OBJECTIVE: To assess the safety and long-term effectiveness of minimally invasive approach in managing "oldest old" endometrial cancer patients. METHODS: This is a retrospective cohort, multi-institutional study. Consecutive patients, treated between 2000 and 2020, with apparent early-stage endometrial cancer patients, aged ≥85 years. Surgery-related outcomes of robotic-assisted, laparoscopic, and vaginal surgery were compared. Survival was evaluated in patients with at least 3-year follow-up data. RESULTS: Charts of 82 endometrial cancer patients "oldest old" were retrieved. Intermediate-high and high-risk endometrial cancer patients accounted for 26 (31.7 %) and 17 (20.7 %), respectively. In total, 12 (15 %), 45 (55 %), and 25 (30 %) patients underwent robotic-assisted, laparoscopic, and vaginal surgery, respectively. Looking at surgery-related outcomes, robotic-assisted surgery correlated with a longer operative time (p <
0.001) and longer length of hospital stay (p = 0.002) in comparison to laparoscopic and vaginal approaches. Overall, seven (8.5 %) conversions from the planned approach occurred. The surgical approach did not influence disease-free survival (p = 0.6061) and overall survival (p = 0.4950). Via multivariate analysis, only serosal/adnexal invasion correlated with the risk of death (HR: 3.752, p = 0.038). CONCLUSIONS: All three minimally invasive approaches are safe and effective methods for managing endometrial cancer in the oldest old population. Chronological age, per se, should not be considered a contraindication for receiving minimally invasive surgery.