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Pados G, Zouzoulas D, Tsolakidis D. Recent management of endometrial cancer: a narrative review of the literature. Front Med (Lausanne) 2024; 10:1244634. [PMID: 38235267 PMCID: PMC10792696 DOI: 10.3389/fmed.2023.1244634] [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: 06/22/2023] [Accepted: 11/23/2023] [Indexed: 01/19/2024] Open
Abstract
Endometrial cancer is a common female gynecological neoplasia and its incidence rate has increased in the past years. Due to its predominant symptoms, most women will present uterine bleeding. It is usually diagnosed at an early stage and surgery has an important role in the treatment plan. The prognosis and quality of life of these patients can be quite favorable, if proper treatment is offered by surgeons. Traditionally, more invasive approaches and procedures were offered to these patients, but recent data suggest that more conservative and minimal invasive choices can be adopted in the treatment algorithm. Minimal invasive surgery, such as laparoscopy and robotic surgery, should be considered as an acceptable alternative, compared to laparotomy with less comorbidities and similar oncological and survival outcomes. Furthermore, sentinel lymph node biopsy has emerged in the surgical staging of endometrial cancer, in order to replace comprehensive lymphadenectomy. It is associated with less intra- and postoperative complications, while preliminary data show no difference in survival rates. However, sentinel lymph node biopsy should be offered within a strict algorithm, to avoid residual metastatic disease. The aim of this review is to analyze all the available data for the application of minimal invasive surgery in early endometrial cancer and especially the role of sentinel lymph node biopsy.
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Affiliation(s)
- George Pados
- Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki, “Papageorgiou” Hospital, Thessaloniki, Greece
- Center for Endoscopic Surgery “Diavalkaniko” Hospital, Thessaloniki, Greece
| | - Dimitrios Zouzoulas
- Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki, “Papageorgiou” Hospital, Thessaloniki, Greece
| | - Dimitrios Tsolakidis
- Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki, “Papageorgiou” Hospital, Thessaloniki, Greece
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Stotz L, Joukhadar R, Hamza A, Thangarajah F, Bardens D, Juhasz-Böss I, Solomayer EF, Radosa MP, Radosa JC. Instrument usage in laparoscopic gynecologic surgery: a prospective clinical trial. Arch Gynecol Obstet 2018; 298:773-779. [PMID: 30116930 DOI: 10.1007/s00404-018-4867-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 08/02/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate instrumental usage in laparoscopic gynecological surgeries and to develop key timesets of a laparoscopic operation, which allows categorization of the operation time into different sections. METHODS In this prospective clinical observational study, frequency of instrument usage, time for instrument switches, and instrument utilization time were recorded in a standardized manner for laparoscopic surgeries in 103 endoscopic surgeries. RESULTS A standard equipment (including atraumatic grasping forceps, irrigation and suction device, bipolar clamp, and laparoscopic scissors) was used for nearly all interventions. Bipolar clamps and scissors were changed most frequently. The tool used for the longest amount of time was the atraumatic grasping forceps. Laparoscopic instruments were switched 51 times per surgery (range 2-250 times). One instrument switch lasted for a median of 0.13 min (0.08-1.2 min). Median time for instrument switch for a single surgery added up to 6.83 min. Instrument switches required 10.5% of the overall operation time. CONCLUSION We analyzed the current instrument usage in laparoscopic gynecological surgeries. The results of our standardized investigation suggest ways to reduce the time required for surgery and provide starting points for the standardization of the work routine.
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Affiliation(s)
- Lisa Stotz
- Clinic for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, 66421, Homburg, Saarland, Germany.
| | - Ralf Joukhadar
- Clinic for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, 66421, Homburg, Saarland, Germany.,Clinic for Gynecology and Polyclinic, Würzburg University Medical Center, Würzburg, Bavaria, Germany
| | - Amr Hamza
- Clinic for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, 66421, Homburg, Saarland, Germany
| | - Fabinshy Thangarajah
- Department of Obstetrics and Gynecology, University of Cologne, Medical Faculty, Cologne, Nordrhein-Westfalen, Germany
| | - David Bardens
- Clinic for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, 66421, Homburg, Saarland, Germany
| | - Ingolf Juhasz-Böss
- Clinic for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, 66421, Homburg, Saarland, Germany
| | - Erich-Franz Solomayer
- Clinic for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, 66421, Homburg, Saarland, Germany
| | - Marc P Radosa
- Department for Gynecology, Diaconia Clinic Kassel, Kassel, Hessen, Germany
| | - Julia C Radosa
- Clinic for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Medical Center, 66421, Homburg, Saarland, Germany
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Ansar P P, Ayyappan S, Mahajan V. Prospective Nonrandomized Comparative Study of Laparoscopic Versus Open Surgical Staging for Endometrial Cancer in India. Indian J Surg Oncol 2018; 9:133-140. [PMID: 29887689 PMCID: PMC5984840 DOI: 10.1007/s13193-017-0633-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 02/20/2017] [Indexed: 10/20/2022] Open
Abstract
Laparoscopic procedures to treat endometrial cancer are currently emerging. At present, we have evidence to do laparoscopic oncologic resections for endometrial cancer as proven by many prospective studies from abroad such as LAP2 by GOG. So, we have decided to assess the safety and feasibility of such a study in our population with the following as our primary objectives: (1) to study whether laparoscopy is better compared to open approach in terms of duration of hospital stay, perioperative morbidity and early recovery from surgical trauma and (2) to study whether the laparoscopic approach is noninferior to the open approach in terms of number of lymph nodes harvested in lymphadenectomy and rate of conversion to open surgery. We did a prospective nonrandomized comparative study of open versus laparoscopy approach for surgical staging of endometrial cancer from 16th May 2013 to 15th May 2015. To prove a significant difference in the hospital stay, we needed 29 patients in each arm. Thirty patients in each arm were enrolled for the study. The median duration of stay in the open arm was 7 days and in the laparoscopy arm it was 5 days. The advantage of 2 days in the laparoscopic arm was statistically significant (P value 0.006). Forty percent of patients in the open arm had to stay in the hospital for more than 7 days whereas only 3% of patients in the laparoscopy arm required to stay for more than 7 days (P value 0.001). This difference was statistically significant. There was no significant difference between the early complication rates between the two arms (20% in open vs. 13% in laparoscopy; P value 0.730). There was a conversion rate of 10% in laparoscopy. The median number of nodes harvested in open arm was 16.50 and in the laparoscopy arm, it was 13.50. The difference was not statistically significant (P value 0.086). Laparoscopy approach for endometrial cancer staging is feasible in Indian patients and the short-term advantages are replicable with same oncologic safety as proved by randomized controlled trials.
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Affiliation(s)
- Ansar P P
- Department of Surgical Oncology, Apollo Specialty Hospitals, Teynampet, Chennai, 600035 India
- Sree Gokulam Medical College and Research Foundaton, Venjaramood, Trivandrum, Kerala 695607 India
- Asaan Manzil, Pullampara P.O Venjaramoodu, Trivandrum, Kerala 695607 India
| | - Ayyappan S
- Department of Surgical Oncology, Apollo Specialty Hospitals, Teynampet, Chennai, 600035 India
| | - Vikash Mahajan
- Department of Surgical Oncology, Apollo Specialty Hospitals, Teynampet, Chennai, 600035 India
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Radosa JC, Radosa CG, Mavrova R, Wagenpfeil S, Hamza A, Joukhadar R, Baum S, Karsten M, Juhasz-Boess I, Solomayer EF, Radosa MP. Postoperative Quality of Life and Sexual Function in Premenopausal Women Undergoing Laparoscopic Myomectomy for Symptomatic Fibroids: A Prospective Observational Cohort Study. PLoS One 2016; 11:e0166659. [PMID: 27898669 PMCID: PMC5127523 DOI: 10.1371/journal.pone.0166659] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 11/01/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction Uterine leiomyomas are the most common benign gynecologic tumors. To date laparoscopy myomectomy is the gold standard for treatment of symptomatic fibroids in reproductive-aged women. Detailed counseling about the effects of this procedure on postoperative sexuality and quality of life is important in these patients. However, available data on these subjects are limited and contradictory. The aim of this study was to assess sexual function and quality of life in premenopausal women undergoing laparoscopic myomectomy for symptomatic uterine fibroids. Material and Methods All premenopausal women who underwent laparoscopic myomectomy for symptomatic fibroids between April 2012 and August 2014 at a tertiary university center were enrolled in this prospective observational cohort study. Sexual function and quality of life were assessed for the pre- and postoperative (six months post-operatively) state using two validated questionnaires, the Female Sexual Function Index (FSFI) and the European Quality of Life Five-Dimension Scale (EQ-5D). Results Ninety-five of the 115 (83%) eligible patients completed the study. Overall a significant improvement in quality of life and sexual function was observed in the study cohort: Median FSFI (28 (18.7–35.2)) and EQ-5D scores (1 (0.61–1) after laparoscopic myomectomy were significantly higher than preoperative scores (21.2 (5.2–33.5); 0.9 (0.2–1); p ≤ 0.01). The number, position and localization of the largest fibroids were not correlated with pre- or postoperative sexual function or quality of life. Conclusion Laparoscopic myomectomy might have positive short-term effects on postoperative quality of life and sexual function in premenopausal women suffering from symptomatic fibroids.
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Affiliation(s)
- Julia Caroline Radosa
- Department of Gynecology & Obstetrics, Saarland University Hospital, Homburg/Saar, Germany
- * E-mail:
| | | | - Russalina Mavrova
- Department of Gynecology & Obstetrics, Saarland University Hospital, Homburg/Saar, Germany
| | - Stefan Wagenpfeil
- Institute of Medical Biometry, Epidemiology & Medical Informatics, Saarland University Hospital, Homburg/Saar, Germany
| | - Amr Hamza
- Department of Gynecology & Obstetrics, Saarland University Hospital, Homburg/Saar, Germany
| | - Ralf Joukhadar
- Department of Gynecology & Obstetrics, Saarland University Hospital, Homburg/Saar, Germany
| | - Sascha Baum
- Department of Gynecology & Obstetrics, Saarland University Hospital, Homburg/Saar, Germany
| | - Maria Karsten
- Department of Gynecology, Charite Berlin, Berlin/Germany
| | - Ingolf Juhasz-Boess
- Department of Gynecology & Obstetrics, Saarland University Hospital, Homburg/Saar, Germany
| | - Erich-Franz Solomayer
- Department of Gynecology & Obstetrics, Saarland University Hospital, Homburg/Saar, Germany
| | - Marc Philipp Radosa
- Department of Gynecology and Obstetrics, Jena University Hospital, Jena, Germany
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Hinshaw SJ, Gunderson S, Eastwood D, Bradley WH. Endometrial carcinoma: The perioperative and long-term outcomes of robotic surgery in the morbidly obese. J Surg Oncol 2016; 114:884-887. [DOI: 10.1002/jso.24417] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/02/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Shirley J. Hinshaw
- Department of Obstetrics and Gynecology; The Medical College of Wisconsin; Milwaukee Wisconsin
| | - Stephanie Gunderson
- Department of Obstetrics and Gynecology; The Medical College of Wisconsin; Milwaukee Wisconsin
| | - Daniel Eastwood
- Division of Biostatistics; The Medical College of Wisconsin; Institute for Health and Society; Milwaukee Wisconsin
| | - William H. Bradley
- Department of Obstetrics and Gynecology; The Medical College of Wisconsin; Milwaukee Wisconsin
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von Heesen A, Takacs Z, Gabriel L, Hamza A, Linxweiler M, von Heesen M, Meyberg-Solomayer G, Solomayer EF, Juhasz-Böss I. Conversion of intraperitoneal cytology during laparoscopic surgery of uterine cancer. Arch Gynecol Obstet 2016; 294:847-54. [PMID: 27177538 DOI: 10.1007/s00404-016-4102-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/08/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The laparoscopic surgery of uterine cancer is an oncological safe treatment option in early stage cancer. However, there are no data about whether laparoscopy can lead to intraperitoneal tumor cell dissemination. We aimed in our study to detect a possible cytological conversion during laparoscopic procedures. METHODS In this prospective study, we included all patients receiving laparoscopic treatment at the early stage endometrial and cervical cancer in the Department of Obstetrics and Gynecology at the University of the Saarland and obtained peritoneal wash for cytological examination at the beginning and at the end of laparoscopic surgery. All patients received stage-adjusted operative and adjuvant therapy. RESULTS We enrolled 43 patients [endometrial cancer (n = 24) and cervical cancer (n = 19)]. At the beginning of the operation, one patient with endometrial cancer and one patient with cervical cancer showed a positive cytology. One tumor cell conversion from negative to positive cytology during surgery was detected in a patient suffering from endometrial cancer stage FIGO Ia. The median duration of surgery was 191.8 ± 79.3 min. The average time of follow-up was 16.5 ± 10.3 month. At the end of data evaluation at December 2014, two patients (8.6 %) are suffering from recurrent disease, two patients died, none of these patients had a positive cytology. All patients with positive cytology are free of cancer. CONCLUSION During laparoscopic surgery of early stage endometrial and cervical cancer, only one conversion of cytology was detected, which proves that laparoscopy does not appear to increase the intraoperative tumor cell dissemination or rate of positive cytological results.
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Affiliation(s)
- A von Heesen
- Department of Obstetrics and Gynecology, University of Saarland, Kirrbergerstr. 100, 66424, Homburg/Saar, Germany.
| | - Z Takacs
- Department of Obstetrics and Gynecology, University of Saarland, Kirrbergerstr. 100, 66424, Homburg/Saar, Germany
| | - L Gabriel
- Department of Obstetrics and Gynecology, University of Saarland, Kirrbergerstr. 100, 66424, Homburg/Saar, Germany
| | - A Hamza
- Department of Obstetrics and Gynecology, University of Saarland, Kirrbergerstr. 100, 66424, Homburg/Saar, Germany
| | - M Linxweiler
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Saarland, Kirrbergerstr. 100, 66424, Homburg/Saar, Germany
| | - M von Heesen
- Department of Surgery, University of Saarland, Kirrbergerstr. 100, 66424, Homburg/Saar, Germany
| | - G Meyberg-Solomayer
- Department of Obstetrics and Gynecology, University of Saarland, Kirrbergerstr. 100, 66424, Homburg/Saar, Germany
| | - E-F Solomayer
- Department of Obstetrics and Gynecology, University of Saarland, Kirrbergerstr. 100, 66424, Homburg/Saar, Germany
| | - I Juhasz-Böss
- Department of Obstetrics and Gynecology, University of Saarland, Kirrbergerstr. 100, 66424, Homburg/Saar, Germany
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Minimally invasive surgery for endometrial cancer: a comprehensive review. Arch Gynecol Obstet 2014; 291:721-7. [DOI: 10.1007/s00404-014-3517-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 10/08/2014] [Indexed: 10/24/2022]
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Comparison of reoperation rates, perioperative outcomes in women with endometrial cancer when the standard of care shifts from open surgery to laparoscopy. Arch Gynecol Obstet 2014; 290:1215-20. [DOI: 10.1007/s00404-014-3347-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 06/27/2014] [Indexed: 10/25/2022]
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Can a lymphadenectomy be avoided in early-stage endometrial adenocarcinoma? Arch Gynecol Obstet 2014; 290:973-8. [DOI: 10.1007/s00404-014-3265-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 04/17/2014] [Indexed: 01/11/2023]
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Juhasz-Böss I, Mallmann P, Möller CP, Solomayer EF. Use of Laparoscopy in the Treatment of Endometrial and Cervical Cancer - Results of a 2012 Germany-wide Survey. Geburtshilfe Frauenheilkd 2014; 73:911-917. [PMID: 24771942 DOI: 10.1055/s-0033-1350877] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 08/07/2013] [Accepted: 08/30/2013] [Indexed: 10/26/2022] Open
Abstract
Introduction: Endoscopy has begun to play an increasingly important role in the surgical therapy of uterine cancers. To date, there is no data on the use of laparoscopy to treat endometrial cancer (EC) and cervical cancer (CC). Method: A Germany-wide, anonymised survey was done of all gynaecological clinics/endoscopy clinics, using a standardised questionnaire. Results: A total of 128 clinics responded: 16 university clinics (12.5 %), 30 hospitals offering maximum care (23.4 %), 66 general hospitals (51.5 %), 5 outpatient clinics (3,9 %), 4 physicians in private practice affiliated to hospitals (3.1 %) and 7 hospitals (5.4 %) which did not indicate status. Laparoscopy was used in the treatment of 82 % of all EC and 54 % of CC. Surgery for EC was done completely laparoscopically in 58 % of cases and with laparoscopic assistance using a vaginal approach in 32 % of cases. If lymphadenectomy (LNE) was additionally performed, this was done abdominally in 42 % of cases and laparoscopically in 53 %. Cervical cancer was treated by laparoscopic radical hysterectomy (HE) in 44 % of cases and by radical HE using a vaginal approach in 14 %. 4 % of hospitals reported the use of other endoscopic methods (e.g. DaVinci). While the majority of hospitals (43.3 %) treated more than 75 % of EC patients using laparoscopy, in many clinics (38.3 %) less than 25 % of CC patients were treated using endoscopy. Discussion: Laparoscopy is used more often in EC surgery as compared to surgery for CC. However, there are still major differences between hospitals with regard to case numbers, the number of uterine cancers treated using endoscopic surgery, and the type of endoscopic surgery.
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Affiliation(s)
- I Juhasz-Böss
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar ; Kommission Uterus der AGO - Arbeitsgemeinschaft Gynäkologische Onkologie e. V
| | - P Mallmann
- Frauenklinik, Uniklinik Köln, Cologne ; Kommission Uterus der AGO - Arbeitsgemeinschaft Gynäkologische Onkologie e. V
| | - C P Möller
- Tagesklinik Altonaer Straße, Hamburg ; AGE - Arbeitsgemeinschaft Gynäkologische Endoskopie e. V. der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe e. V. (DGGG)
| | - E F Solomayer
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar ; AGE - Arbeitsgemeinschaft Gynäkologische Endoskopie e. V. der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe e. V. (DGGG)
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Five minutes of extended assisted ventilation with an open umbilical trocar valve significantly reduces postoperative abdominal and shoulder pain in patients undergoing laparoscopic hysterectomy. Eur J Obstet Gynecol Reprod Biol 2013; 171:122-7. [DOI: 10.1016/j.ejogrb.2013.08.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 08/03/2013] [Indexed: 11/17/2022]
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Tuschy B, Berlit S, Sütterlin M, Hornemann A. Duration of hospital stay after gynaecologic laparoscopic surgery: preferences of patients. Arch Gynecol Obstet 2013; 288:335-9. [DOI: 10.1007/s00404-013-2733-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 01/17/2013] [Indexed: 11/28/2022]
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