrial cancer, while also offering improved perioperative results.