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Mandato VD, Paterlini M, Torricelli F, Rabitti E, Mastrofilippo V, Aguzzoli L. Perceived social support and quality of life in endometrial cancer patients: a longitudinal study. Front Oncol 2024; 14:1447644. [PMID: 39156703 PMCID: PMC11327120 DOI: 10.3389/fonc.2024.1447644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 07/17/2024] [Indexed: 08/20/2024] Open
Abstract
Objective This study aimed to assess the influence of medical history, perceived physician-patient communication, and perceived social support on changes in the quality of life (QoL) during the first year of follow-up in patients undergoing surgery for endometrial cancer (EC), the most prevalent gynecological cancer in Western countries, especially in Central and Eastern Europe and North America. Methods This prospective longitudinal study included 98 EC patients. All participants completed the Short Form 36 (SF-36) and the Multidimensional Scale of Perceived Social Support (MSPSS) one month and one year after surgery. Additionally, one month after surgery, they responded to a questionnaire designed by the researchers concerning the key aspects of physician-patient communication. Results Our findings revealed that patients reporting high social support one month after surgery demonstrated significantly improved emotional well-being (EWB) at both one month and one year after the surgery, with statistically significant higher scores in the dimension of EWB (p<0.05). The support from a significant other at one year correlates with greater PF (p<0.005), fewer limitations due to physical health (p<0.05), less pain (p<0.05), less fatigue (p<0.05), and better general and EWB (p<0.05). Conclusion This study underscores the significance of perceived social support for patients cross endometrial cancer. The multifaceted nature of social support, encompassing emotional assistance and information sharing, emerges as a pivotal factor aiding patients in confronting the challenges inherent to EC. This form of support contributes to bolstering psychological well-being and enhancing overall QoL.
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Affiliation(s)
- Vincenzo Dario Mandato
- Obstetrics and Gynecological Oncology, Azienda Unità Sanitaria Locale (AUSL) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Marcella Paterlini
- Department of Obstetrics and Pediatrics, Azienda Unità Sanitaria Locale (AUSL) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Federica Torricelli
- Laboratory of Translational Research, Azienda Unità Sanitaria Locale (AUSL) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Elisa Rabitti
- Psycho-oncology Unit, Azienda Unità Sanitaria Locale (AUSL) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Valentina Mastrofilippo
- Obstetrics and Gynecological Oncology, Azienda Unità Sanitaria Locale (AUSL) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
| | - Lorenzo Aguzzoli
- Obstetrics and Gynecological Oncology, Azienda Unità Sanitaria Locale (AUSL) - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) di Reggio Emilia, Reggio Emilia, Italy
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Balafoutas D, Vlahos N. The role of minimally invasive surgery in gynaecological cancer: an overview of current trends. Facts Views Vis Obgyn 2024; 16:23-33. [PMID: 38551472 PMCID: PMC11198884 DOI: 10.52054/fvvo.16.1.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024] Open
Abstract
Background The capabilities of minimally invasive surgery, either as conventional laparoscopy, or as robotic surgery, have increased to an extent that it enables complex operations in the field of gynaecological oncology. Objective To document the role of minimally invasive gynaecological surgery in cancer. Materials and methods A review of the literature that shaped international guidelines and clinical practice. Main outcome measures Current guidelines of major international scientific associations and trends in accepted clinical practice. Results In recent years, evidence on oncologic outcome has limited the role of minimally invasive techniques in cervical cancer, while the treatment of early endometrial cancer with laparoscopy and robotic surgery has become the international standard. In ovarian cancer, the role of minimally invasive surgery is still limited. Current evidence on perioperative morbidity underlines the necessity to implicate minimally invasive techniques whenever possible. Conclusion The optimal surgical route for the treatment of gynaecological cancer remains in many cases controversial. The role of minimally invasive surgery remains increasing in the course of time. What is new? This comprehensive review offers an entire perspective on the current role of minimally invasive surgery in gynaecological cancer therapy.
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Bijkerk V, Jacobs LM, Albers KI, Gurusamy KS, van Laarhoven CJ, Keijzer C, Warlé MC. Deep neuromuscular blockade in adults undergoing an abdominal laparoscopic procedure. Cochrane Database Syst Rev 2024; 1:CD013197. [PMID: 38288876 PMCID: PMC10825891 DOI: 10.1002/14651858.cd013197.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND Laparoscopic surgery is the preferred option for many procedures. To properly perform laparoscopic surgery, it is essential that sudden movements and abdominal contractions in patients are prevented, as it limits the surgeon's view. There has been a growing interest in the potential beneficial effect of deep neuromuscular blockade (NMB) in laparoscopic surgery. Deep NMB improves the surgical field by preventing abdominal contractions, and it is thought to decrease postoperative pain. However, it is uncertain if deep NMB improves intraoperative safety and thereby improves clinical outcomes. OBJECTIVES To evaluate the benefits and harms of deep neuromuscular blockade versus no, shallow, or moderate neuromuscular blockade during laparoscopic intra- or transperitoneal procedures in adults. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 31 July 2023. SELECTION CRITERIA We included randomised clinical trials (irrespective of language, blinding, or publication status) in adults undergoing laparoscopic intra- or transperitoneal procedures comparing deep NMB to moderate, shallow, or no NMB. We excluded trials that did not report any of the primary or secondary outcomes of our review. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. all-cause mortality, 2. health-related quality of life, and 3. proportion of participants with serious adverse events. Our secondary outcomes were 4. proportion of participants with non-serious adverse events, 5. readmissions within three months, 6. short-term pain scores, 7. measurements of postoperative recovery, and 8. operating time. We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS We included 42 randomised clinical trials with 3898 participants. Most trials included participants undergoing intraperitoneal oncological resection surgery. We present the Peto fixed-effect model for most dichotomous outcomes as only sparse events were reported. Comparison 1: deep versus moderate NMB Thirty-eight trials compared deep versus moderate NMB. Deep NMB may have no effect on mortality, but the evidence is very uncertain (Peto odds ratio (OR) 7.22, 95% confidence interval (CI) 0.45 to 115.43; 12 trials, 1390 participants; very low-certainty evidence). Deep NMB likely results in little to no difference in health-related quality of life up to four days postoperative (mean difference (MD) 4.53 favouring deep NMB on the Quality of Recovery-40 score, 95% CI 0.96 to 8.09; 5 trials, 440 participants; moderate-certainty evidence; mean difference lower than the mean clinically important difference of 10 points). The evidence is very uncertain about the effect of deep NMB on intraoperatively serious adverse events (deep NMB 38/1150 versus moderate NMB 38/1076; Peto OR 0.95, 95% CI 0.59 to 1.52; 21 trials, 2231 participants; very low-certainty evidence), short-term serious adverse events (up to 60 days) (deep NMB 37/912 versus moderate NMB 42/852; Peto OR 0.90, 95% CI 0.56 to 1.42; 16 trials, 1764 participants; very low-certainty evidence), and short-term non-serious adverse events (Peto OR 0.94, 95% CI 0.65 to 1.35; 11 trials, 1232 participants; very low-certainty evidence). Deep NMB likely does not alter the duration of surgery (MD -0.51 minutes, 95% CI -3.35 to 2.32; 34 trials, 3143 participants; moderate-certainty evidence). The evidence is uncertain if deep NMB alters the length of hospital stay (MD -0.22 days, 95% CI -0.49 to 0.06; 19 trials, 2084 participants; low-certainty evidence) or pain scores one hour after surgery (MD -0.31 points on the numeric rating scale, 95% CI -0.59 to -0.03; 22 trials, 1823 participants; very low-certainty evidence; mean clinically important difference 1 point) and 24 hours after surgery (MD -0.60 points on the numeric rating scale, 95% CI -1.05 to -0.15; 16 trials, 1404 participants; very low-certainty evidence; mean clinically important difference 1 point). Comparison 2: deep versus shallow NMB Three trials compared deep versus shallow NMB. The trials did not report on mortality and health-related quality of life. The evidence is very uncertain about the effect of deep NMB compared to shallow NMB on the proportion of serious adverse events (RR 1.66, 95% CI 0.50 to 5.57; 2 trials, 158 participants; very low-certainty evidence). Comparison 3: deep versus no NMB One trial compared deep versus no NMB. There was no mortality in this trial, and health-related quality of life was not reported. The proportion of serious adverse events was 0/25 in the deep NMB group and 1/25 in the no NMB group. AUTHORS' CONCLUSIONS There was insufficient evidence to draw conclusions about the effects of deep NMB compared to moderate NMB on all-cause mortality and serious adverse events. Deep NMB likely results in little to no difference in health-related quality of life and duration of surgery compared to moderate NMB, and it may have no effect on the length of hospital stay. Due to the very low-certainty evidence, we do not know what the effect is of deep NMB on non-serious adverse events, pain scores, or readmission rates. Randomised clinical trials with adequate reporting of all adverse events would reduce the current uncertainties. Due to the low number of identified trials and the very low certainty of evidence, we do not know what the effect of deep NMB on serious adverse events is compared to shallow NMB and no NMB. We found no trials evaluating mortality and health-related quality of life.
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Affiliation(s)
- Veerle Bijkerk
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Anesthesiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Lotte Mc Jacobs
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Kim I Albers
- Department of Anesthesiology, Radboud University Medical Center, Nijmegen, Netherlands
| | | | | | - Christiaan Keijzer
- Department of Anesthesiology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Michiel C Warlé
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
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Martin F, Vautrin N, Elnar AA, Goetz C, Bécret A. Evaluation of the impact of an enhanced recovery after surgery (ERAS) programme on the quality of recovery in patients undergoing a scheduled hysterectomy: a prospective single-centre before-after study protocol (RAACHYS study). BMJ Open 2022; 12:e055822. [PMID: 35393312 PMCID: PMC8990258 DOI: 10.1136/bmjopen-2021-055822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The enhanced recovery after surgery (ERAS) programmes following hysterectomies have been studied since 2010, and their positive effects on clinical or economic criteria are now well established. However, the benefits on health outcomes, especially rapid recovery after surgery from patients' perspective is lacking in literature, leading to develop scores supporting person-centred and value-based care such as patient-reported outcome measures. The aim of this study is to assess the impact of an ERAS programme on patients' well-being after undergoing hysterectomy. METHODS AND ANALYSIS This is an observational, prospective single-centre before-after clinical trial. 148 patients are recruited and allocated into two groups, before and after ERAS programme implementation, respectively. The ERAS programme consists in optimising factors dealing with early rehabilitation, such as preoperative patient education, multimodal pain management, early postoperative fluid taken and mobilisation. A self-questionnaire quality of recovery-15 (QoR-15) on the preoperative day 1 (D-1), postoperative day 0 evening (D0) and the postoperative day 1 (D+1) is completed by patients. Patients scheduled to undergo hysterectomy, aged 18 years and above, whose physical status are classified as American Society of Anesthesiologists score 1-3 and who are able to return home after being discharged from hospital and contact their physician or the medical department if necessary are recruited for this study. The total duration of inclusion is 36 months. The primary outcome is the difference in QoR-15 scores measured on D+1 which will be compared between the 'before' and the 'after' group, using multiple linear regression model. ETHICS AND DISSEMINATION Approval was obtained from the Ethical Committee (Paris, France). Subjects are actually being recruited after giving their oral agreement or non-objection to participate in this clinical trial and following the oral and written information given by the anaesthesiologist practitioner.Trial registration number: ClinicalTrials.gov: NCT04268576 (Pre-result).
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Affiliation(s)
- Flora Martin
- Anesthesiology, CHR Metz-Thionville, Metz, France
- Faculté de médecine, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | | | | | - Christophe Goetz
- Clinical Research Support Unit, CHR Metz-Thionville, Metz, France
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Tomov ST, Gorchev GA, Kiprova DK, Lyubenov AD, Hinkova NH, Tomova VD, Gorcheva ZV, Ahmad S. Peri-operative and survival outcomes analysis of patients with endometrial cancer managed by three surgical approaches: a long-term Bulgarian experience. J Robot Surg 2022; 16:1367-1382. [PMID: 35142980 DOI: 10.1007/s11701-022-01374-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/21/2022] [Indexed: 12/24/2022]
Abstract
The study aim was to assess the peri-operative, oncologic, and survival outcomes for patients with endometrial cancer (EC) managed by abdominal hysterectomy (AH), laparoscopic hysterectomy (LH), or robotic hysterectomy (RH) approaches at premier centers in Bulgaria. We analyzed histologically diagnosed EC cases operated via any of the three surgical methods during 2008-2019. Data analyses included patients and tumor characteristics, peri-operative outcomes, and disease status. We grouped FIGO stages I and II to represent early-stage EC and to investigate their survival. Kaplan-Meier and Cox regression analyses were performed to determine disease-free survival (DFS) and overall survival (OS). Consecutive 917 patients (AH = 466; LH = 60, RH = 391) formed the basis of study analyses. Most of demographics and tumor characteristics of the patients were comparable across the groups except few minor variations (e.g., LH/RH cases were younger, heavier, more stage IA, endometrioid, G1, low-risk group). LH and RH group cases had significantly lower operative time than AH (p < 0.001), shorter hospital length-of-stay (p < 0.001), higher post-operative Hgb (p < 0.001). RH cases had fewer blood transfusions than AH or LH (p < 0.001). Cox multivariate analyses indicate that OS was not influenced by the type of surgical approach. Despite the fact that the DFS in "early-stage" EC is significantly better in AH group than RH, the type of surgery (i.e., AH, LH, or RH) for "all stages" is insignificant factor for DFS. With our long-term experience, minimally invasive surgical approach resulted in superior peri-operative, oncologic, and survival outcomes. Specifically, RH is not only safe in terms of post-operative results, but also for mortality and oncologic rates.
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Affiliation(s)
- Slavcho T Tomov
- Medical University Pleven, University Hospital "Saint Marina", Pleven, 5800, Bulgaria.
| | - Grigor A Gorchev
- Medical University Pleven, University Hospital "Saint Marina", Pleven, 5800, Bulgaria
| | - Desislava K Kiprova
- Medical University Pleven, University Hospital "Saint Marina", Pleven, 5800, Bulgaria
| | - Aleksandar D Lyubenov
- Medical University Pleven, University Hospital "Saint Marina", Pleven, 5800, Bulgaria
| | - Nadezhda H Hinkova
- Medical University Pleven, University Hospital "Saint Marina", Pleven, 5800, Bulgaria
| | - Vesela D Tomova
- Medical University Pleven, University Hospital "Saint Marina", Pleven, 5800, Bulgaria
| | - Zornitsa V Gorcheva
- Medical University Pleven, University Hospital "Saint Marina", Pleven, 5800, Bulgaria
| | - Sarfraz Ahmad
- Gynecologic Oncology Program, AdventHealth Cancer Institute, 2501 N. Orange Ave., Suite 786, Orlando, FL, 32804, USA. .,FSU and UCF Colleges of Medicine, Orlando, FL 32804, USA.
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Who will be readmitted? Evaluation of the laparoscopic hysterectomy readmission score in a gynecologic oncology population undergoing robotic-assisted hysterectomy. Gynecol Oncol 2021; 164:628-638. [PMID: 34969534 DOI: 10.1016/j.ygyno.2021.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/06/2021] [Accepted: 12/05/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The laparoscopic hysterectomy readmission score (LHRS) was created to identify patients for whom same day discharge (SDD) after minimally invasive hysterectomy (MIH) may not be advisable and includes diabetes, chronic obstructive pulmonary disease, disseminated cancer, chronic steroid use, bleeding disorder, length of surgery, and any postoperative complication prior to discharge. We evaluated the performance of the score at predicting readmission in a gynecologic oncology population, and additionally sought to determine if any factors known prior to surgery could replace those that are not known until the time of surgery (operative time and postoperative complication). METHODS This was a single-institution retrospective cohort study of women undergoing robotic hysterectomy by a gynecologic oncologist in 2018. Associations between pre-operative, operative and post-operative factors and 30-day readmission, SDD and postoperative complications were assessed using logistic regression. RESULTS The 30-day readmission rate among the 423 women in the cohort was 4.5% and 1.9% in those undergoing SDD. Readmission rates by LHRS were: score 1 (4.9%), score 2 (7.8%), score 3 (13.6%), score 4 (16.7%). Patients with a LHRS of ≥3 had higher odds of readmission compared to those with a lower score (OR 4.20, p = 0.02). Infectious morbidity accounted for the majority of postoperative complications, emergency room visits and readmissions. We did not identify preoperative factors to replace the intra- and post-operative factors used in the score. CONCLUSIONS The readmission rate following MIH is low, and a LHRS of ≥3 is associated with increased risk of readmission. Our findings support the applicability of the LHRS to a gynecologic oncology population; addressing risk factors for postoperative infection or closer follow up for patients with a LHRS ≥3 could reduce postoperative readmissions.
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Ito H, Moritake T, Terauchi F, Isaka K. Introduction of gasless laparoscopic surgery as a minimally invasive procedure for endometrial cancer and its usefulness from the viewpoint of the learning curve. World J Surg Oncol 2021; 19:347. [PMID: 34922565 PMCID: PMC8684144 DOI: 10.1186/s12957-021-02453-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 11/22/2021] [Indexed: 01/21/2023] Open
Abstract
Background We investigated the usefulness of gasless laparoscopic surgery (GLS) using a subcutaneous abdominal wall lifting method for endometrial cancer. Methods We studied 105 patients with early endometrial cancer who underwent GLS (55) or open surgery (50). A uterine manipulator was used in all GLS cases. We compared operative time, blood loss, number of lymph nodes removed, hospital stay, perioperative complications, cases converted to laparotomy, and recurrence and survival rates. We also studied the learning curve and proficiency of GLS. Results The GLS group had significantly longer operative time (265 vs. 191 min), reduced blood loss (184 vs. 425 mL), shorter hospital stay (9.9 vs. 17.6 days), and fewer postoperative complications (1.8 vs. 12.0%) than the open group. No case was converted to laparotomy. Disease-free and overall survival rates at 4 years postoperatively (GLS vs. open groups) were 98.0 versus 97.8 and 100 versus 95.7%, respectively, and there was no significant difference between the groups. Regarding the learning curve for GLS, two different phases were observed in approximately 10 cases. Operator 2, who was not accustomed to laparoscopic surgery, showed a significant reduction in operative time in the later phase 2. Conclusions GLS for endometrial cancer results in less bleeding, shorter hospital stay, and fewer complications than open surgery. Recurrence and survival rates were not significantly different from those of open surgery. This technique may be introduced in a short time for operators who are skilled at open surgery but not used to laparoscopic surgery.
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Affiliation(s)
- Hiroe Ito
- Department of Obstetrics and Gynecology, Tokyo Medical University Hospital, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Tetsuya Moritake
- Department of Obstetrics and Gynecology, Tokyo Medical University Hospital, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.,Department of Obstetrics and Gynecology, Sugawara Hospital, Koshigaya, Japan
| | - Fumitoshi Terauchi
- Department of Obstetrics and Gynecology, Tokyo Medical University Hospital, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.,Department of Obstetrics and Gynecology, Sugawara Hospital, Koshigaya, Japan
| | - Keiichi Isaka
- Department of Obstetrics and Gynecology, Tokyo Medical University Hospital, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan. .,Robotic Surgery Center, Tokyo International Ohori Hospital, Tokyo, Japan.
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Perioperative morbidity of different operative approaches in early cervical carcinoma: a systematic review and meta-analysis comparing minimally invasive versus open radical hysterectomy. Arch Gynecol Obstet 2021; 306:295-314. [PMID: 34625835 PMCID: PMC9349163 DOI: 10.1007/s00404-021-06248-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/09/2021] [Indexed: 11/08/2022]
Abstract
Purpose Radical hysterectomy and pelvic lymphadenectomy is the standard treatment for early cervical cancer. Studies have shown superior oncological outcome for open versus minimal invasive surgery, but peri- and postoperative complication rates were shown vice versa. This meta-analysis evaluates the peri- and postoperative morbidities and complications of robotic and laparoscopic radical hysterectomy compared to open surgery. Methods Embase and Ovid-Medline databases were systematically searched in June 2020 for studies comparing robotic, laparoscopic and open radical hysterectomy. There was no limitation in publication year. Inclusion criteria were set analogue to the LACC trial. Subgroup analyses were performed regarding the operative technique, the study design and the date of publication for the endpoints intra- and postoperative morbidity, estimated blood loss, hospital stay and operation time. Results 27 studies fulfilled the inclusion criteria. Five prospective, randomized-control trials were included. Meta-analysis showed no significant difference between robotic radical hysterectomy (RH) and laparoscopic hysterectomy (LH) concerning intra- and perioperative complications. Operation time was longer in both RH (mean difference 44.79 min [95% CI 38.16; 51.42]), and LH (mean difference 20.96 min; [95% CI − 1.30; 43.22]) than in open hysterectomy (AH) but did not lead to a rise of intra- and postoperative complications. Intraoperative morbidity was lower in LH than in AH (RR 0.90 [0.80; 1.02]) as well as in RH compared to AH (0.54 [0.33; 0.88]). Intraoperative morbidity showed no difference between LH and RH (RR 1.29 [0.23; 7.29]). Postoperative morbidity was not different in any approach. Estimated blood loss was lower in both LH (mean difference − 114.34 [− 122.97; − 105.71]) and RH (mean difference − 287.14 [− 392.99; − 181.28]) compared to AH, respectively. Duration of hospital stay was shorter for LH (mean difference − 3.06 [− 3.28; − 2.83]) and RH (mean difference − 3.77 [− 5.10; − 2.44]) compared to AH. Conclusion Minimally invasive radical hysterectomy appears to be associated with reduced intraoperative morbidity and blood loss and improved reconvalescence after surgery. Besides oncological and surgical factors these results should be considered when counseling patients for radical hysterectomy and underscore the need for new randomized trials.
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Gao J, Dang J, Chu J, Liu X, Wang J, You J, Jin Z. A Comparative Analysis of Robotic Single-Site Surgery and Laparoendoscopic Single-Site Surgery as Therapeutic Options for Stage IB1 Cervical Squamous Carcinoma. Cancer Manag Res 2021; 13:3485-3492. [PMID: 33911898 PMCID: PMC8071700 DOI: 10.2147/cmar.s299827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/02/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose To compare perioperative outcomes between robotic single-site surgical technique and conventional laparoendoscopic single-site surgical technique. Methods This was a retrospective cohort study involving 67 patients who received robotic single-site surgery or laparoendoscopic single-site surgery for the treatment of stage IB1 cervical squamous carcinoma. The robotic single-site radical hysterectomy technique combined with pelvic lymph node dissections were performed in 32 patients while the laparoendoscopic single-site radical hysterectomy technique combined with pelvic lymph node dissections were performed in 35 patients. Results The enrolled patients had been diagnosed with stage IB1 cervical squamous carcinoma. The perioperative outcomes were mean age (51.63±8.32 years in the lymph node dissection (RSS group) and 53.14±8.14 years in the lymph node dissection (LESS group), p=0.453); BMIs (23.76±2.72 in the RSS group and 23.46±2.28 in the LESS group, p=0.629); shorter operative times (223.56±15.43 min in the RSS group and 248.61±20.89 min in the LESS group, p<0.01) and less estimated blood loss (217.25±16.77 mL in the RSS group and 294.74±24.00 mL in the LESS group, p<0.01). None of the study participants exhibited postoperative pain. There were no statistically significant differences in the length of hospital stay (p=0.865), perioperative complications (p=0.602), duration of closure and removal of catheter (p=0.518) as well as in pathological diagnoses between the two groups. Conclusion Robotic single-site surgery can be used in the treatment of early stage cervical cancer as it exhibits acceptable operative times and perioperative outcomes. This surgical technique is feasible and safe.
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Affiliation(s)
- Jinghai Gao
- Department of Obstetrics and Gynecology, Shanghai ChangZheng Hospital, Naval Medical University, Shanghai, 200003, People's Republic of China
| | - Jianhong Dang
- Department of Obstetrics and Gynecology, Shanghai ChangZheng Hospital, Naval Medical University, Shanghai, 200003, People's Republic of China
| | - Jing Chu
- Department of Obstetrics and Gynecology, Shanghai ChangZheng Hospital, Naval Medical University, Shanghai, 200003, People's Republic of China
| | - Xiaojun Liu
- Department of Obstetrics and Gynecology, Shanghai ChangZheng Hospital, Naval Medical University, Shanghai, 200003, People's Republic of China
| | - Jing Wang
- Department of Obstetrics and Gynecology, Shanghai ChangZheng Hospital, Naval Medical University, Shanghai, 200003, People's Republic of China
| | - Jiahao You
- Department of Obstetrics and Gynecology, Shanghai ChangZheng Hospital, Naval Medical University, Shanghai, 200003, People's Republic of China
| | - Zhijun Jin
- Department of Obstetrics and Gynecology, Shanghai ChangZheng Hospital, Naval Medical University, Shanghai, 200003, People's Republic of China
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Tanaka T, Ueda S, Miyamoto S, Terada S, Konishi H, Kogata Y, Fujiwara S, Tanaka Y, Taniguchi K, Komura K, Ohmichi M. Oncologic outcomes for patients with endometrial cancer who received minimally invasive surgery: a retrospective observational study. Int J Clin Oncol 2020; 25:1985-1994. [PMID: 32648131 DOI: 10.1007/s10147-020-01744-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/01/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laparoscopic hysterectomy has been performed for patients with endometrial cancer as minimally invasive surgery; however, the long-term outcomes of high-risk disease compared to open surgery remain unclear. METHODS Eight hundred and eighty-three patients with endometrial cancer who underwent laparoscopic or abdominal hysterectomy were categorized into three groups. Low-risk disease was defined as stage IA disease with endometrioid carcinoma of grade 1 or 2. Uterine-confined disease was defined as stage IA disease with high-grade tumors or stage IB and II disease. Advanced disease was defined as stage III or IV disease. The progression-free survival (PFS) and overall survival (OS) rates were compared between laparoscopic and laparotomic hysterectomy. RESULTS Among 478 patients with low-risk disease, including 226 with laparoscopy and 252 with laparotomy, the prognosis was not significantly different between the groups (3-year PFS rate, 97.4% vs. 97.1%, p = 0.8; 3-year OS rate, 98.6% vs. 98.3%, p = 0.9). Among the 229 patients with uterine-confined disease, including 51 with laparoscopy and 178 with laparotomy, the prognosis was not significantly different between the groups (3-year PFS rate, 90.5% vs. 85.5%, p = 0.7; 3-year OS rate, 91.3% vs. 92.5%, p = 0.8). Among the 176 patients with advanced disease, including 24 with laparoscopy and 152 with laparotomy, laparoscopic hysterectomy had a higher PFS rate and OS rate than laparotomic hysterectomy (3-year PFS rate, 74.5% vs. 51.5%, p = 0.01; 3-year OS rate, 92.3% vs. 75.1%, p = 0.03). CONCLUSIONS Laparoscopic procedures are not associated with a poorer outcome than laparotomy in patients with advanced endometrial cancer or uterine-confined endometrial cancer.
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Affiliation(s)
- Tomohito Tanaka
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
- Translational Research Program, Osaka Medical College, Takatsuki, Japan.
| | - Shoko Ueda
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Shunsuke Miyamoto
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Shinichi Terada
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Hiromi Konishi
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Yuhei Kogata
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Satoe Fujiwara
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Yoshimichi Tanaka
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Kohei Taniguchi
- Translational Research Program, Osaka Medical College, Takatsuki, Japan
| | - Kazumasa Komura
- Translational Research Program, Osaka Medical College, Takatsuki, Japan
| | - Masahide Ohmichi
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
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Tsuji S, Hori K, Tashima L, Yoshimura M, Ito K. Multiple metastases after laparoscopic surgery for early-stage endometrial cancer: A case report. Int J Surg Case Rep 2020; 76:552-556. [PMID: 33207430 PMCID: PMC7607062 DOI: 10.1016/j.ijscr.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/03/2020] [Accepted: 10/03/2020] [Indexed: 11/17/2022] Open
Abstract
Laparoscopic surgery is less invasive but leads to a peculiar recurrence pattern. Aspiration biopsy provides limited diagnostic accuracy in some cases. Preoperative histological diagnosis should always be confirmed with D&C. Preoperative recurrence risk might be underestimated. TLH associated with poor oncologic outcomes in moderate to high recurrence risk.
Introduction Laparoscopic surgery for early-stage endometrial cancer is associated with lower morbidity compared to open surgery and has comparable oncologic outcomes. We observed unexpected multiple metastases after laparoscopic surgery for endometrial cancer, the recurrence risk of which has previously been estimated to be low. Herein, we present this case and discuss the optimal management of endometrial cancer. Presentation of case A 58-year-old woman complaining of atypical genital bleeding lasting for 5 months was diagnosed with stage IA endometrioid carcinoma grade 1. According to our primary strategy, she underwent a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. The post-operative diagnosis was consistent with the pre-operative diagnosis. Since the recurrence risk was post-operatively revised to an intermediate level, she was administered adjuvant chemotherapy. However, multiple metastases were observed 4 months post-operatively, and despite treatment for recurrent disease, she died 2 months later. The uterine specimen was re-examined after the diagnosis of recurrence, and the post-operative diagnosis was revised to endometrioid carcinoma grade 3, indicating that her recurrence risk might have been underestimated. Discussion The multiple metastases observed in this case, including those in the subcutaneous tissue, were presumably caused by pneumoperitoneum. Aspiration biopsy was used to confirm the histological diagnosis pre-operatively. However, dilation and curettage would have been preferable, considering aspiration biopsy provides limited diagnostic accuracy in some cases. Laparoscopic surgery is less invasive; however, it leads to a peculiar recurrence pattern, which is sometimes difficult to assess pre-operatively. Conclusion Physicians should carefully consider indications for laparoscopic surgery for malignant diseases.
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Affiliation(s)
- Saori Tsuji
- Department of Obstetrics and Gynecology, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki City, Hyogo Prefecture, Japan.
| | - Kensuke Hori
- Department of Obstetrics and Gynecology, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki City, Hyogo Prefecture, Japan.
| | - Lena Tashima
- Department of Obstetrics and Gynecology, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki City, Hyogo Prefecture, Japan.
| | - Michiko Yoshimura
- Department of Pathology, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki City, Hyogo Prefecture, Japan.
| | - Kimihiko Ito
- Department of Obstetrics and Gynecology, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki City, Hyogo Prefecture, Japan.
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12
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Johansson CYM, Chan FKH. Robotic-assisted versus conventional laparoscopic hysterectomy for endometrial cancer. Eur J Obstet Gynecol Reprod Biol X 2020; 8:100116. [PMID: 32995747 PMCID: PMC7508988 DOI: 10.1016/j.eurox.2020.100116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 11/20/2022] Open
Abstract
Objective The safety and efficacy of robotic-assisted laparoscopic hysterectomy (RALH) compared with conventional total laparoscopic hysterectomy (TLH) for surgical staging of endometrial cancer has not been clearly established. With the commencement of a robotic program at our institution, our objective was to evaluate and compare the surgical outcomes of RALH with TLH for endometrial cancer. Methods A retrospective cohort study was performed on 39 patients who underwent RALH and 41 patients who underwent TLH for endometrial cancer at a tertiary care academic institution. Results In the setting of endometrial cancer RALH is significantly longer to perform than TLH (mean operating time 133 min vs 107 min, p = 0.0001). There is higher estimated blood loss in TLH cases than RALH cases (78 mL vs 22 mL, p = 0.015). Women who underwent RALH had a shorter length of stay (1.3 days vs 1.8 days, p = 0.006) than TLH patients, and six cases (15 %) of the RALH group were discharged on the same day of surgery. There were no differences between the RALH and TLH groups in intraoperative or postoperative complications and there were no conversions to laparotomy. Conclusion RALH is safe and feasible for the treatment of endometrial cancer, with low morbidity, less blood loss and shorter length of stay than TLH. RALH is associated with longer mean operating times than TLH and this may improve with enlisting a consistent experienced team. Prospective randomised studies which include analysis of quality of life measures and long-term outcomes are required to further establish the role of RALH in the surgical staging of endometrial cancer.
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Moss EL, Morgan G, Martin AP, Sarhanis P, Ind T. Surgical trends, outcomes and disparities in minimal invasive surgery for patients with endometrial cancer in England: a retrospective cohort study. BMJ Open 2020; 10:e036222. [PMID: 32938592 PMCID: PMC7497536 DOI: 10.1136/bmjopen-2019-036222] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To examine surgical outcomes and trends in the implementation of minimally invasive surgery (MIS) use for endometrial cancer (EC). DESIGN Retrospective cohort study. SETTING English National Health Service hospitals 2011-2017/2018. POPULATION 35 304 patients having a hysterectomy for EC identified from Hospital Episode Statistics. METHODS Univariate and multivariate analyses compared MIS to open hysterectomy (OH) by assessing the association between demographic, clinical and hospital characteristics by using logistic regression. A propensity score was created, to control for confounding factors including demographics, clinical and hospital characteristics, from a logistic regression which enabled the inverse probability weighting of treatment to be applied in order to compare outcomes of treatment. MAIN OUTCOME MEASURES The association between route of surgery on perioperative morbidity and mortality. RESULTS The MIS rate rose from 40.3% in 2011 to 68.7% in 2017/2018, however, there was significant geographical variation (p<0.001). The overall 90-day mortality was significantly higher with OH versus MIS (OR 0.34, 95% CI 0.18 to 0.62, p=0.0002). MIS rates were significantly lower in patients from the lowest socioeconomic group (LSEG) compared with patients from the highest group (HSEG) (55.4% vs 59.9%, p<0.01), and in the black population as compared with white and Asian populations (40.4% vs 58.6% and 56.0%, p<0.0001). When patients from LSEG and black patients were treated in hospitals with high MIS rates, the MIS rate increased close to that of the HSEG and white patients (81.0% and 74.1% vs 83.2% and 82.6%). CONCLUSIONS Further investigation is needed to understand the barriers to MIS and improve access so that as many patients as possible can benefit from the reduced morbidity/mortality associated with MIS.
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Affiliation(s)
- Esther L Moss
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | | | - Antony P Martin
- HCD Economics, Warrington, UK
- Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
| | - Panos Sarhanis
- Department of Gynaecology, North West London Hospitals NHS Trust, Harrow, UK
| | - Thomas Ind
- Department of Gynaecological Oncology, Royal Marsden Hospital NHS Trust, London, UK
- Department of Obstetrics and Gynaecology, St George's University of London, London, UK
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14
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Zanagnolo V, Baroni C, Achilarre MT, Aloisi A, Betella I, Bogliolo S, Garbi A, Maruccio M, Multinu F, Aletti G, Maggioni A. Oncologic Outcomes of Robotic Radical Hysterectomy (RRH) for Patients with Early-Stage Cervical Cancer: Experience at a Referral Cancer Center. Ann Surg Oncol 2020; 28:1819-1829. [PMID: 32860175 DOI: 10.1245/s10434-020-09016-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/26/2020] [Indexed: 01/23/2023]
Abstract
PURPOSE To evaluate oncologic outcomes of early stage cervical cancer patients who underwent robotic radical hysterectomy (RRH) in a referral center, a retrospective analysis was performed. METHODS From January 2010 to December 2018, medical records of stage IA2-IIA1 cervical cancer patients, who underwent radical hysterectomy at our institute, were retrospectively reviewed. We focused our analysis on those who underwent RRH. RESULTS A total of 198 patients were included in the final analysis. Median follow up was 52 months. At last follow-up, 188 (94.9%) women were disease-free, 9 (4.5%) had died, and 1 (0.5%) was alive with recurrent disease. At 4.5 years, PFS was 93.1% (SE ± 2.1) and OS was 95.1% (SE ± 1.8). Stratified by tumor size, PFS for tumor < 2 cm versus tumor ≥ 2 cm was statistically different (96.8% ± 2.3 and 87.9% ± 4.1 respectively, p = 0.01), as well as OS (100% and 89.8% ± 40 respectively, p = 0.01).Stratified by evidence of tumor at time of robotic surgery, PFS was statistically different in women with no residual tumor after conisation versus those with residual disease (100% ± 2.5 and 90.8% ± 2.8 respectively, p = 0.04). A recurrence occurred in 11 patients (5.6%). CONCLUSIONS Based on our results, we could speculate that robotic approach, along with some technical precautions to avoid spillage, might be safe as primary treatment of early-stage cervical cancer, especially for tumor < 2 cm and in case of no evidence of disease at time of radical hysterectomy after previous conisation.
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Affiliation(s)
- Vanna Zanagnolo
- Department of Gynecology Oncology, Robotic Gynecologic Cancer Surgery Unit, IEO, European Institute of Oncology IRCCS, Milan, 20141, Milan, Italy.
| | - Clara Baroni
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
| | - Maria Teresa Achilarre
- Department of Gynecology Oncology, Robotic Gynecologic Cancer Surgery Unit, IEO, European Institute of Oncology IRCCS, Milan, 20141, Milan, Italy
| | - Alessia Aloisi
- Department of Gynecology Oncology, Robotic Gynecologic Cancer Surgery Unit, IEO, European Institute of Oncology IRCCS, Milan, 20141, Milan, Italy
| | - Ilaria Betella
- Department of Gynecology Oncology, Robotic Gynecologic Cancer Surgery Unit, IEO, European Institute of Oncology IRCCS, Milan, 20141, Milan, Italy
| | - Stefano Bogliolo
- Department of Gynecology Oncology, Robotic Gynecologic Cancer Surgery Unit, IEO, European Institute of Oncology IRCCS, Milan, 20141, Milan, Italy
| | - Annalisa Garbi
- Department of Gynecology Oncology, Robotic Gynecologic Cancer Surgery Unit, IEO, European Institute of Oncology IRCCS, Milan, 20141, Milan, Italy
| | - Matteo Maruccio
- Department of Gynecology Oncology, Robotic Gynecologic Cancer Surgery Unit, IEO, European Institute of Oncology IRCCS, Milan, 20141, Milan, Italy
| | - Francesco Multinu
- Department of Gynecology Oncology, Robotic Gynecologic Cancer Surgery Unit, IEO, European Institute of Oncology IRCCS, Milan, 20141, Milan, Italy
| | - Giovanni Aletti
- Department of Gynecology Oncology, Robotic Gynecologic Cancer Surgery Unit, IEO, European Institute of Oncology IRCCS, Milan, 20141, Milan, Italy
| | - Angelo Maggioni
- Department of Gynecology Oncology, Robotic Gynecologic Cancer Surgery Unit, IEO, European Institute of Oncology IRCCS, Milan, 20141, Milan, Italy
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15
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Comparison of Laparoscopy and Laparotomy in Early-Stage Endometrial Cancer: Early Experiences from a Developing Country. JOURNAL OF ONCOLOGY 2020; 2020:2157520. [PMID: 32411233 PMCID: PMC7210537 DOI: 10.1155/2020/2157520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 03/03/2020] [Accepted: 04/16/2020] [Indexed: 11/17/2022]
Abstract
After minimally invasive surgery gained popularity in gynecology, laparoscopic operations became widespread among oncologic operations. However, more studies evaluating experiences of oncologic surgeons during the learning period of laparoscopy are needed. To compare the surgical outcomes and perioperative complications of laparoscopic surgery and laparotomy in the treatment of early-stage endometrioid endometrial cancer patients, we retrospectively investigated patients who underwent surgery due to endometrial cancer at our institution between 2014 and 2018. Early-stage (stage I) endometrioid endometrial cancer patients were included in the study. Operative times, length of hospital stay, extracted pelvic lymph nodes, perioperative complications, and blood loss were compared. A total of 128 patients were treated for stage I endometrial cancer during the study period. Sixty-two patients (48.4%) underwent laparoscopic surgery, and 66 (51.6%) patients underwent laparotomy. Median operation time and pelvic lymph node count in the laparotomy and laparoscopy groups did not demonstrate statistically significant differences. However, the length of hospital stay, estimated blood loss, and perioperative complication rate were lower in the laparoscopic surgery group. Laparoscopic surgery in early-stage endometrial cancer may be performed with less blood loss, shorter duration of hospital stays, and similar lymph node counts compared to laparotomic surgery.
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16
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Nasioudis D, Frey MK, Chapman-Davis E, Caputo TA, Holcomb K. Outcomes of minimally invasive surgery for patients with endometrial carcinoma involving the cervix. Int J Gynecol Cancer 2020; 30:619-625. [PMID: 32276935 DOI: 10.1136/ijgc-2019-001023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/09/2020] [Accepted: 01/14/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Most studies evaluating the oncologic safety of minimally invasive surgery for endometrial cancer focus on patients with stage I disease. The aim of this study was to investigate the outcomes of minimally invasive surgery for patients with endometrial carcinoma involving the cervix. METHODS Patients diagnosed between January 2010 and December 2015, with clinical stage II endometrial carcinoma, who underwent hysterectomy with lymphadenectomy, were drawn from the National Cancer Database. Inclusion criteria were clinical International Federation of Gynecology and Obstetrics (FIGO 2009) stage II, patients who underwent hysterectomy with lymphadenectomy, and known route of surgery (open or minimally invasive). Patients who received radiation therapy prior to surgery, those who had subtotal/supracervical hysterectomy, or unknown type of hysterectomy were excluded. The exposure of interest was performance of minimally invasive surgery either laparoscopic or robotic-assisted. Overall survival (primary endpoint) was assessed for patients diagnosed between January 2010 and December 2014 following generation of Kaplan-Meier curves and compared with the log-rank test. A Cox model was constructed to control for confounders. RESULTS A total of 2175 patients were identified and 1282 (58.9%) had minimally invasive surgery. Of these, 339 and 943 patients had laparoscopic or robotic-assisted laparoscopic hysterectomy, respectively. Minimally invasive surgery was converted to open surgery in 74 (5.8%) patients. Those undergoing minimally invasive surgery had shorter hospital stay (median 1 vs 3 days, p<0.001), lower unplanned readmission rate (2.7% vs 4.7%, p=0.014), and 90-day mortality (0.8% vs 1.8%, p=0.05). Patients who had open surgery (n=796) had worse overall survival compared with those who had minimally invasive surgery (n=1048, p=0.003); 3-year overall survival rates were 76.8% and 83.6%, respectively. After controlling for patient age, race, type of insurance, presence of co-morbidities, performance of extensive lymphadenectomy, presence of positive lymph nodes, tumor histology, presence of lymphovascular space invasion, tumor size, and administration of radiotherapy, performance of minimally invasive surgery was not associated with worse survival (HR 0.90, 95% CI 0.73 to 1.11). CONCLUSIONS In this retrospective analysis, minimally invasive surgery in patients with stage II endometrial carcinoma was associated with superior short-term peri-operative outcomes and improved 3-year overall survival.
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Affiliation(s)
- Dimitrios Nasioudis
- Division of Gynecologic Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Melissa K Frey
- Division of Gynecologic Oncology, Weill Cornell Medical College, New York, New York, USA
| | - Eloise Chapman-Davis
- Division of Gynecologic Oncology, Weill Cornell Medical College, New York, New York, USA
| | - Thomas A Caputo
- Division of Gynecologic Oncology, Weill Cornell Medical College, New York, New York, USA
| | - Kevin Holcomb
- Division of Gynecologic Oncology, Weill Cornell Medical College, New York, New York, USA
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Society of gynecologic oncology future of physician payment reform task force: Lessons learned in developing and implementing surgical alternative payment models. Gynecol Oncol 2020; 156:701-709. [PMID: 31916980 DOI: 10.1016/j.ygyno.2019.12.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/23/2019] [Indexed: 11/24/2022]
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18
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Jiang Y, Jia N, Zhu M, He Y, Che X, Lv T, Feng W. Comparison of survival and perioperative outcomes following simple and radical hysterectomy for stage II endometrial cancer: a single-institution, retrospective, matched-pair analysis. J Int Med Res 2019; 47:4469-4481. [PMID: 31357882 PMCID: PMC6753566 DOI: 10.1177/0300060519863190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective We aimed to compare the survival and perioperative outcomes of patients with
stage II endometrial cancer (EC) undergoing simple hysterectomy (SH) or
radical hysterectomy (RH), to validate the various guidelines. Methods A total of 155 consecutive patients diagnosed with stage II EC from 2000 to
2014 were reviewed. We identified 40 pairs of patients (40 SH and 40 RH) who
were matched in terms of age, pathological type, and lymphovascular space
invasion status using matched-pair analysis. Patient data were collected
from medical records and outcomes were determined by telephone
follow-up. Results Among the 80 patients in the two groups, seven died from tumor recurrence.
However, cancer-related survival rates were not significantly different
between the SH and RH groups. The 3-year cancer-related survival rates in
the SH and RH groups were 94.97% and 92.53%, and the 5-year survival rates
were 92.40% and 90.03%, respectively. Regarding perioperative outcomes, the
SH group had significantly less intraoperative bleeding and a significantly
shorter catheter-indwelling time than the RH group. Conclusions SH provides similar survival outcomes and a superior perioperative quality of
life compared with RH in patients with stage II EC.
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Affiliation(s)
- Yahui Jiang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Nan Jia
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Menghan Zhu
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Yuan He
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Xiaoxia Che
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Tianjiao Lv
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Weiwei Feng
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Department of Gynecology and Obstetrics, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
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Monterossi G, Buca D, Dinoi G, La Fera E, Zannoni GF, Spadola S, Scambia G, Fanfani F. Intra-operative assessment of sentinel lymph node status by one-step nucleic acid amplification assay (OSNA) in early endometrial cancer: a prospective study. Int J Gynecol Cancer 2019; 29:1016-1020. [PMID: 31175137 DOI: 10.1136/ijgc-2018-000113] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/26/2019] [Accepted: 04/01/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Sentinel node mapping has been proposed to reduce surgical side effects, maintaining the accuracy in nodal status assessment for endometrial cancer. OBJECTIVE To investigate the role of one-step nucleic acid amplification assay (OSNA) analysis, in the intra-operative tailoring of full nodal dissection, and to analyze the correlation between the type of sentinel node metastasis and the risk of non-sentinel node metastasis. METHODS Surgical and pathological data were collected from 141 consecutive, clinical stage I patients with endometrial cancer undergoing surgical staging. Patients were excluded if they had previous pelvic or abdominal radiotherapy, chemotherapy, abdominal cancer, pelvic or abdominal lymphadenectomy, or contraindications to indocyanine green. All sentinel nodes were analyzed by OSNA, and full lymphadenectomy was performed in positive cases. Statistical analysis was performed using Χ2 and Fisher's exact test to determine whether any of these characteristics could accurately predict the non-sentinel nodes status in positive sentinel node patients. RESULTS A total of 141 patients were included in the analysis. Bilateral sentinel nodes were identified in 104 (73.8%) patients, with a median number of 2 (range 2-6) sentinel nodes per patient. In the remaining 37 patients (26.2%), a unilateral sentinel node was obtained, with a median of 1 (range 1-3) sentinel node per patient. Thirty-three (12.0%) positive nodes were found in 24 (17.0%) patients: micro-metastases and macro-metastases were detected in 22 and 2 patients, respectively. At final pathology, all patients with positive non-sentinel nodes had macro-metastases in the sentinel node, whereas in micro-metastatic sentinel nodes no other positive nodes were found at full lymphadenectomy (p<0.001). CONCLUSIONS Our results showed a correlation between the type of metastasis in the sentinel lymph node (SLN) and the incidence of positive non-SLNs. These data suggest a potential role of OSNA analysis in the surgical tailoring of patients with early endometrial cancer, with the goal of definitive risk stratification and a better individualization of adjuvant therapy.
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Affiliation(s)
| | - Danilo Buca
- Università degli Studi Gabriele d'Annunzio Chieti e Pescara Dipartimento di Scienze, Chieti Scalo, Italy
| | - Giorgia Dinoi
- Policlinico Universitario Agostino Gemelli, Roma, Italy
| | | | | | | | - Giovanni Scambia
- Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Policlinico Universitario Agostino Gemelli, Roma, Italy
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Jørgensen SL, Mogensen O, Wu C, Lund K, Iachina M, Korsholm M, Jensen PT. Nationwide Introduction of Minimally Invasive Robotic Surgery for Early-Stage Endometrial Cancer and Its Association With Severe Complications. JAMA Surg 2019; 154:530-538. [PMID: 30810740 PMCID: PMC6584253 DOI: 10.1001/jamasurg.2018.5840] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 11/23/2018] [Indexed: 01/11/2023]
Abstract
Importance Minimally invasive laparoscopic surgery (MILS) for endometrial cancer reduces surgical morbidity compared with a total abdominal hysterectomy. However, only a minority of women with early-stage endometrial cancer undergo MILS. Objective To evaluate the association between the Danish nationwide introduction of minimally invasive robotic surgery (MIRS) and severe complications in patients with early-stage endometrial cancer. Design, Setting, and Participants In this nationwide prospective cohort study of 5654 women with early-stage endometrial cancer who had undergone surgery during the period from January 1, 2005, to June 30, 2015, data from the Danish Gynecological Cancer Database were linked with national registers on socioeconomic status, deaths, hospital diagnoses, and hospital treatments. The women were divided into 2 groups; group 1 underwent surgery before the introduction of MIRS in their region, and group 2 underwent surgery after the introduction of MIRS. Women with an unknown disease stage, an unknown association with MIRS implementation, unknown histologic findings, sarcoma, or synchronous cancer were excluded, as were women who underwent vaginal or an unknown surgical type of hysterectomy. Statistical analysis was conducted from February 2, 2017, to May 4, 2018. Exposure Minimally invasive robotic surgery, MILS, or total abdominal hysterectomy. Main Outcomes and Measures Severe complications were dichotomized and encompassed death within 30 days after surgery and intraoperative and postoperative complications diagnosed within 90 days after surgery. Results A total of 3091 women (mean [SD] age, 67 [10] years) were allocated to group 1, and a total of 2563 women (mean [SD] age, 68 [10] years) were allocated to group 2. In multivariate logistic regression analyses, the odds of severe complications were significantly higher in group 1 than in group 2 (odds ratio [OR], 1.39; 95% CI, 1.11-1.74). The proportion of women undergoing MILS was 14.1% (n = 436) in group 1 and 22.2% in group 2 (n = 569). The proportion of women undergoing MIRS in group 2 was 50.0% (n = 1282). In group 2, multivariate logistic regression analyses demonstrated that a total abdominal hysterectomy was associated with increased odds of severe complications compared with MILS (OR, 2.58; 95% CI, 1.80-3.70) and MIRS (OR, 3.87; 95% CI, 2.52-5.93). No difference was found for MILS compared with MIRS (OR, 1.50; 95% CI, 0.99-2.27). Conclusions and Relevance The national introduction of MIRS changed the surgical approach for early-stage endometrial cancer from open surgery to minimally invasive surgery. This change in surgical approach was associated with a significantly reduced risk of severe complications.
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Affiliation(s)
- Siv Lykke Jørgensen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- Faculty of Health Sciences, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Ole Mogensen
- Faculty of Health Sciences, Clinical Institute, University of Southern Denmark, Odense, Denmark
- Department of Pelvic Cancer, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Chunsen Wu
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Faculty of Health Sciences, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Ken Lund
- Centre for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Maria Iachina
- Centre for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Malene Korsholm
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- Faculty of Health Sciences, Clinical Institute, University of Southern Denmark, Odense, Denmark
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Pernille Tine Jensen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Faculty of Health Sciences, Clinical Institute, University of Southern Denmark, Odense, Denmark
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Liu Z, Tian S, Yan Z, Yu X, Li X, Tao Y. Robotic single-site surgery for mature cyst teratoma cystectomy: an initial case series study in a single medical center in China. Ther Clin Risk Manag 2019; 15:179-185. [PMID: 30774353 PMCID: PMC6353228 DOI: 10.2147/tcrm.s176852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To report the first case series of robotic single-site (RSS) surgery via the da Vinci Si Surgical System for mature cyst teratoma cystectomy in China. Materials and methods The study was devised as a retrospective study in a single medical center. Five patients with mature cyst teratomas requested a minimally invasive surgical treatment. These patients were treated with RSS surgery for mature cyst teratoma between January 2014 and January 2015. RSS mature cyst teratoma cystectomies were performed with the da Vinci single-site platform in the Hainan branch of PLA General Hospital. Data regarding patient characteristics, surgical approach, and perioperative clinical outcomes were collected and analyzed in a retrospective study. Results All RSS procedures were completed successfully in the five patients. No instrument failure was noted during the procedures. The median operating time was 65 minutes (range 45–100 minutes). The median docking time was 20 minutes (range 18–28 minutes). No instrument failure was noted during any surgical procedures. The median blood loss was 30 mL (range 10–70 mL). No patient had massive intraoperative bleeding nor required a transfusion. No extra trocar was placed during the surgery. None of the patients had bladder or rectal injury. The median length of stay in hospital was 2.8 days. All patients were followed up until 6 months postoperatively, and no surgical complication occurred. Conclusion RSS mature cyst teratoma cystectomy using the wristed semirigid instrumentation is feasible. Randomized controlled trials with a larger number of patients and longer postoperative follow-up should be conducted to further evaluate the effect of this therapeutic strategy.
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Affiliation(s)
- Zhongyu Liu
- Department of Obstetrics and Gynecology, PLA General Hospital, Beijing 100853, PR China,
| | - Shuang Tian
- Department of Obstetrics and Gynecology, PLA General Hospital, Beijing 100853, PR China,
| | - Zhifeng Yan
- Department of Obstetrics and Gynecology, PLA General Hospital, Beijing 100853, PR China,
| | - Xiurong Yu
- Department of Anesthesia Surgery Center, Hainan Branch of PLA General Hospital, Sanya 572013, PR China
| | - Xiuli Li
- Department of Obstetrics and Gynecology, PLA General Hospital, Beijing 100853, PR China, .,Department of Obstetrics and Gynecology, Hainan Branch of PLA General Hospital, Sanya 572013, PR China,
| | - Ye Tao
- Department of Ophthalmology, PLA General Hospital, Beijing 100853, PR China,
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Emons G, Steiner E, Vordermark D, Uleer C, Bock N, Paradies K, Ortmann O, Aretz S, Mallmann P, Kurzeder C, Hagen V, van Oorschot B, Höcht S, Feyer P, Egerer G, Friedrich M, Cremer W, Prott FJ, Horn LC, Prömpeler H, Langrehr J, Leinung S, Beckmann MW, Kimmig R, Letsch A, Reinhardt M, Alt-Epping B, Kiesel L, Menke J, Gebhardt M, Steinke-Lange V, Rahner N, Lichtenegger W, Zeimet A, Hanf V, Weis J, Mueller M, Henscher U, Schmutzler RK, Meindl A, Hilpert F, Panke JE, Strnad V, Niehues C, Dauelsberg T, Niehoff P, Mayr D, Grab D, Kreißl M, Witteler R, Schorsch A, Mustea A, Petru E, Hübner J, Rose AD, Wight E, Tholen R, Bauerschmitz GJ, Fleisch M, Juhasz-Boess I, Lax S, Runnebaum I, Tempfer C, Nothacker MJ, Blödt S, Follmann M, Langer T, Raatz H, Wesselmann S, Erdogan S. Interdisciplinary Diagnosis, Therapy and Follow-up of Patients with Endometrial Cancer. Guideline (S3-Level, AWMF Registry Number 032/034-OL, April 2018) - Part 2 with Recommendations on the Therapy and Follow-up of Endometrial Cancer, Palliative Care, Psycho-oncological/Psychosocial Care/Rehabilitation/Patient Information and Healthcare Facilities. Geburtshilfe Frauenheilkd 2018; 78:1089-1109. [PMID: 30581199 PMCID: PMC6261739 DOI: 10.1055/a-0715-2964] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 08/23/2018] [Accepted: 08/23/2018] [Indexed: 01/27/2023] Open
Abstract
Summary The first German interdisciplinary S3-guideline on the diagnosis, therapy and follow-up of patients with endometrial cancer was published in April 2018. Funded by German Cancer Aid as part of an Oncology Guidelines Program, the lead coordinators of the guideline were the German Society of Gynecology and Obstetrics (DGGG) and the Gynecological Oncology Working Group (AGO) of the German Cancer Society (DKG). Purpose Using evidence-based, risk-adapted therapy to treat low-risk women with endometrial cancer avoids unnecessarily radical surgery and non-useful adjuvant radiotherapy and/or chemotherapy. This can significantly reduce therapy-induced morbidity and improve the patient's quality of life as well as avoiding unnecessary costs. For women with endometrial cancer and a high risk of recurrence, the guideline defines the optimal extent of surgical radicality together with the appropriate chemotherapy and/or adjuvant radiotherapy if required. An evidence-based optimal use of different therapeutic modalities should improve the survival rates and quality of life of these patients. This S3-guideline on endometrial cancer is intended as a basis for certified gynecological cancer centers. The aim is that the quality indicators established in this guideline will be incorporated in the certification processes of these centers. Methods The guideline was compiled in accordance with the requirements for S3-level guidelines. This includes, in the first instance, the adaptation of source guidelines selected using the DELBI instrument for appraising guidelines. Other consulted sources included reviews of evidence, which were compiled from literature selected during systematic searches of literature databases using the PICO scheme. In addition, an external biostatistics institute was commissioned to carry out a systematic search and assessment of the literature for one part of the guideline. Identified materials were used by the interdisciplinary working groups to develop suggestions for Recommendations and Statements, which were then subsequently modified during structured consensus conferences and/or additionally amended online using the DELPHI method, with consent between members achieved online. The guideline report is freely available online. Recommendations Part 2 of this short version of the guideline presents recommendations for the therapy of endometrial cancer including precancers and early endometrial cancer as well as recommendations on palliative medicine, psycho-oncology, rehabilitation, patient information and healthcare facilities to treat endometrial cancer. The management of precancers of early endometrial precancerous conditions including fertility-preserving strategies is presented. The concept used for surgical primary therapy of endometrial cancer is described. Radiotherapy and adjuvant medical therapy to treat endometrial cancer and uterine carcinosarcomas are described. Recommendations are given for the follow-up care of endometrial cancer, recurrence and metastasis. Palliative medicine, psycho-oncology including psychosocial care, and patient information and rehabilitation are presented. Finally, the care algorithm and quality assurance steps for the diagnosis, therapy and follow-up of patients with endometrial cancer are outlined.
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Affiliation(s)
- Günter Emons
- Klinik für Gynäkologie und Geburtshilfe, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Eric Steiner
- Frauenklinik, GPR Klinikum Rüsselsheim am Main, Rüsselsheim, Germany
| | - Dirk Vordermark
- Radiotherapy, Universität Halle (Saale), Halle (Saale), Germany
| | - Christoph Uleer
- Facharzt für Frauenheilkunde und Geburtshilfe, Hildesheim, Germany
| | - Nina Bock
- Klinik für Gynäkologie und Geburtshilfe, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Kerstin Paradies
- Konferenz Onkologischer Kranken- und Kinderkrankenpflege, Hamburg, Germany
| | - Olaf Ortmann
- Frauenheilkunde und Geburtshilfe, Universität Regensburg, Regensburg, Germany
| | - Stefan Aretz
- Institut für Humangenetik, Universität Bonn, Zentrum für erbliche Tumorerkrankungen, Universitätsklinikum Bonn, Bonn, Germany
| | | | | | - Volker Hagen
- Klinik für Innere Medizin II, St.-Johannes-Hospital Dortmund, Germany
| | - Birgitt van Oorschot
- Interdisziplinäres Zentrum Palliativmedizin, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Stefan Höcht
- Xcare, Praxis für Strahlentherapie, Saarlouis, Germany
| | - Petra Feyer
- Klinik für Strahlentherapie und Radioonkologie, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Gerlinde Egerer
- Zentrum für Innere Medizin, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | | | | | | | - Heinrich Prömpeler
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Jan Langrehr
- Klinik für Allgemein-, Gefäß- und Viszeralchirurgie, Martin-Luther-Krankenhaus, Berlin, Germany
| | | | | | - Rainer Kimmig
- Women's Department, University Hospital of Essen, Essen, Germany
| | - Anne Letsch
- Medizinische Klinik mit Schwerpunkt Hämatologie und Onkologie, Charité, Campus Benjamin Franklin, Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Reinhardt
- Klinik für Nuklearmedizin, Pius Hospital Oldenburg, Oldenburg, Germany
| | - Bernd Alt-Epping
- Klinik für Palliativmedizin, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Ludwig Kiesel
- Obstetrics and Gynecology, Reproductive Medicine, University of Muenster, Muenster, Germany
| | - Jan Menke
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Marion Gebhardt
- Frauenselbsthilfe nach Krebs e. V., Erlangen, Erlangen/Forchheim, Germany
| | - Verena Steinke-Lange
- MGZ - Medizinisch Genetisches Zentrum, München und Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, München, Germany
| | - Nils Rahner
- Institut für Humangenetik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Werner Lichtenegger
- Frauenklinik Charité, Campus Virchow-Klinikum, Universitätsmedizin Berlin, Berlin, Germany
| | - Alain Zeimet
- Frauenheilkunde, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Volker Hanf
- Frauenklinik Nathanstift - Klinikum Fürth, Fürth, Germany
| | - Joachim Weis
- Stiftungsprofessur Selbsthilfeforschung, Tumorzentrum/CCC Freiburg, Universitätsklinikum Freiburg, Freiburg, Germany
| | - Michael Mueller
- Universitätsklinik für Frauenheilkunde, Inselspital Bern, Bern, Switzerland
| | | | - Rita K Schmutzler
- Center for Familial Breast and Ovarian Cancer, University Hospital of Cologne, Cologne, Germany
| | - Alfons Meindl
- Frauenklinik am Klinikum rechts der Isar, München, Germany
| | - Felix Hilpert
- Mammazentrum, Krankenhaus Jerusalem, Hamburg, Germany
| | - Joan Elisabeth Panke
- Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e. V., Essen, Germany
| | - Vratislav Strnad
- Strahlenklinik, Universitätsklinikum Erlangen, CCC ER-EMN, Universitäts-Brustzentrum Franken, Erlangen, Germany
| | | | - Timm Dauelsberg
- Winkelwaldklinik Nordrach, Fachklinik für onkologische Rehabilitation, Nordrach, Germany
| | - Peter Niehoff
- Strahlenklinik, Sana Klinikum Offenbach, Offenbach, Germany
| | - Doris Mayr
- Pathologisches Institut, LMU München, München, Germany
| | - Dieter Grab
- Frauenklinik Klinikum Harlaching, München, Germany
| | - Michael Kreißl
- Klinik für Radiologie und Nuklearmedizin, Universitätsklinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | - Ralf Witteler
- Obstetrics and Gynecology, Reproductive Medicine, University of Muenster, Muenster, Germany
| | | | | | - Edgar Petru
- Frauenheilkunde, Med. Univ. Graz, Graz, Austria
| | - Jutta Hübner
- Klinikum für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany
| | | | - Edward Wight
- Frauenklinik des Universitätsspitals Basel, Basel, Switzerland
| | - Reina Tholen
- Deutscher Verband für Physiotherapie, Referat Bildung und Wissenschaft, Köln, Germany
| | - Gerd J Bauerschmitz
- Klinik für Gynäkologie und Geburtshilfe, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Markus Fleisch
- Landesfrauenklinik, HELIOS Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - Ingolf Juhasz-Boess
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Saar, Germany
| | - Sigurd Lax
- Institut für Pathologie, Landeskrankenhaus Graz West, Graz, Austria
| | | | - Clemens Tempfer
- Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Herne, Germany
| | | | | | - Markus Follmann
- Deutsche Krebsgesellschaft, Office des Leitlinienprogrammes Onkologie, Berlin, Germany
| | - Thomas Langer
- Deutsche Krebsgesellschaft, Office des Leitlinienprogrammes Onkologie, Berlin, Germany
| | - Heike Raatz
- Institut für Klinische Epidemiologie & Biostatistik (CEB), Basel, Switzerland
| | | | - Saskia Erdogan
- Klinik für Gynäkologie und Geburtshilfe, Universitätsmedizin Göttingen, Göttingen, Germany
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Bruintjes MH, Albers KI, Gurusamy KS, Rovers MM, van Laarhoven CJHM, Warle MC. Deep neuromuscular blockade in adults undergoing an abdominal laparoscopic procedure. Hippokratia 2018. [DOI: 10.1002/14651858.cd013197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Moira H Bruintjes
- Radboud University Nijmegen Medical Center; Department of Surgery; Geert Grooteplein Zuid 10 Nijmegen Netherlands 6525 GA
| | - Kim I Albers
- Radboud University Nijmegen Medical Centre; Department of Anesthesiology; Nijmegen Netherlands
| | - Kurinchi Selvan Gurusamy
- University College London; Division of Surgery and Interventional Science; 9th Floor, Royal Free Hospital Rowland Hill Street London UK NW3 2PF
| | - Maroeska M Rovers
- Radboud University Nijmegen Medical Centre; Department of Operating Rooms; Hp 630, route 631 PO Box 9101 Nijmegen Netherlands 6500 HB
| | - Cornelis JHM van Laarhoven
- Radboud University Nijmegen Medical Centre; Department of Surgery; PO Box 9101 internal code 618 Nijmegen Netherlands 6500 HB
| | - Michiel C Warle
- Radboud University Nijmegen Medical Center; Department of Surgery; Geert Grooteplein Zuid 10 Nijmegen Netherlands 6525 GA
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Vardar MA, Gulec UK, Guzel AB, Gumurdulu D, Khatib G, Seydaoglu G. Laparoscopic surgery for low, intermediate and high-risk endometrial cancer. J Gynecol Oncol 2018; 30:e24. [PMID: 30740955 PMCID: PMC6393633 DOI: 10.3802/jgo.2019.30.e24] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/05/2018] [Accepted: 11/09/2018] [Indexed: 12/13/2022] Open
Abstract
Objective The aim of the present study was to compare the long-term outcomes of the laparotomy (LT) and laparoscopic surgery and to evaluate the results according to low, intermediate, and high-risk groups of endometrial cancer (EC). Methods We identified 801 patients with EC and these patients were classified as group 1, who underwent LT (n=515); and group 2, who underwent laparoscopy (LS) (n=286). Patient's demographics, clinical characteristics such as stage, grade, histopathologic type, lymphovascular space invasion, myometrial invasion, lymph node involvement, and risk groups, peri- and post-operative outcomes, and survival outcomes were compared between the groups according to risk classification. Survival outcomes were assessed using Kaplan-Meier method. Results The demographic characteristics of both groups were similar except age. Shorter hospital stay and fewer complications were observed in group 2. The overall survival (OS) were similar in the low, low-intermediate, high-intermediate and high-risk groups (p=0.269, 0.476, 0.078, and 0.085; respectively) for LS compared to LT. The covariate analysis revealed that the death and recurrence risks were approximately twice higher in the LT group than in the LS group (odds ratio [OR]=1.9; 95% confidence interval [CI]=1.2–3.1 for OS; OR=2.0; 95% CI=1.2–3.3 for disease-free survival). Conclusion The results of our study support the well-known positive aspects of LS as well as safe and effective use in cases of intermediate and high-risk EC.
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Affiliation(s)
- Mehmet Ali Vardar
- Department of Obstetrics and Gynecology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Umran Kucukgoz Gulec
- Department of Obstetrics and Gynecology, Cukurova University Faculty of Medicine, Adana, Turkey.
| | - Ahmet Baris Guzel
- Department of Obstetrics and Gynecology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Derya Gumurdulu
- Department of Pathology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ghanim Khatib
- Department of Obstetrics and Gynecology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Gulsah Seydaoglu
- Department of Biostatistics, Cukurova University Faculty of Medicine, Adana, Turkey
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Nieto VL, Huang Y, Hou JY, Tergas AI, St. Clair CM, Ananth CV, Neugut AI, Hershman DL, Wright JD. Use and outcomes of minimally invasive hysterectomy for women with nonendometrioid endometrial cancers. Am J Obstet Gynecol 2018; 219:463.e1-463.e12. [PMID: 30086293 DOI: 10.1016/j.ajog.2018.07.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Minimally invasive hysterectomy is now used routinely for women with uterine cancer. Most studies of minimally invasive surgery for endometrial cancer have focused on low-risk endometrioid tumors, with few reports of the safety of the procedure for women with higher risk histologic subtypes. OBJECTIVE The purpose of this study was to examine the use of and survival associated with minimally invasive hysterectomy for women with uterine cancer and high-risk histologic subtypes. STUDY DESIGN We used the National Cancer Database to identify women with stages I-III uterine cancer who underwent hysterectomy from 2010-2014. Women with serous carcinomas, clear cell carcinomas, and sarcomas were examined. Women who had laparoscopic or robotic-assisted hysterectomy were compared with those who underwent open abdominal hysterectomy. After a propensity score inverse probability of treatment weighted analysis, the effect of minimally invasive hysterectomy on overall, 30-day, and 90-day mortality rates was examined for each histologic subtype of uterine cancer. RESULTS Of 94,507 patients who were identified, 64,417 patients (68.2%) underwent minimally invasive hysterectomy. Among women with endometrioid tumors (n=81,115), 70.8% underwent minimally invasive hysterectomy. The rates of minimally invasive surgery in those women with nonendometrioid tumors (n=13,392) was 57.6% for serous carcinomas, 57.0% for clear cell tumors, 47.3% for sarcomas, 32.2% for leiomyosarcomas, 47.9% for stromal sarcomas, and 48.5% for carcinosarcomas. Performance of minimally invasive surgery increased across all histologic subtypes between 2010 and 2014. For nonendometrioid subtypes, robotic-assisted procedures accounted for 47.9-75.7% of minimally invasive hysterectomies by 2014. In a multivariable model, women with nonendometrioid tumors were less likely to undergo minimally invasive surgery than those with endometrioid tumors (P<.05). There was no association between route of surgery and 30-day, 90-day, or overall mortality rates for any of the nonendometrioid histologic subtypes. CONCLUSION The use of minimally invasive surgery is increasing rapidly for women with stage I-III nonendometrioid uterine tumors. Performance of minimally invasive surgery does not appear to impact survival adversely.
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Silva ASE, de Carvalho JPM, Anton C, Fernandes RP, Baracat EC, Carvalho JP. Introduction of robotic surgery for endometrial cancer into a Brazilian cancer service: a randomized trial evaluating perioperative clinical outcomes and costs. Clinics (Sao Paulo) 2018; 73:e522s. [PMID: 30281698 PMCID: PMC6131215 DOI: 10.6061/clinics/2017/e522s] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/04/2018] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the clinical outcome and costs after the implementation of robotic surgery in the treatment of endometrial cancer, compared to the traditional laparoscopic approach. METHODS In this prospective randomized study from 2015 to 2017, eighty-nine patients with endometrial carcinoma that was clinically restricted to the uterus were randomized in robotic surgery (44 cases) and traditional laparoscopic surgery (45 cases). We compared the number of retrieved lymph nodes, total time of surgery, time of each surgical step, blood loss, length of hospital stay, major and minor complications, conversion rates and costs. RESULTS The ages of the patients ranged from 47 to 69 years. The median body mass index was 31.1 (21.4-54.2) in the robotic surgery arm and 31.6 (22.9-58.6) in the traditional laparoscopic arm. The median tumor sizes were 4.0 (1.5-10.0) cm and 4.0 (0.0-9.0) cm in the robotic and traditional laparoscopic surgery groups, respectively. The median total numbers of lymph nodes retrieved were 19 (3-61) and 20 (4-34) in the robotic and traditional laparoscopic surgery arms, respectively. The median total duration of the whole procedure was 319.5 (170-520) minutes in the robotic surgery arm and 248 (85-465) minutes in the traditional laparoscopic arm. Eight major complications were registered in each group. The total cost was 41% higher for robotic surgery than for traditional laparoscopic surgery. CONCLUSIONS Robotic surgery for endometrial cancer presented equivalent perioperative morbidity to that of traditional laparoscopic surgery. The duration and total cost of robotic surgery were higher than those of traditional laparoscopic surgery.
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Affiliation(s)
- Alexandre Silva e Silva
- Disciplina de Ginecologia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - João Paulo Mancusi de Carvalho
- Disciplina de Ginecologia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Cristina Anton
- Disciplina de Ginecologia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Rodrigo Pinto Fernandes
- Disciplina de Ginecologia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Edmund Chada Baracat
- Disciplina de Ginecologia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Jesus Paula Carvalho
- Disciplina de Ginecologia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
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Edey KA, Rundle S, Hickey M. Hormone replacement therapy for women previously treated for endometrial cancer. Cochrane Database Syst Rev 2018; 5:CD008830. [PMID: 29763969 PMCID: PMC6494585 DOI: 10.1002/14651858.cd008830.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Endometrial cancer is the sixth most common cancer in women worldwide and most commonly occurs after the menopause (75%) (globocan.iarc.fr). About 319,000 new cases were diagnosed worldwide in 2012. Endometrial cancer is commonly considered as a potentially 'curable cancer,' as approximately 75% of cases are diagnosed before disease has spread outside the uterus (FIGO (International Federation of Gynecology and Obstetrics) stage I). The overall five-year survival for all stages is about 86%, and, if the cancer is confined to the uterus, the five-year survival rate may increase to 97%. The majority of women diagnosed with endometrial cancer have early-stage disease, leading to a good prognosis after hysterectomy and removal of the ovaries (oophorectomy), with or without radiotherapy. However, women may have early physiological and psychological postmenopausal changes, either pre-existing or as a result of oophorectomy, depending on age and menopausal status at the time of diagnosis. Lack of oestrogen can cause hot flushes, night sweats, genital tract atrophy and longer-term adverse effects, such as osteoporosis and cardiovascular disease. These changes may be temporarily managed by using oestrogens, in the form of hormone replacement therapy (HRT). However, there is a theoretical risk of promoting residual tumour cell growth and increasing cancer recurrence. Therefore, this is a potential survival disadvantage in a woman who has a potentially curable cancer. In premenopausal women with endometrial cancer, treatment induces early menopause and this may adversely affect overall survival. Additionally, most women with early-stage disease will be cured of their cancer, making longer-term quality of life (QoL) issues more pertinent. Following bilateral oophorectomy, premenopausal women may develop significant and debilitating menopausal symptoms, so there is a need for information about the risk and benefits of taking HRT, enabling women to make an informed decision, weighing the advantages and disadvantages of using HRT for their individual circumstances. OBJECTIVES To assess the risks and benefits of HRT (oestrogen alone or oestrogen with progestogen) for women previously treated for endometrial cancer. SEARCH METHODS We searched the Cochrane Register of Controlled Trials (CENTRAL 2017, Issue 5), MEDLINE (1946 to April, week 4, 2017) and Embase (1980 to 2017, week 18). We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of review articles. SELECTION CRITERIA We included randomised controlled trials (RCTs), in all languages, that examined the efficacy of symptom relief and the safety of using HRT in women treated for endometrial cancer, where safety in this situation was considered as not increasing the risk of recurrence of endometrial cancer above that of women not taking HRT. DATA COLLECTION AND ANALYSIS Two review authors independently assessed whether potentially relevant studies met the inclusion criteria. We used standard methodological procedures expected by Cochrane. MAIN RESULTS We identified 2190 unique records, evaluated the full text of seven studies and included one study with 1236 participants. This study reported tumour recurrence in 2.3% of women in the oestrogen arm versus 1.9% of women receiving placebo (risk ratio (RR) 1.17, 95% confidence interval (CI) 0.54 to 2.50; very low-certainty evidence). The study reported one woman in the HRT arm (0.16%) and three women in the placebo arm (0.49%) who developed breast cancer (new malignancy) during follow-up (RR 0.80, 95% CI 0.32 to 2.01; 1236 participants, 1 study; very low-certainty evidence). The study did not report on symptom relief, overall survival or progression-free survival for HRT versus placebo. However, they did report the percentage of women alive with no evidence of disease (94.3% in the HRT group and 95.6% in the placebo group) and the percentage of women alive irrespective of disease progression (95.8% in the HRT group and 96.9% in the placebo group) at the end of the 36 months' follow-up. The study did not report time to recurrence and it was underpowered due to closing early. The authors closed it as a result of the publication of the Women's Health Initiative (WHI) study, which, at that time, suggested that risks of exogenous hormone therapy outweighed benefits and had an impact on study recruitment. No assessment of efficacy was reported. AUTHORS' CONCLUSIONS Currently, there is insufficient high-quality evidence to inform women considering HRT after treatment for endometrial cancer. The available evidence (both the single RCT and non-randomised evidence) does not suggest significant harm, if HRT is used after surgical treatment for early-stage endometrial cancer. There is no information available regarding use of HRT in higher-stage endometrial cancer (FIGO stage II and above). The use of HRT after endometrial cancer treatment should be individualised, taking account of the woman's symptoms and preferences, and the uncertainty of evidence for and against HRT use.
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Affiliation(s)
| | - Stuart Rundle
- Northern Gynaecological Oncology CentreGynaecological OncologyQueen Elizabeth HospitalSheriff HillGatesheadUKNE9 6SX
| | - Martha Hickey
- The Royal Women's HospitalThe University of MelbourneLevel 7, Research PrecinctMelbourneVictoriaAustraliaParkville 3052
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Nagar H, Goodall RJ, Lyons TJ, Schmidt-Hansen M, Morrison J. Sentinel node biopsy for diagnosis of lymph node involvement in endometrial cancer. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2018. [DOI: 10.1002/14651858.cd013021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Hans Nagar
- Belfast City Hospital and the Royal Maternity Hospital; Belfast Health and Social Care Trust; Belfast UK
| | | | - Thomas J Lyons
- University of Bristol; School of Medical Sciences; 38 Kings Parade Avenue Bristol UK BS8 2RB
| | - Mia Schmidt-Hansen
- Royal College of Obstetricians and Gynaecologists; National Guideline Alliance; 27 Sussex Pl Regent's Park London UK NW1 4RG
| | - Jo Morrison
- Musgrove Park Hospital; Department of Gynaecological Oncology; Taunton and Somerset NHS Foundation Trust Taunton Somerset UK TA1 5DA
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Abstract
Minimally invasive surgery continues to transform the field of gynecologic oncology and has now become the standard of care for many early-stage malignancies. The proven benefits of minimally invasive surgery are driving the rapid introduction and dissemination of novel technologies and the increasing ability to perform even the most complex procedures less invasively. In this article, we will review the current literature on traditional multiport laparoscopy, robotic-assisted laparoscopy, laparoendoscopic single-site surgery as well as robotic-assisted laparoendoscopic single-site surgery, with a specific focus on their role in the treatment of gynecologic malignancies.
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Wollinga T, Ezendam NPM, Eggink FA, Smink M, van Hamont D, Pijlman B, Boss E, Robbe EJ, Ngo H, Boll D, Mom CH, van der Aa MA, Kruitwagen RFLP, Nijman HW, Pijnenborg JMA. Implementation of laparoscopic hysterectomy for endometrial cancer over the past decade. GYNECOLOGICAL SURGERY 2018; 15:7. [PMID: 29568254 PMCID: PMC5847214 DOI: 10.1186/s10397-018-1040-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/12/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Laparoscopic hysterectomy (LH) for the treatment of early-stage endometrial carcinoma/cancer (EC) has demonstrated to be safe in several randomized controlled trials. Yet, data on implementation of LH in clinical practice are limited. In the present study, implementation of LH for EC was evaluated in a large oncology network in the Netherlands. RESULTS Retrospectively, a total of 556 EC patients with FIGO stage I-II were registered in the selected years. The proportion of LH gradually increased from 11% in 2006 to 85% in 2015. LH was more often performed in patients with low-grade EC and was not related to the studied patient characteristics. The introduction of TLH was frequently preceded by LAVH. Patients treated in teaching hospitals were more likely to undergo a LH compared to patients in non-teaching hospitals. The conversion rate was 7.7%, and the overall complication rates between LH and AH were comparable, but less postoperative complications in LH. CONCLUSIONS Implementation of laparoscopic hysterectomy for early-stage EC increased from 11 to 85% in 10 years. Implementation of TLH was often preceded by LAVH and was faster in teaching hospitals.
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Affiliation(s)
- Tim Wollinga
- Medical Faculty, Erasmus University, Rotterdam, The Netherlands
- Department of Obstetrics and Gynecology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Nicole P. M. Ezendam
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Florine A. Eggink
- Department of Obstetrics and Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Marieke Smink
- Department of Obstetrics and Gynecology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Dennis van Hamont
- Department of Obstetrics and Gynecology, Amphia Hospital, Breda, The Netherlands
| | - Brenda Pijlman
- Department of Obstetrics and Gynecology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands
| | - Erik Boss
- Department of Obstetrics and Gynecology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Elisabeth J. Robbe
- Department of Obstetrics and Gynecology, St. Anna Hospital, Geldrop, The Netherlands
| | - Huy Ngo
- Department of Obstetrics and Gynecology, Elkerliek Hospital, Helmond, The Netherlands
| | - Dorry Boll
- Department of Obstetrics and Gynecology, Catharina Hospital, Eindhoven, The Netherlands
| | - Constantijne H. Mom
- Department of Gynecologic Oncology, Gynecological Oncology Centre Amsterdam, Amsterdam, The Netherlands
| | - Maaike A. van der Aa
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Roy F. L. P. Kruitwagen
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, The Netherlands
- GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Hans W. Nijman
- Department of Obstetrics and Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Johanna M. A. Pijnenborg
- Department of Obstetrics and Gynecology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
- Department of Obstetrics and Gynecology, Radboud University Medical Centre, 791, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Minimally invasive hysterectomy surgery rates for endometrial cancer performed at National Comprehensive Cancer Network (NCCN) Centers. Gynecol Oncol 2018; 148:480-484. [PMID: 29338923 DOI: 10.1016/j.ygyno.2018.01.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/31/2017] [Accepted: 01/02/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Minimally invasive surgery (MIS) is a quality measure for endometrial cancer (EC) established by the Society of Gynecologic Oncology and the American College of Surgeons. Our study objective was to assess the proportion of EC cases performed by MIS at National Comprehensive Cancer Network (NCCN) centers and evaluate perioperative outcomes. METHODS A retrospective cohort study of women who underwent surgical treatment for EC from 2013 to 2014 was conducted at four NCCN centers. Multivariable mixed logistic regression models analyzed factors associated with failure to perform MIS and perioperative complications. RESULTS In total 1621 patients were evaluated; 86.5% underwent MIS (robotic-assisted 72.5%, laparoscopic 20.9%, vaginal 6.6%). On multivariable analysis, factors associated with failure to undergo MIS were uterine size >12cm (Odds Ratio [OR]: 0.17, 95% CI 0.03-0.9), stage III (OR: 0.16, 95% CI 0.05-0.49) and IV disease (OR: 0.07, 95% CI 0.02-0.22). For stage I/II disease, complications occurred in 5.1% of MIS and 21.7% of laparotomy cases (p<0.01). Laparotomy was associated with increases in any complication (OR: 6.0, 95% CI 3.3-10.8), gastrointestinal (OR: 7.2, 95% CI 2.6-19.5), wound (OR: 3.7, 95% CI 1.5-9.2), respiratory (OR 37.5, 95% CI 3.9-358.0), VTE (OR 10.5, 95% CI 1.3-82.8) and 30-day readmission (OR: 2.6, 95% CI 1.4-4.9) compared to MIS. CONCLUSIONS At NCCN-designated centers, the MIS hysterectomy rate in EC is higher than the published national average, with low perioperative complications. Previously identified disparities of age, race, and BMI were not observed. A proposed MIS hysterectomy benchmark of >80% in EC care is feasible when performed at high volume centers.
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Ind T, Laios A, Hacking M, Nobbenhuis M. A comparison of operative outcomes between standard and robotic laparoscopic surgery for endometrial cancer: A systematic review and meta-analysis. Int J Med Robot 2017; 13:e1851. [PMID: 28762635 PMCID: PMC5724687 DOI: 10.1002/rcs.1851] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/19/2017] [Accepted: 06/09/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Evidence has been systematically assessed comparing robotic with standard laparoscopy for treatment of endometrial cancer. METHODS A search of Medline, Embase and Cochrane databases was performed until 30th October 2016. RESULTS Thirty-six papers including 33 retrospective studies, two matched case-control studies and one randomized controlled study were used in a meta-analysis. Information from a further seven registry/database studies were assessed descriptively. There were no differences in the duration of surgery but days stay in hospital were shorter in the robotic arm (0.46 days, 95%CI 0.26 to 0.66). A robotic approach had less blood loss (57.74 mL, 95%CI 38.29 to 77.20), less conversions to laparotomy (RR = 0.41, 95%CI 0.29 to 0.59), and less overall complications (RR = 0.82, 95%CI 0.72 to 0.93). A robotic approach had higher costs ($1746.20, 95%CI $63.37 to $3429.03). CONCLUSION A robotic approach has favourable clinical outcomes but is more expensive.
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Affiliation(s)
- Thomas Ind
- Department of Gynaecological OncologyRoyal Marsden HospitalLondonUK
- St George's University of LondonLondonUK
| | - Alex Laios
- Department of Gynaecological OncologyRoyal Marsden HospitalLondonUK
| | - Matthew Hacking
- Department of Gynaecological OncologyRoyal Marsden HospitalLondonUK
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Gomes MTV, Machado AMN, Podgaec S, Barison GAS. Initial experience with single-port robotic hysterectomy. EINSTEIN-SAO PAULO 2017; 15:476-480. [PMID: 29364368 PMCID: PMC5875163 DOI: 10.1590/s1679-45082017ao4134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 09/28/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This article presents the first series of robotic single-port hysterectomy cases performed at a hospital in Brazil. METHODS From November 2014 to October 2016, 11 patients were indicated to undergo, and nine of them were submitted to single-port hysterectomy using da Vinci Single-Site® platform. However, in two patients, due to multiple previous abdominal surgeries, large uterine volume, and/or a uterus with no mobility, a pneumoperitoneum was performed with a Verres needle, and the pelvic cavity was assessed using a 5mm optics endoscope. In these cases, single-port surgery was not recommended; therefore, multiportal robotic access was chosen, and no intercurrent events were reported. Nine single-port cases were operated on by the same surgeon at Hospital Israelita Albert Einstein. Patient data analyzed included age, body mass index, previous surgeries, and clinical diagnosis. Surgical data included operative time, skin incision, report of intraoperative complications, need for conversion to laparotomy, need for transfer to intensive care unit, need for blood transfusion, inadvertent injury to other organs, length of hospital stay, and death. RESULTS All cases were completed with da Vinci Single-Site® system, with no intercurrent events. Four patients presented with adenomyosis as the surgical indication, two had uterine myoma, one endometrial cancer, one endometrial polyp, and one desquamative inflammatory vaginitis. The mean age of patients was 44 years (range, 40 to 54 years), and body mass index varied between 23.4 and 33.2kg/m2 (mean 26.4). No complications occurred in any of the cases, such as intestinal or bladder injury, bleeding, or the need for a second surgery. All nine procedures were completed with the robotic single-port access, and no patient required a blood transfusion. CONCLUSION Although this study merely presented an initial series of patients submitted to robotic single-port surgery, it demonstrated that the method is feasible and safe, suggesting the possible use of this technique in elective hysterectomy and other gynecological procedures in the future, as described in large reference centers of advanced surgery worldwide. Specifically, in gynecological practice, existing evidence on the use of robot-assisted, single-port surgery seems promising, and although it is not indicated in all cases, it should be considered as a surgical option. Nonetheless, further randomized and controlled clinical studies are necessary to establish the preeminence of robot-assisted, single-port surgery versus single-incision and conventional laparoscopy.
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Affiliation(s)
| | | | - Sérgio Podgaec
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Moss HA, Havrilesky LJ, Chino J. Insurance coverage among women diagnosed with a gynecologic malignancy before and after implementation of the Affordable Care Act. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.06.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mehta A, Xu T, Hutfless S, Makary MA, Sinno AK, Tanner EJ, Stone RL, Wang K, Fader AN. Patient, surgeon, and hospital disparities associated with benign hysterectomy approach and perioperative complications. Am J Obstet Gynecol 2017; 216:497.e1-497.e10. [PMID: 28034651 PMCID: PMC5576033 DOI: 10.1016/j.ajog.2016.12.020] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 12/13/2016] [Accepted: 12/19/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hysterectomy is among the most common major surgical procedures performed in women. Approximately 450,000 hysterectomy procedures are performed each year in the United States for benign indications. However, little is known regarding contemporary US hysterectomy trends for women with benign disease with respect to operative technique and perioperative complications, and the association between these 2 factors with patient, surgeon, and hospital characteristics. OBJECTIVE We sought to describe contemporary hysterectomy trends and explore associations between patient, surgeon, and hospital characteristics with surgical approach and perioperative complications. STUDY DESIGN Hysterectomies performed for benign indications by general gynecologists from July 2012 through September 2014 were analyzed in the all-payer Maryland Health Services Cost Review Commission database. We excluded hysterectomies performed by gynecologic oncologists, reproductive endocrinologists, and female pelvic medicine and reconstructive surgeons. We included both open hysterectomies and those performed by minimally invasive surgery, which included vaginal hysterectomies. Perioperative complications were defined using the Agency for Healthcare Research and Quality patient safety indicators. Surgeon hysterectomy volume during the 2-year study period was analyzed (0-5 cases annually = very low, 6-10 = low, 11-20 = medium, and ≥21 = high). We utilized logistic regression and negative binomial regression to identify patient, surgeon, and hospital characteristics associated with minimally invasive surgery utilization and perioperative complications, respectively. RESULTS A total of 5660 hospitalizations were identified during the study period. Most patients (61.5%) had an open hysterectomy; 38.5% underwent a minimally invasive surgery procedure (25.1% robotic, 46.6% laparoscopic, 28.3% vaginal). Most surgeons (68.2%) were very low- or low-volume surgeons. Factors associated with a lower likelihood of undergoing minimally invasive surgery included older patient age (reference 45-64 years; 20-44 years: adjusted odds ratio, 1.16; 95% confidence interval, 1.05-1.28), black race (reference white; adjusted odds ratio, 0.70; 95% confidence interval, 0.63-0.78), Hispanic ethnicity (adjusted odds ratio, 0.62; 95% confidence interval, 0.48-0.80), smaller hospital (reference large; small: adjusted odds ratio, 0.26; 95% confidence interval, 0.15-0.45; medium: adjusted odds ratio, 0.87; 95% confidence interval, 0.79-0.96), medium hospital hysterectomy volume (reference ≥200 hysterectomies; 100-200: adjusted odds ratio, 0.78; 95% confidence interval, 0.71-0.87), and medium vs high surgeon volume (reference high; medium: adjusted odds ratio, 0.87; 95% confidence interval, 0.78-0.97). Complications occurred in 25.8% of open and 8.2% of minimally invasive hysterectomies (P < .0001). Minimally invasive hysterectomy (adjusted odds ratio, 0.22; 95% confidence interval, 0.17-0.27) and large hysterectomy volume hospitals (reference ≥200 hysterectomies; 1-100: adjusted odds ratio, 2.26; 95% confidence interval, 1.60-3.20; 101-200: adjusted odds ratio, 1.63; 95% confidence interval, 1.23-2.16) were associated with fewer complications, while patient payer, including Medicare (reference private; adjusted odds ratio, 1.86; 95% confidence interval, 1.33-2.61), Medicaid (adjusted odds ratio, 1.63; 95% confidence interval, 1.30-2.04), and self-pay status (adjusted odds ratio, 2.41; 95% confidence interval, 1.40-4.12), and very-low and low surgeon hysterectomy volume (reference ≥21 cases; 1-5 cases: adjusted odds ratio, 1.73; 95% confidence interval, 1.22-2.47; 6-10 cases: adjusted odds ratio, 1.60; 95% confidence interval, 1.11-2.23) were associated with perioperative complications. CONCLUSION Use of minimally invasive hysterectomy for benign indications remains variable, with most patients undergoing open, more morbid procedures. Older and black patients and smaller hospitals are associated with open hysterectomy. Patient race and payer status, hysterectomy approach, and surgeon volume were associated with perioperative complications. Hysterectomies performed for benign indications by high-volume surgeons or by minimally invasive techniques may represent an opportunity to reduce preventable harm.
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Affiliation(s)
- Ambar Mehta
- Johns Hopkins School of Medicine, Baltimore, MD
| | - Tim Xu
- Johns Hopkins School of Medicine, Baltimore, MD
| | - Susan Hutfless
- Department of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, MD
| | - Martin A Makary
- Department of Surgery, Johns Hopkins Medicine, Baltimore, MD
| | - Abdulrahman K Sinno
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD
| | - Edward J Tanner
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD
| | - Rebecca L Stone
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD
| | - Karen Wang
- Division of Gynecologic Specialties, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD
| | - Amanda N Fader
- Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD.
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Sundar S, Balega J, Crosbie E, Drake A, Edmondson R, Fotopoulou C, Gallos I, Ganesan R, Gupta J, Johnson N, Kitson S, Mackintosh M, Martin-Hirsch P, Miles T, Rafii S, Reed N, Rolland P, Singh K, Sivalingam V, Walther A. BGCS uterine cancer guidelines: Recommendations for practice. Eur J Obstet Gynecol Reprod Biol 2017; 213:71-97. [PMID: 28437632 DOI: 10.1016/j.ejogrb.2017.04.015] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
Abstract
The British Gynaecological Cancer Society has issued the first Endometrial (Uterine) Cancer guidelines as recommendation for practice for the UK.
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Affiliation(s)
- Sudha Sundar
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Janos Balega
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Emma Crosbie
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Alasdair Drake
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Richard Edmondson
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Christina Fotopoulou
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom.
| | - Ioannis Gallos
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Raji Ganesan
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Janesh Gupta
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Nick Johnson
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Sarah Kitson
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Michelle Mackintosh
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Pierre Martin-Hirsch
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Tracie Miles
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Saeed Rafii
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Nick Reed
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Phil Rolland
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Kavita Singh
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Vanitha Sivalingam
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
| | - Axel Walther
- British Gynaecological Cancer Society, C/O Williams Denton CYF, Bangor LL57 4FE, United Kingdom
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Ind TEJ, Marshall C, Hacking M, Chiu S, Harris M, Nobbenhuis M. The effect of obesity on clinical and economic outcomes in robotic endometrial cancer surgery. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2017; 4:33-37. [PMID: 30697561 PMCID: PMC6193434 DOI: 10.2147/rsrr.s123108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The aim of this study was to compare the financial and clinical outcomes in robotic-assisted laparoscopic surgery for primary endometrial cancer between obese and nonobese women. The hospital finance department assessed the total admission costs for robotic surgery for endometrial cancer in 54 women. This included a subanalysis for costs over nine areas (ward and clinics, drugs and pharmacy, medical staff, theaters, blood products, imaging, pathology, rehabilitation therapy, and high dependency costs). Furthermore, a prospective collection of morbidity and surgical outcome data was performed. The study group included 21 nonobese and 33 obese women (body mass index >30). Obese women were more likely to stay for more than one night in hospital (20/33 [60.6%] compared to 4/21 [19.0%], P=0.032) and to have high dependency care (25/33 [75.8%] compared to 10/21 [47.6%], P=0.032). Theater time was on average 35 min longer (95% confidence interval [CI] 5–65 min, P=0.0252). Both the groups were comparable for comorbidities except for the presence of diabetes being present in the obese group (13/33 [39.4%] compared to 0/21 [0.0%], P=0.007). There were six Clavien-Dindo grade II complications in the obese group and two in the nonobese group. The average overall costs were £1,852 greater (95% CI £431–£3,277, P=0.012) in the obese group. Diabetes and hypertension were associated with increased costs, but obesity was the only independent variable. In conclusion, greater resource should be allocated to obese women undergoing primary surgery for endometrial cancer.
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Affiliation(s)
- Thomas E J Ind
- Department of Gynaecological Oncology, Royal Marsden Hospital, .,Department of Obstetrics and Gynaecology, St. George's University of London,
| | | | - Matthew Hacking
- Department of Anaesthesia, Royal Marsden Hospital, London, UK
| | - Selina Chiu
- Department of Gynaecological Oncology, Royal Marsden Hospital,
| | - Michelle Harris
- Department of Gynaecological Oncology, Royal Marsden Hospital,
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Paik ES, Lee YY, Kim TJ, Choi CH, Lee JW, Kim BG, Bae DS. Feasibility of laparoscopic cytoreduction in patients with localized recurrent epithelial ovarian cancer. J Gynecol Oncol 2016; 27:e24. [PMID: 27029745 PMCID: PMC4823355 DOI: 10.3802/jgo.2016.27.e24] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 10/22/2015] [Accepted: 11/22/2015] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To assess the feasibility of laparoscopic cytoreduction in patients with localized recurrent epithelial ovarian cancer (EOC) by comparing its outcomes to those of laparotomy. METHODS We performed retrospective analysis in 79 EOC patients who had a localized single recurrent site, as demonstrated by computed tomography (CT) scan, magnetic resonance imaging, or positron emission tomography/CT scan; had no ascites; were disease-free for 12 or more months prior; and who had undergone secondary cytoreduction (laparoscopy in 31 patients, laparotomy in 48 patients) at Samsung Medical Center between 2002 and 2013. By reviewing the electronic medical records, we investigated the patients' baseline characteristics, surgical characteristics, and surgical outcomes. RESULTS There were no statistically significant differences between laparoscopy and laparotomy patients in terms of age, body mass index, cancer antigen 125 level, tumor type, initial stage, grade, recurrence site, type of procedures used in the secondary cytoreduction, adjuvant chemotherapy, and disease-free interval from the previous treatment. With regards to surgical outcomes, reduced operating time, shorter hospital stay, and less estimated blood loss were achieved in the laparoscopy group. Complete debulking was achieved in all cases in the laparoscopy group. CONCLUSION The laparoscopic approach is feasible without compromising morbidity and survival in selected groups of patients with recurrent EOC. The laparoscopic approach can be a possible treatment option for recurrent EOC.
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Affiliation(s)
- E Sun Paik
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoo-Young Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae-Joong Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chel Hun Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong-Won Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Byoung-Gie Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk-Soo Bae
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Talhouk A, McAlpine JN. New classification of endometrial cancers: the development and potential applications of genomic-based classification in research and clinical care. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2016; 3:14. [PMID: 27999680 PMCID: PMC5154099 DOI: 10.1186/s40661-016-0035-4] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 11/22/2016] [Indexed: 01/13/2023]
Abstract
Endometrial carcinoma (EC) is the fourth most common cancer in women in the developed world. Classification of ECs by histomorphologic criteria has limited reproducibility and better tools are needed to distinguish these tumors and enable a subtype-specific approach to research and clinical care. Based on the Cancer Genome Atlas, two research teams have developed pragmatic molecular classifiers that identify four prognostically distinct molecular subgroups. These methods can be applied to diagnostic specimens (e.g., endometrial biopsy) with the potential to completely change the current risk stratification systems and enable earlier informed decision making. The evolution of genomic classification in ECs is shared herein, as well as potential applications and discussion of the essential research still needed in order to optimally integrate molecular classification in to current standard of care.
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Affiliation(s)
- A Talhouk
- Department of Pathology and Laboratory Medicine, University of British Columbia and BC Cancer Agency, Vancouver, BC Canada
| | - J N McAlpine
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, University of British Columbia, 2775 Laurel St. 6th Floor, Vancouver, BC Canada V5Z 1M9
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Predictive Factor of Conversion to Laparotomy in Minimally Invasive Surgical Staging for Endometrial Cancer. Int J Gynecol Cancer 2016; 26:290-300. [PMID: 26569058 DOI: 10.1097/igc.0000000000000594] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The aim of the study was to identify risk factors associated with laparotomy conversion during total laparoscopic hysterectomy for endometrial cancer. METHODS This is a retrospective study examining endometrial cancer cases that underwent hysterectomy-based surgical staging initiated via conventional laparoscopic approach. Factors related to patient, tumor, and surgeon were examined to establish risk of laparotomy conversion using a multivariate logistic regression model. RESULTS There were 251 cases identified including 30 cases (12.0%) of laparotomy conversion. The most common indication for laparotomy conversion was a large uterus (27.0%), followed by extensive adhesions (24.3%) and surgical complications (18.9%). Outcomes of cases resulting in laparotomy conversion include longer surgical time (333 vs 224 minutes, P < 0.001), larger blood loss (350 vs 100 mL, P < 0.001), longer hospital stay (4 vs 2 days, P < 0.001), and increased risk of hospital readmission (10% vs 1.4%, P = 0.024). In multivariate analysis, morbid obesity (odds ratio [OR], 4.51; P = 0.011), suboptimal pelvic examination or enlarged uterus during preoperative evaluation (OR, 3.55; P = 0.034), para-aortic lymphadenectomy (OR, 10.5; P = 0.001), uterine size 250 g or greater (OR, 3.49; P = 0.026), and extrauterine disease (OR, 4.68; P = 0.012) remained the independent predictors for laparotomy conversion. The following numbers of risk factors were significantly correlated with laparotomy-conversion rate: none, 1.1%; single risk factor, 5.3% (OR, 5.00; P = 0.15); double risk factors, 21.7% (OR, 24.9; P = 0.002); and triple or more risk factors, 50% (OR, 90.0; P < 0.001). Ultrasonographic 3-dimensional volumes of 496 cm in preoperative uterine size correlate with actual uterine weight of 250 g (Y = 61.5 + 0.38X, P < 0.001). CONCLUSIONS Laparotomy conversion significantly impacts outcomes of patients with endometrial cancer. In this setting, our predictive model for laparotomy conversion will be useful to guide the surgical management of endometrial cancer.
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Edey KA, Rundle S, Hickey M. Hormone replacement therapy for women previously treated for endometrial cancer. Hippokratia 2016. [DOI: 10.1002/14651858.cd008830.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Stuart Rundle
- Northern Gynaecological Oncology Centre; Gynaecological Oncology; Queen Elizabeth Hospital Sheriff Hill Gateshead UK NE9 6SX
| | - Martha Hickey
- The Royal Women's Hospital; The University of Melbourne; Level 7, Research Precinct Melbourne Victoria Australia Parkville 3052
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Nevis IF, Vali B, Higgins C, Dhalla I, Urbach D, Bernardini MQ. Robot-assisted hysterectomy for endometrial and cervical cancers: a systematic review. J Robot Surg 2016; 11:1-16. [PMID: 27424111 DOI: 10.1007/s11701-016-0621-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 06/27/2016] [Indexed: 12/31/2022]
Abstract
Total and radical hysterectomies are the most common treatment strategies for early-stage endometrial and cervical cancers, respectively. Surgical modalities include open surgery, laparoscopy, and more recently, minimally invasive robot-assisted surgery. We searched several electronic databases for randomized controlled trials and observational studies with a comparison group, published between 2009 and 2014. Our outcomes of interest included both perioperative and morbidity outcomes. We included 35 observational studies in this review. We did not find any randomized controlled trials. The quality of evidence for all reported outcomes was very low. For women with endometrial cancer, we found that there was a reduction in estimated blood loss between the robot-assisted surgery compared to both laparoscopy and open surgery. There was a reduction in length of hospital stay between robot-assisted surgery and open surgery but not laparoscopy. There was no difference in total lymph node removal between the three modalities. There was no difference in the rate of overall complications between the robot-assisted technique and laparoscopy. For women with cervical cancer, there were no differences in estimated blood loss or removal of lymph nodes between robot-assisted and laparoscopic procedure. Compared to laparotomy, robot-assisted hysterectomy for cervical cancer showed an overall reduction in estimated blood loss. Although robot-assisted hysterectomy is clinically effective for the treatment of both endometrial and cervical cancers, methodologically rigorous studies are lacking to draw definitive conclusions.
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Affiliation(s)
- Immaculate F Nevis
- Health Quality Ontario, 130 Bloor Street West, 10th Floor, Toronto, ON, M5S 1N5, Canada.
| | - Bahareh Vali
- Health Quality Ontario, 130 Bloor Street West, 10th Floor, Toronto, ON, M5S 1N5, Canada
| | - Caroline Higgins
- Health Quality Ontario, 130 Bloor Street West, 10th Floor, Toronto, ON, M5S 1N5, Canada
| | - Irfan Dhalla
- Health Quality Ontario, 130 Bloor Street West, 10th Floor, Toronto, ON, M5S 1N5, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | - David Urbach
- Toronto General Hospital, University of Toronto, Toronto, ON, M5G 2M9, Canada
| | - Marcus Q Bernardini
- Department of Gynecologic Oncology, Princess Margaret Hospital, University of Toronto, 610, University Avenue, Toronto, ON, M5G 2M9, Canada
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Kössler-Ebs JB, Grummich K, Jensen K, Hüttner FJ, Müller-Stich B, Seiler CM, Knebel P, Büchler MW, Diener MK. Incisional Hernia Rates After Laparoscopic or Open Abdominal Surgery—A Systematic Review and Meta-Analysis. World J Surg 2016; 40:2319-30. [DOI: 10.1007/s00268-016-3520-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Arsène E, Bleu G, Merlot B, Boulanger L, Vinatier D, Kerdraon O, Collinet P. Implications of a two-step procedure in surgical management of patients with early-stage endometrioid endometrial cancer. J Gynecol Oncol 2016; 26:125-33. [PMID: 25872893 PMCID: PMC4397228 DOI: 10.3802/jgo.2015.26.2.125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 02/13/2015] [Accepted: 03/01/2015] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Since European Society for Medical Oncology (ESMO) recommendations and French guidelines, pelvic lymphadenectomy should not be systematically performed for women with early-stage endometrioid endometrial cancer (EEC) preoperatively assessed at presumed low- or intermediate-risk. The aim of our study was to evaluate the change of our surgical practices after ESMO recommendations, and to evaluate the rate and morbidity of second surgical procedure in case of understaging after the first surgery. METHODS This retrospective single-center study included women with EEC preoperatively assessed at presumed low- or intermediate-risk who had surgery between 2006 and 2013. Two periods were defined the times before and after ESMO recommendations. Demographics characteristics, surgical management, operative morbidity, and rate of understaging were compared. The rate of second surgical procedure required for lymph node resection during the second period and its morbidity were also studied. RESULTS Sixty-one and sixty-two patients were operated for EEC preoperatively assessed at presumed low-or intermediate-risk before and after ESMO recommendations, respectively. Although immediate pelvic lymphadenectomy was performed more frequently during the first period than the second period (88.5% vs. 19.4%; p<0.001), the rate of postoperative risk-elevating or upstaging were comparable between the two periods (31.1% vs. 27.4%; p=0.71). Among the patients requiring second surgical procedure during the second period (21.0%), 30.8% did not undergo the second surgery due to their comorbidity or old age. For the patients who underwent second surgical procedure, mean operative time of the second procedure was 246.1±117.8 minutes. Third operation was required in 33.3% of them because of postoperative complications. CONCLUSION Since ESMO recommendations, second surgical procedure for lymph node resection is often required for women with EEC presumed at low- or intermediate-risk. This reoperation is not always performed due to age/comorbidity of the patients, and presents a significant morbidity.
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Affiliation(s)
- Emmanuelle Arsène
- Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France.
| | - Géraldine Bleu
- Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France
| | - Benjamin Merlot
- Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France
| | - Loïc Boulanger
- Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France
| | - Denis Vinatier
- Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France.; University of Lille-Nord-de-France, Lille, France
| | - Olivier Kerdraon
- Department of Anatomopathology, University Hospital of Lille, Lille, France
| | - Pierre Collinet
- Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France.; University of Lille-Nord-de-France, Lille, France
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Nezhat C, Main J, Paka C, Soliemannjad R, Parsa MA. Advanced gynecologic laparoscopy in a fast-track ambulatory surgery center. JSLS 2016; 18:JSLS-D-13-00291. [PMID: 25392631 PMCID: PMC4154421 DOI: 10.4293/jsls.2014.00291] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background/Objectives: It has been shown that major gynecologic laparoscopy is safe in hospital ambulatory settings, but there is little data to suggest the same in freestanding ambulatory surgery centers. This study evaluates the safety and efficacy of advanced gynecologic laparoscopic surgery using a fast-track model in freestanding ambulatory surgery centers and discusses our institution protocols. Methods: Retrospective, multicenter review was conducted of major gynecologic surgeries from August 1st 2010 to September 30th 2011 in 3 surgical centers with one primary surgeon. All patients were treated for symptomatic uterine leiomyomas and/or endometriosis. Primary outcome measures were unplanned admissions and discharge within 23 hours. Results: One hundred and thirty-four patients underwent major laparoscopic gynecologic surgery with a total of 160 procedures: 77 stage IV endometriosis treatment including 7 disk excisions of endometriosis from the large bowel, 3 ureteroneocystostomies and 1 partial bladder resection, 38 myomectomies, and 34 hysterectomies including 12 modified radical hysterectomies. The overall unplanned admission rate was 4.5%. One hundred and thirty-one patients (97.7%) were discharged within 24 hours after surgery. Three patients (2.2%) were transferred to the hospital postoperatively: 1 patient for observation of postoperative anemia and 2 patients for postoperative fever. Three patients (2.2%) were admitted to the hospital after discharge: 1 patient for postoperative ileus, 1 patient for postoperative fever, and 1 patient with septic pelvic thrombophlebitis. These postoperative issues all resolved without complication, and all patients had an uneventful follow-up. Conclusions: With appropriate resources and an experienced surgeon, advanced laparoscopic surgery can be safely performed in a fast-track ambulatory surgery center with a high rate of discharge within 23 hours and low unplanned readmission rate.
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Affiliation(s)
- Camran Nezhat
- Center for Special Minimally Invasive and Robotic Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - Jillian Main
- Center for Special Minimally Invasive and Robotic Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - Chandhana Paka
- Center for Special Minimally Invasive and Robotic Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - Rose Soliemannjad
- Center for Special Minimally Invasive and Robotic Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - M Ali Parsa
- Center for Special Minimally Invasive and Robotic Surgery, Stanford University Medical Center, Palo Alto, CA, USA
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Yin H, Gui T. Comparative analyses of postoperative complications and prognosis of different surgical procedures in stage II endometrial carcinoma treatment. Onco Targets Ther 2016; 9:781-6. [PMID: 26937200 PMCID: PMC4762433 DOI: 10.2147/ott.s95806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate the impact of surgical resection extent on the postoperative complications and the prognosis in patients with stage II endometrial cancer. METHODS A total of 54 patients were retrospectively reviewed, 35 patients underwent subradical hysterectomy and 19 patients received radical hysterectomy, both with simultaneous bilateral salpingo-oophorectomy and pelvic and paraaortic lymphadenectomy. RESULTS Comparing the surgical outcomes in subradical hysterectomy group vs radical hysterectomy group, there were no significant differences in operative time, estimated blood loss, and hospital stay. After surgery, 37.1% vs 36.8% patients received postoperative radiotherapy in the subradical hysterectomy group vs radical hysterectomy group, without statistically significant difference. As for postoperative complications, the early postoperative complication rate in patients who underwent subradical hysterectomy was 14.3%, significantly lower than that in patients submitted to radical hysterectomy (14.3% vs 42.1%), with P=0.043. However, there was no significant difference in late postoperative complication rate between the two surgical procedures. Regarding the clinical prognosis, patients receiving the subradical hysterectomy showed similar survival to their counterparts undergoing the radical procedures. The relapse rate was 5.71% vs 5.26%, respectively, without significant difference. There were no deaths in both surgical groups. CONCLUSION For stage II endometrial carcinoma, subradical hysterectomy presented with less early postoperative complications and similar survival duration and recurrence compared with radical hysterectomy and should be advocated in clinical treatment.
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Affiliation(s)
- Hongmei Yin
- Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, Shandong, People's Republic of China
| | - Ting Gui
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
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Wright JD, Burke WM, Tergas AI, Hou JY, Huang Y, Hu JC, Hillyer GC, Ananth CV, Neugut AI, Hershman DL. Comparative Effectiveness of Minimally Invasive Hysterectomy for Endometrial Cancer. J Clin Oncol 2016; 34:1087-96. [PMID: 26834057 DOI: 10.1200/jco.2015.65.3212] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Despite the potential benefits of minimally invasive hysterectomy for uterine cancer, population-level data describing the procedure's safety in unselected patients are lacking. We examined the use of minimally invasive surgery and the association between the route of the procedure and long-term survival. METHODS We used the SEER-Medicare database to identify women with stage I-III uterine cancer who underwent hysterectomy from 2006 to 2011. Patients who underwent abdominal hysterectomy were compared with those who had minimally invasive hysterectomy (laparoscopic and robot-assisted). Perioperative morbidity, use of adjuvant therapy, and long-term survival were examined after propensity score balancing. RESULTS We identified 6,304 patients, including 4,139 (65.7%) who underwent abdominal hysterectomy and 2,165 (34.3%) who underwent minimally invasive hysterectomy; performance of minimally invasive hysterectomy increased from 9.3% in 2006 to 61.7% in 2011. Robot-assisted procedures accounted for 62.3% of the minimally invasive operations. Compared with women who underwent abdominal hysterectomy, minimally invasive hysterectomy was associated with a lower overall complication rate (22.7% v 39.7%; P < .001), and lower perioperative mortality (0.6% v 1.1%), but these women were more likely to receive adjuvant pelvic radiotherapy (34.3% v 31.3%) and brachytherapy (33.6% v 31.0%; P < .05). The complication rate was higher after robot-assisted hysterectomy compared with laparoscopic hysterectomy (23.7% v 19.5%; P = .03). There was no association between the use of minimally invasive hysterectomy and either overall (HR, 0.89; 95% CI, 0.75 to 1.04) or cancer-specific (HR, 0.83; 95% CI, 0.59 to 1.16) mortality. CONCLUSION Minimally invasive hysterectomy does not appear to compromise long-term survival for women with endometrial cancer.
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Affiliation(s)
- Jason D Wright
- Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY.
| | - William M Burke
- Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY
| | - Ana I Tergas
- Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY
| | - June Y Hou
- Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY
| | - Yongmei Huang
- Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY
| | - Jim C Hu
- Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY
| | - Grace Clarke Hillyer
- Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY
| | - Cande V Ananth
- Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY
| | - Alfred I Neugut
- Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY
| | - Dawn L Hershman
- Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY
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The effect of increased experience on complications in robotic hysterectomy for malignant and benign gynecological disease. J Robot Surg 2015; 9:321-30. [PMID: 26530844 DOI: 10.1007/s11701-015-0534-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 09/27/2015] [Indexed: 10/23/2022]
Abstract
The study objective was to assess the effect of increased experience on complications in robotic hysterectomy for malignant and benign gynecological disease. This is a retrospective cohort study. It is a Canadian Task Force classification II-2 study conducted at the University Hospital, Sweden. The patients were 949 women planned for robotic hysterectomy for malignant (75 %) and benign (25 %) gynecological disease between October 2005 and December 2013. They were continuously evaluated for the rate of intraoperative and postoperative complications up to 1-year post-surgery, the latter according to Clavien-Dindo classification following the introduction of robotic surgery with special awareness of complications possibly related to robot-specific risk factors, the description of refinement of practice and assessment of the effect of these measures. The rate of intraoperative complications, the overall rate of complications and the rate of ≥grade 3 complications decreased from the first to the last time period (4.8 vs 2.6 %, p = 0.037, 34 vs 19 %, p = 0.003 and 13.5 vs 3.2 %, p = 0.0003, respectively). The rate of intraoperative complications and the rate of postoperative complications possibly related to robot-specific risk factors was reduced from the first to the last time period (3.8 vs 0.6 %, p = 0.028 and 7.7 vs 1.5 %, p = 0.003, respectively). In patients undergoing robotic hysterectomy for malignant and benign gynecological disease intraoperative and postoperative complications and complications possibly related to the robotic approach diminish with training, experience and refinement of practice.
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Şenol T, Polat M, Şanverdi İ, Özkaya E, Karateke A. Laparoscopic staging of endometrial cancer: Does it have any impact on survival? Turk J Obstet Gynecol 2015; 12:139-143. [PMID: 28913058 PMCID: PMC5558387 DOI: 10.4274/tjod.78466] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 06/30/2015] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To assess whether laporoscopic approach to endometrial cancer is associated with survival. MATERIALS AND METHODS In total, 158 patients with endometrial cancer underwent staging surgery at a tertiary referral center, 30 of whom underwent laparoscopy, whereas the remainder received treatment with a conventional approach. Survival between groups was analyzed. RESULTS The comparison of the groups revealed similar disease-free survival (p=0.791). Histology, cervical, adnexal and serosal involvement were found to be significantly correlated with recurrence in the laparoscopically staged group, whereas CA 125, histology, tumor grade, tumor diameter, cervical involvement, degree of myometrial invasion, adnexal and serosal involvement, and pelvic metastasis were significanly correlated with recurrence in the conventionally managed group. CONCLUSION Laparoscopic approach to endometrial cancer, along with its widely accepted postoperative advantages, has similar disease-free survival but different variables affect recurrence rates.
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Affiliation(s)
- Taylan Şenol
- Zeynep Kamil Training and Research Hospital, Clinic of Women and Children's Health, İstanbul, Turkey
| | - Mesut Polat
- Zeynep Kamil Training and Research Hospital, Clinic of Women and Children's Health, İstanbul, Turkey
| | - İlhan Şanverdi
- Zeynep Kamil Training and Research Hospital, Clinic of Women and Children's Health, İstanbul, Turkey
| | - Enis Özkaya
- Zeynep Kamil Training and Research Hospital, Clinic of Women and Children's Health, İstanbul, Turkey
| | - Ateş Karateke
- Zeynep Kamil Training and Research Hospital, Clinic of Women and Children's Health, İstanbul, Turkey
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Melamed A, Katz Eriksen JL, Hinchcliff EM, Worley MJ, Berkowitz RS, Horowitz NS, Muto MG, Urman RD, Feltmate CM. Same-Day Discharge After Laparoscopic Hysterectomy for Endometrial Cancer. Ann Surg Oncol 2015; 23:178-85. [DOI: 10.1245/s10434-015-4582-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Indexed: 11/18/2022]
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