Patients with high-risk histology endometrial cancer (EC; grade 3 endometrioid adenocarcinoma, papillary serous carcinoma [PS], clear cell carcinoma [CC], and carcinosarcoma) were compared between minimally invasive surgery (MIS) and open surgery (OPS) for their risk of recurrence and mortality. Researchers performed a comprehensive literature search for studies comparing MIS and OPS for high-risk histology EC patients published up through January 2022. Rates of recurrence and mortality were used as cutoffs. This analysis looked at potential participant selection, recurrence/death detection, and manuscript publication biases in the study’s design. Assessment of cross-study heterogeneity led investigators to utilize random- or fixed-effects meta-analytical models for pooled estimations of the effect of MIS on recurrence/mortality. According to study group, the research yielded 9 observational studies, 8 of which were retrospective and 1 of which was prospective (MIS, 8,877 patients; OPS, 5,751 patients). According to a meta-analysis using a fixed-effects model, there was no evidence that MIS increased the risk of recurrence or mortality compared to OPS (hazard ratio [HR], 0.86; 95% CI, 0.71-1.05; P=0.13 and P<0.001, respectively). Subgroup analyses by stage (early vs. all), histology (PS vs. CC), and MIS type all showed the same trend (laparoscopy vs. robotic). No publication bias was found. These results from a meta-analysis of observational studies showed that MIS did not negatively affect the outcomes of patients with high-risk histology who had undergone EC treatment. Verifying the findings of this rare but fatal malignancy could be accomplished by well-designed randomized controlled trials.