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Collins A, Jacob A, Moss E. Robotic-assisted surgery in high-risk surgical patients with endometrial cancer. Best Pract Res Clin Obstet Gynaecol 2024; 92:102421. [PMID: 37980868 DOI: 10.1016/j.bpobgyn.2023.102421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/08/2023] [Accepted: 10/10/2023] [Indexed: 11/21/2023]
Abstract
Many patients diagnosed with an endometrial cancer are at high-risk for surgery due to factors such as advanced age, raised body mass index or frailty. Minimally-invasive surgery, in particular robotic-assisted, is increasingly used in the surgical management of endometrial cancer however, there are a lack of clinical trials investigating outcomes in high-risk patient populations. This article will review the current evidence and identify areas of uncertainty where future research is needed.
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Affiliation(s)
- Anna Collins
- College of Life Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK; Deparatment of Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, LE1 5WW, UK
| | - Annie Jacob
- Department of Anaesthesia, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, LE1 5WW, UK
| | - Esther Moss
- College of Life Sciences, University of Leicester, University Road, Leicester, LE1 7RH, UK; Deparatment of Gynaecological Oncology, University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, LE1 5WW, UK.
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Cho SH, Lee JY, Nam EJ, Kim S, Kim YT, Kim SW. Comparison of Single-Port Laparoscopy with Other Surgical Approaches in Endometrial Cancer Surgical Staging: Propensity-Score-Matched Analysis. Cancers (Basel) 2023; 15:5322. [PMID: 38001582 PMCID: PMC10670050 DOI: 10.3390/cancers15225322] [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: 10/14/2023] [Revised: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
This single-institution, retrospective study aimed to compare the surgical outcomes of single-port, multi-port, and robot-assisted laparoscopy, as well as laparotomy, in patients with endometrial cancer who underwent surgical staging between January 2006 and December 2017. This study evaluated various parameters, including disease-free survival (DFS), overall survival (OS), recurrence rate (RR), recurrence site, and intra- and postoperative complications. Propensity score matching was performed to account for baseline characteristics, and a total of 881 patients were included in the analysis. The 3-year DFS of single-port laparoscopy was similar to that of the other groups, but laparotomy exhibited a lower 3-year DFS compared to multi-port (p = 0.001) and robot-assisted (p = 0.031) laparoscopy. Single-port laparoscopy resulted in a significantly higher 3-year OS than laparotomy (p = 0.013). After propensity score matching, the four groups demonstrated similar survival outcomes (3-year DFS: p = 0.533; 3-year OS: p = 0.328) and recurrence rates (10.3%, 12.1%, 10.3%, and 15.9% in the single-port, multi-port, and robot-assisted laparoscopy and laparotomy groups, respectively, p = 0.552). Recurrence most commonly occurred in distant organs. The single-port laparoscopy group had the longest operative time (205.1 ± 76.9 min) but the least blood loss (69.5 ± 90.8 mL) and the shortest postoperative hospital stay (5.2 ± 2.3 days). In contrast, the laparotomy group had the shortest operative time (163.4 ± 51.0 min) but the highest blood loss (368.3 ± 326.4 mL) and the longest postoperative hospital stay (10.3 ± 4.6 days). The transfusion rate was 0% in the single-port laparoscopy group and 3.7% in the laparotomy group. Notably, the laparotomy group had the highest wound complication rate (p = 0.001), whereas no wound hernias were observed in the three minimally invasive approaches. In conclusion, the survival outcomes were comparable between the methods, with the benefit of lower blood loss and shorter hospital stay observed in the single-port laparoscopy group. This study suggests that single-port laparoscopy is a feasible approach for endometrial cancer surgical staging.
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Affiliation(s)
- Sang Hyun Cho
- Department of Obstetrics and Gynecology, Graduate School, Yonsei University College of Medicine, Seoul 03722, Republic of Korea;
- Department of Obstetrics and Gynecology, St. Vincent’s Hospital, The Catholic University of Korea, Suwon 16247, Republic of Korea
| | - Jung-Yun Lee
- Department of Obstetrics and Gynecology, Women’s Cancer Center, Yonsei Cancer Center, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.-Y.L.); (E.J.N.); (S.K.); (Y.T.K.)
| | - Eun Ji Nam
- Department of Obstetrics and Gynecology, Women’s Cancer Center, Yonsei Cancer Center, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.-Y.L.); (E.J.N.); (S.K.); (Y.T.K.)
| | - Sunghoon Kim
- Department of Obstetrics and Gynecology, Women’s Cancer Center, Yonsei Cancer Center, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.-Y.L.); (E.J.N.); (S.K.); (Y.T.K.)
| | - Young Tae Kim
- Department of Obstetrics and Gynecology, Women’s Cancer Center, Yonsei Cancer Center, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.-Y.L.); (E.J.N.); (S.K.); (Y.T.K.)
| | - Sang Wun Kim
- Department of Obstetrics and Gynecology, Women’s Cancer Center, Yonsei Cancer Center, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.-Y.L.); (E.J.N.); (S.K.); (Y.T.K.)
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Lechartier C, Bernard J, Renaud MC, Plante M. Robotic-assisted surgery for endometrial cancer is safe in morbidly and extremely morbidly obese patients. Gynecol Oncol 2023; 172:15-20. [PMID: 36905768 DOI: 10.1016/j.ygyno.2023.02.014] [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: 12/04/2022] [Revised: 02/19/2023] [Accepted: 02/24/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE Obesity has risen to affect >25% of the Canadian population. Perioperative challenges with increased morbidity are encountered. We evaluated the outcome of robotic-assisted surgery for endometrial cancer (EC) in obese patients. METHODS We retrospectively reviewed all robotic surgeries performed for EC in women with BMI ≥40 kg/m2, from 2012 to 2020 in our center. Patients were divided into 2 groups (class III: 40-49 kg/m2, class IV: ≥50 kg/m2). Complications and outcome were compared. RESULTS 185 patients were included: 139 class III and 46 class IV. The main histology was endometrioid adenocarcinoma (70,5% of class III and 58,1% of class IV (p = 0,138)). The mean blood loss, overall sentinel node detection and median length of stay were similar in both groups. Six class III (4,3%) and 3 class IV (6,5%) patients required conversion to laparotomy due to poor surgical field exposure (p = 0,692). The rate of intraoperative complications was similar between the 2 groups (1.4% in class III vs none in class IV, p = 1). There were 10 class III (7,2%) and 10 class IV (21,7%) post-operative complications (p = 0.011), but most were grade 2 (3,6% in class III vs 13% in class IV, p = 0.029)). Grade 3 and 4 postoperative complications were low (2.7%) and not statistically different between the 2 groups. Readmission rate was low in both groups (4 in each group, p = 1.07). Recurrence occurred in 5,8% of class III and 4,3% of class IV patients (p = 1). CONCLUSION Robotic-assisted surgery for EC in class III and class IV obese patients is a safe and feasible procedure, with low complication rate, similar oncologic outcome, conversion rate, blood loss, readmission rate and length of hospital stay.
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Affiliation(s)
- Céline Lechartier
- Gynecologic Oncology Division, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, Canada.
| | - Juliette Bernard
- Gynecologic Oncology Division, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, Canada
| | - Marie-Claude Renaud
- Gynecologic Oncology Division, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, Canada
| | - Marie Plante
- Gynecologic Oncology Division, L'Hôtel-Dieu de Québec, Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, Canada.
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Obermair A, Nicklin J, Gebski V, Hayes SC, Graves N, Mileshkin L, Lin MY, Beale P, Baxter E, Robledo K, Salomon C, Hanna GB, Janda M. A phase III randomized clinical trial comparing sentinel node biopsy with no retroperitoneal node dissection in apparent early-stage endometrial cancer - ENDO-3: ANZGOG trial 1911/2020. Int J Gynecol Cancer 2021; 31:1595-1601. [PMID: 34728527 DOI: 10.1136/ijgc-2021-003029] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Sentinel node biopsy is a surgical technique to explore lymph nodes for surgical staging of endometrial cancer, which has replaced full retroperitoneal lymph node dissection. However, the effectiveness of sentinel node biopsy, its value to patients, and potential harms compared with no-node dissection have never been shown in a randomized trial. PRIMARY OBJECTIVES Stage 1 will test recovery from surgery. Stage 2 will compare disease-free survival at 4.5 years between patients randomized to sentinel node biopsy versus no retroperitoneal node dissection. STUDY HYPOTHESIS The primary hypothesis for stage 1 is that treatment with sentinel node biopsy will not cause detriment to patient outcomes (lymphedema, morbidity, loss of quality of life) and will not increase treatment-related morbidity or health services costs compared with patients treated without a retroperitoneal node dissection at 12 months after surgery. The primary hypothesis for stage 2 is that disease-free survival at 4.5 years after surgery in patients without retroperitoneal node dissection is not inferior to those receiving sentinel node biopsy. TRIAL DESIGN This phase III, open-label, two-arm, multistage, randomized non-inferiority trial (ENDO-3) will determine the value of sentinel node biopsy for surgical management of endometrial cancer. Patients with endometrial cancer are randomized to receive: (1) laparoscopic/robotic hysterectomy, bilateral salpingo-oophorectomy with sentinel node biopsy or (2) laparoscopic/robotic hysterectomy, bilateral salpingo-oophorectomy without retroperitoneal node dissection. In stage 1, 444 patients will be enrolled to demonstrate feasibility and quality of life. If this is demonstrated, we will enroll another 316 patients in stage 2. MAJOR INCLUSION AND EXCLUSION CRITERIA Inclusion criteria include women aged 18 years or older with histologically confirmed endometrial cancer; clinical stage 1, who meet the criteria for laparoscopic or robotic total hysterectomy and bilateral salpingo-oophorectomy. Patients with uterine mesenchymal tumors are excluded. PRIMARY ENDPOINTS The endpoint for stage 1 is surgical recovery, with the proportion of patients returning to usual daily activities at 3 months post-surgery as measured with the EQ-5D. Stage 2 is disease-free survival at 4.5 years. SAMPLE SIZE 760 participants (both stages). ESTIMATED DATES FOR COMPLETING ACCRUAL AND PRESENTING RESULTS Stage 1 commenced in January 2021 and is planned to be completed in December 2024 when 444 participants have completed 12 months' follow-up. Stage 2 will enroll a further 316 participants for a total of 760 patients. TRIAL REGISTRATION NCT04073706.
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Affiliation(s)
- Andreas Obermair
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Brisbane, Queensland, Australia .,Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jim Nicklin
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Val Gebski
- Biostatistics and Research Methodology, University of Sydney NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia
| | - Sandra C Hayes
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Nicholas Graves
- Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Linda Mileshkin
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ming Yin Lin
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Phillip Beale
- Australia New Zealand Gynaecological Oncology Group (ANZGOG), Sydney, New South Wales, Australia
| | - Eva Baxter
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Kristy Robledo
- Biostatistics and Research Methodology, University of Sydney NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia
| | - Carlos Salomon
- Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - George B Hanna
- Department of Surgery & Cancer, Faculty of Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Monika Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Vardar MA, Guzel AB, Taskin S, Gungor M, Ozgul N, Salman C, Kucukgoz-Gulec U, Khatib G, Taskiran C, Dünder I, Ortac F, Yuce K, Terek C, Simsek T, Ozsaran A, Onan A, Coban G, Topuz S, Demirkiran F, Takmaz O, Kose MF, Gocmen A, Seydaoglu G, Gumurdulu D, Ayhan A. Could the Long-Term Oncological Safety of Laparoscopic Surgery in Low-Risk Endometrial Cancer also Be Valid for the High-Intermediate- and High-Risk Patients? A Multi-Center Turkish Gynecologic Oncology Group Study Conducted with 2745 Endometrial Cancer Cases. (TRSGO-End-001). Curr Oncol 2021; 28:4328-4340. [PMID: 34898563 PMCID: PMC8628704 DOI: 10.3390/curroncol28060368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/10/2021] [Accepted: 10/26/2021] [Indexed: 12/16/2022] Open
Abstract
This study was conducted to compare the long-term oncological outcomes of laparotomy and laparoscopic surgeries in endometrial cancer under the light of the 2016 ESMO-ESGO-ESTRO risk classification system, with particular focus on the high–intermediate- and high-risk categories. Using multicentric databases between January 2005 and January 2016, disease-free and overall survivals of 2745 endometrial cancer cases were compared according to the surgery route (laparotomy vs. laparoscopy). The high–intermediate- and high-risk patients were defined with respect to the 2016 ESMO-ESGO-ESTRO risk classification system, and they were analyzed with respect to differences in survival rates. Of the 2745 patients, 1743 (63.5%) were operated by laparotomy, and the remaining were operated with laparoscopy. The total numbers of high–intermediate- and high-risk endometrial cancer cases were 734 (45%) patients in the laparotomy group and 307 (30.7%) patients in the laparoscopy group. Disease-free and overall survivals were not statistically different when compared between laparoscopy and laparotomy groups in terms of low-, intermediate-, high–intermediate- and high-risk endometrial cancer. In conclusion, regardless of the endometrial cancer risk category, long-term oncological outcomes of the laparoscopic approach were found to be comparable to those treated with laparotomy. Our results are encouraging to consider laparoscopic surgery for high–intermediate- and high-risk endometrial cancer cases.
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Affiliation(s)
- Mehmet Ali Vardar
- Gynecologic Oncology Department, Medical Faculty, Çukurova University, Adana 01380, Turkey; (M.A.V.); (A.B.G.); (U.K.-G.)
| | - Ahmet Baris Guzel
- Gynecologic Oncology Department, Medical Faculty, Çukurova University, Adana 01380, Turkey; (M.A.V.); (A.B.G.); (U.K.-G.)
| | - Salih Taskin
- Gynecologic Oncology Department, Medical Faculty, Ankara University, Ankara 06100, Turkey; (S.T.); (M.G.); (I.D.); (F.O.)
| | - Mete Gungor
- Gynecologic Oncology Department, Medical Faculty, Ankara University, Ankara 06100, Turkey; (S.T.); (M.G.); (I.D.); (F.O.)
- Gynecologic Oncology Department, Medical Faculty, Acıbadem University, İstanbul 34684, Turkey;
| | - Nejat Ozgul
- Gynecologic Oncology Department, Medical Faculty, Hacettepe University, Ankara 06230, Turkey; (N.O.); (C.S.); (K.Y.)
| | - Coskun Salman
- Gynecologic Oncology Department, Medical Faculty, Hacettepe University, Ankara 06230, Turkey; (N.O.); (C.S.); (K.Y.)
| | - Umran Kucukgoz-Gulec
- Gynecologic Oncology Department, Medical Faculty, Çukurova University, Adana 01380, Turkey; (M.A.V.); (A.B.G.); (U.K.-G.)
| | - Ghanim Khatib
- Gynecologic Oncology Department, Medical Faculty, Çukurova University, Adana 01380, Turkey; (M.A.V.); (A.B.G.); (U.K.-G.)
- Correspondence: ; Tel.: +90-322-3386060-3195-3196; Fax: +90-322-3386527
| | - Cagatay Taskiran
- Gynecologic Oncology Department, Medical Faculty, Gazi University, Ankara 06560, Turkey; (C.T.); (A.O.)
- Gynecologic Oncology Department, Medical Faculty, Koç University, İstanbul 34450, Turkey
| | - Ilkkan Dünder
- Gynecologic Oncology Department, Medical Faculty, Ankara University, Ankara 06100, Turkey; (S.T.); (M.G.); (I.D.); (F.O.)
| | - Firat Ortac
- Gynecologic Oncology Department, Medical Faculty, Ankara University, Ankara 06100, Turkey; (S.T.); (M.G.); (I.D.); (F.O.)
| | - Kunter Yuce
- Gynecologic Oncology Department, Medical Faculty, Hacettepe University, Ankara 06230, Turkey; (N.O.); (C.S.); (K.Y.)
| | - Cosan Terek
- Gynecologic Oncology Department, Medical Faculty, Ege University, İzmir 35040, Turkey; (C.T.); (A.O.)
| | - Tayup Simsek
- Gynecologic Oncology Department, Medical Faculty, Akdeniz University, Antalya 07070, Turkey;
| | - Aydın Ozsaran
- Gynecologic Oncology Department, Medical Faculty, Ege University, İzmir 35040, Turkey; (C.T.); (A.O.)
| | - Anil Onan
- Gynecologic Oncology Department, Medical Faculty, Gazi University, Ankara 06560, Turkey; (C.T.); (A.O.)
| | - Gonca Coban
- Gynecologic Oncology Department, Adana Training and Research Hospital, Başkent University, Adana 01250, Turkey;
| | - Samet Topuz
- Gynecologic Oncology Department, Çapa Medical Faculty, İstanbul University, İstanbul 34093, Turkey;
| | - Fuat Demirkiran
- Gynecologic Oncology Department, Medical Faculty, İstanbul University, Cerrahpaşa, İstanbul 34098, Turkey;
| | - Ozguc Takmaz
- Gynecologic Oncology Department, Medical Faculty, Acıbadem University, İstanbul 34684, Turkey;
| | - M. Faruk Kose
- Gynecologic Oncology Department, Medical Faculty, Medipol University, İstanbul 34200, Turkey;
| | - Ahmet Gocmen
- Gynecologic Oncology Department, Umraniye Training and Research Hospital, İstanbul 34760, Turkey;
| | - Gulsah Seydaoglu
- Department of Biostatistics, Medical Faculty, Çukurova University, Adana 01380, Turkey;
| | - Derya Gumurdulu
- Department of Gynecologic Pathology, Medical Faculty, Çukurova University, Adana 01380, Turkey;
| | - Ali Ayhan
- Gynecologic Oncology Department, Medical Faculty, Başkent University, Ankara 06490, Turkey;
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Casarin J, Bogani G, Piovano E, Falcone F, Ferrari F, Odicino F, Puppo A, Bonfiglio F, Donadello N, Pinelli C, Laganà AS, Ditto A, Malzoni M, Greggi S, Raspagliesi F, Ghezzi F. Survival implication of lymphadenectomy in patients surgically treated for apparent early-stage uterine serous carcinoma. J Gynecol Oncol 2021; 31:e64. [PMID: 32808495 PMCID: PMC7440990 DOI: 10.3802/jgo.2020.31.e64] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Uterine serous carcinoma (USC) is a rare highly aggressive disease. In the present study, we aimed to investigate the survival implication of the systematic lymphadenectomy in patients who underwent surgery for apparent early-stage USC. METHODS Consecutive patients with apparent early-stage USC surgically treated at six Italian referral cancer centers were analyzed. A comparison was made between patients who underwent retroperitoneal staging including at least pelvic lymphadenectomy "LND" vs. those who underwent hysterectomy alone "NO-LND". Baseline, surgical and oncological outcomes were analyzed. Kaplan- Meier curves were calculated for disease-free survival (DFS) and disease-specific survival (DSS). Associations were evaluated with Cox proportional hazard regression and summarized using hazard ratio (HR). RESULTS One hundred forty patients were analyzed, 106 LND and 34 NO-LND. NO-LND group (compared to LND group) included older patients (median age, 73 vs.67 years) and with higher comorbidities (median Charlson Comorbidity Index, 6 vs. 5) (p<0.001). No differences in terms of recurrence rate (LND vs. NO-LND, 33.1% vs. 41.4%; p=0.240) were observed. At Cox regression analysis lymphadenectomy did not significantly influence DFS (HR=0.59; 95% confidence interval [CI]=0.32-1.08; p=0.09), and DSS (HR=0.14; 95% CI=0.02-1.21; multivariable analysis p=0.07). Positive node was independently associated with worse DFS (HR=6.22; 95% CI=3.08-12.60; p<0.001) and DSS (HR=5.51; 95% CI=2.31-13.10; p<0.001), while adjuvant chemotherapy was associated with improved DFS (HR=0.38; 95% CI=0.17-0.86; p=0.02) and age was independently associated with worse DSS (HR=1.07; 95% CI=1.02-1.13; p<0.001). CONCLUSIONS Although lymphadenectomy did not show survival benefits in patients who underwent surgery for apparent early-stage USC, the presence of lymph node metastasis was the main adverse prognostic factors, supporting the prognostic role of the retroperitoneal staging also in this histological subtype.
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Affiliation(s)
- Jvan Casarin
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
| | - Giorgio Bogani
- Department of Gynecologic Oncology, National Cancer Institute, Milan, Italy
| | - Elisa Piovano
- Obstetrics and Gynecology Unit, Regina Montis Regalis Hospital, Mondovì, Italy
| | - Francesca Falcone
- Department of Gynecologic Oncology Surgery, Istituto Nazionale Tumori, IRCSS, "Fondazione G. Pascale", Naples, Italy.,Endoscopica Malzoni - Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Federico Ferrari
- Department of Obstetrics and Gynecology, Spedali Civili, Brescia, Italy
| | - Franco Odicino
- Department of Obstetrics and Gynecology, Spedali Civili, Brescia, Italy
| | - Andrea Puppo
- Obstetrics and Gynecology Unit, Regina Montis Regalis Hospital, Mondovì, Italy
| | | | - Nicoletta Donadello
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Ciro Pinelli
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | | | - Antonino Ditto
- Department of Gynecologic Oncology, National Cancer Institute, Milan, Italy
| | - Mario Malzoni
- Endoscopica Malzoni - Center for Advanced Endoscopic Gynecological Surgery, Avellino, Italy
| | - Stefano Greggi
- Department of Gynecologic Oncology Surgery, Istituto Nazionale Tumori, IRCSS, "Fondazione G. Pascale", Naples, Italy
| | | | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
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7
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Nagar H, Wietek N, Goodall RJ, Hughes W, Schmidt-Hansen M, Morrison J. Sentinel node biopsy for diagnosis of lymph node involvement in endometrial cancer. Cochrane Database Syst Rev 2021; 6:CD013021. [PMID: 34106467 PMCID: PMC8189170 DOI: 10.1002/14651858.cd013021.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Pelvic lymphadenectomy provides prognostic information for those diagnosed with endometrial (womb) cancer and provides information that may influence decisions regarding adjuvant treatment. However, studies have not shown a therapeutic benefit, and lymphadenectomy causes significant morbidity. The technique of sentinel lymph node biopsy (SLNB), allows the first draining node from a cancer to be identified and examined histologically for involvement with cancer cells. SLNB is commonly used in other cancers, including breast and vulval cancer. Different tracers, including colloid labelled with radioactive technetium-99, blue dyes, e.g. patent or methylene blue, and near infra-red fluorescent dyes, e.g. indocyanine green (ICG), have been used singly or in combination for detection of sentinel lymph nodes (SLN). OBJECTIVES To assess the diagnostic accuracy of sentinel lymph node biopsy (SLNB) in the identification of pelvic lymph node involvement in women with endometrial cancer, presumed to be at an early stage prior to surgery, including consideration of the detection rate. SEARCH METHODS We searched MEDLINE (1946 to July 2019), Embase (1974 to July 2019) and the relevant Cochrane trial registers. SELECTION CRITERIA We included studies that evaluated the diagnostic accuracy of tracers for SLN assessment (involving the identification of a SLN plus histological examination) against a reference standard of histological examination of removed pelvic +/- para-aortic lymph nodes following systematic pelvic +/- para-aortic lymphadenectomy (PLND/PPALND) in women with endometrial cancer, where there were sufficient data for the construction of two-by-two tables. DATA COLLECTION AND ANALYSIS Two review authors (a combination of HN, JM, NW, RG, and WH) independently screened titles and abstracts for relevance, classified studies for inclusion/exclusion and extracted data. We assessed the methodological quality of studies using the QUADAS-2 tool. We calculated the detection rate as the arithmetic mean of the total number of SLNs detected out of the total number of women included in the included studies with the woman as the unit of analysis, used univariate meta-analytical methods to estimate pooled sensitivity estimates, and summarised the results using GRADE. MAIN RESULTS The search revealed 6259 unique records after removal of duplicates. After screening 232 studies in full text, we found 73 potentially includable records (for 52 studies), although we were only able to extract 2x2 table data for 33 studies, including 2237 women (46 records) for inclusion in the review, despite writing to trial authors for additional information. We found 11 studies that analysed results for blue dye alone, four studies for technetium-99m alone, 12 studies that used a combination of blue dye and technetium-99m, nine studies that used indocyanine green (ICG) and near infra-red immunofluorescence, and one study that used a combination of ICG and technetium-99m. Overall, the methodological reporting in most of the studies was poor, which resulted in a very large proportion of 'unclear risk of bias' ratings. Overall, the mean SLN detection rate was 86.9% (95% CI 82.9% to 90.8%; 2237 women; 33 studies; moderate-certainty evidence). In studies that reported bilateral detection the mean rate was 65.4% (95% CI 57.8% to 73.0%) . When considered according to which tracer was used, the SLN detection rate ranged from 77.8% (95% CI 70.0% to 85.6%) for blue dye alone (559 women; 11 studies; low-certainty evidence) to 100% for ICG and technetium-99m (32 women; 1 study; very low-certainty evidence). The rates of positive lymph nodes ranged from 5.2% to 34.4% with a mean of 20.1% (95% CI 17.7% to 22.3%). The pooled sensitivity of SLNB was 91.8% (95% CI 86.5% to 95.1%; total 2237 women, of whom 409 had SLN involvement; moderate-certainty evidence). The sensitivity for of SLNB for the different tracers were: blue dye alone 95.2% (95% CI 77.2% to 99.2%; 559 women; 11 studies; low-certainty evidence); Technetium-99m alone 90.5% (95% CI 67.7% to 97.7%; 257 women; 4 studies; low-certainty evidence); technetium-99m and blue dye 91.9% (95% CI 74.4% to 97.8%; 548 women; 12 studies; low-certainty evidence); ICG alone 92.5% (95% CI 81.8% to 97.1%; 953 women; 9 studies; moderate-certainty evidence); ICG and blue dye 90.5% (95% CI 63.2.6% to 98.1%; 215 women; 2 studies; low-certainty evidence); and ICG and technetium-99m 100% (95% CI 63% to 100%; 32 women; 1 study; very low-certainty evidence). Meta-regression analyses found that the sensitivities did not differ between the different tracers used, between studies with a majority of women with FIGO stage 1A versus 1B or above; between studies assessing the pelvic lymph node basin alone versus the pelvic and para-aortic lymph node basin; or between studies that used subserosal alone versus subserosal and cervical injection. It should be noted that a false-positive result cannot occur, as the histological examination of the SLN is unchanged by the results from any additional nodes removed at systematic lymphadenectomy. AUTHORS' CONCLUSIONS The diagnostic test accuracy for SLNB using either ICG alone or a combination of a dye (blue or ICG) and technetium-99m is probably good, with high sensitivity, where a SLN could be detected. Detection rates with ICG or a combination of dye (ICG or blue) and technetium-99m may be higher. The value of a SLNB approach in a treatment pathway, over adjuvant treatment decisions based on uterine factors and molecular profiling, requires examination in a high-quality intervention study.
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Affiliation(s)
- Hans Nagar
- Belfast Health and Social Care Trust, Belfast City Hospital and the Royal Maternity Hospital, Belfast, UK
| | - Nina Wietek
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Richard J Goodall
- Department of Surgery and Cancer , Imperial College London, London, UK
| | - Will Hughes
- Department of Plastic Surgery, Addenbrookes Hospital, Cambridge, UK
| | - Mia Schmidt-Hansen
- National Guideline Alliance, Royal College of Obstetricians and Gynaecologists, London, UK
| | - Jo Morrison
- Department of Gynaecological Oncology, GRACE Centre, Musgrove Park Hospital, Taunton, UK
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8
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Sanjida S, Obermair A, Gebski V, Armfield N, Janda M. Long-term quality of life outcomes of women treated for early-stage endometrial cancer. Int J Gynecol Cancer 2020; 31:530-536. [PMID: 33361459 DOI: 10.1136/ijgc-2020-002145] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To compare long-term quality of life in women treated for early-stage endometrial cancer with population norms, and to compare quality of life outcomes of patients who had total laparoscopic or total abdominal hysterectomy. METHODS Once the last enrolled patient had completed 4.5 years of follow-up after surgery, participants in the Laparoscopic Approach to Cancer of the Endometrium (LACE) clinical trial were asked to complete a self-administered questionnaire. Two instruments-EuroQol 5 Dimension 3-level (EQ-5D-3L) and the Functional Assessment of Cancer Treatment-General Population (FACT-GP)-were used to determine quality of life. The mean computed EQ-5D-3L index scores for LACE participants at different age categories were compared with Australian normative scores; and the FACT-GP scores were compared between patients treated with surgical treatments. RESULTS Of 760 women originally enrolled in the LACE trial, 259 (50.2%) of 516 women consented to provide long-term follow-up data at a median of 9 years (range 6-12) after surgery. On the EQ-5D-3L, long-term endometrial cancer survivors reported higher prevalence of anxiety/depression than normative levels across all age groups (55-64 years, 30% vs 14.9%; 65-74 years, 30.1% vs 15.8%; ≥75 years, 25.9% vs 10.7%). For women ≥75 years of age, the prevalence of impairment in mobility (57.6% vs 43.3%) and usual activities (58.8% vs 37.9%) was also higher than for population norms. For the FACT-GP, the physical (effect size: -0.28, p<0.028) and functional (effect size: -0.30, p<0.015) well-being sub-scale favored the total laparoscopic hysterectomy compared with total abdominal hysterectomy recipients. CONCLUSION Compared with population-based norms, long-term endometrial cancer survivors reported higher prevalence of anxiety/depression across all age groups, and deficits in mobility and usual activities for women aged ≥75 years. Physical and functional well-being were better among women who were treated with total laparoscopic hysterectomy than among those receiving total abdominal hysterectomy.
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Affiliation(s)
- Saira Sanjida
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Andreas Obermair
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Nigel Armfield
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Monika Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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9
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El-Achi V, Weishaupt J, Carter J, Saidi S. Robotic versus laparoscopic hysterectomy in morbidly obese women for endometrial cancer. J Robot Surg 2020; 15:483-487. [PMID: 32737804 DOI: 10.1007/s11701-020-01133-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/26/2020] [Indexed: 11/30/2022]
Abstract
Surgery is the mainstay treatment for endometrial cancer and complex atypical endometrial hyperplasia. These conditions are more common in the obese women and as such these patients pose additional risks and challenges to surgery. Laparoscopic hysterectomy (LH) is preferred over open surgery in obese patients as it reduces surgical morbidity. However, more recently, robotic-assisted hysterectomy (RH) has been used in morbidly obese patients to overcome the limitations of conventional laparoscopy. To compare the surgical outcomes of morbidly obese patients undergoing LH or RH for endometrial cancer or complex atypical hyperplasia. A retrospective analysis of morbidly obese patients (BMI > 40 kg/m2) who underwent LH or RH for endometrial cancer or complex atypical hyperplasia at the Chris O'Brien Lifehouse Gynaecological Oncology Unit from 2015 to 2019 was performed. Data was collected from the prospectively maintained gynaecology oncology database and descriptive analysis was performed. 33 (51.6%) underwent LH and 31 (48.4%) had RH. More LHs were performed 2015-2017 period, whereas there were more RHs performed in 2018-2019 period (p = 0.01). The difference between theatre time use and operating time for LH surgery compared to RH was significantly shorter (45.7 for LH versus 61.9 min for RH, p = 0.009). RH was performed more commonly when BMI was > 50 kg/m2 (p = 0.02). There has been an increase in the use of RH in morbidly obese patients, particularly for women with a BMI > 50 kg/m2.
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Affiliation(s)
- Vanessa El-Achi
- Chris O'Brien Lifehouse, Sydney, Australia. .,RPA Women and Babies, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, NSW, 2050, Australia.
| | | | - Jonathan Carter
- Chris O'Brien Lifehouse, Sydney, Australia.,University of Sydney, Sydney, Australia
| | - Sam Saidi
- Chris O'Brien Lifehouse, Sydney, Australia.,University of Sydney, Sydney, Australia
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10
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Caughey L, Sanjida S, Obermair A, Janda M. The use of CAM products, practices, and practitioners by long-term endometrial cancer survivors in Australia. Support Care Cancer 2020; 28:5479-5489. [DOI: 10.1007/s00520-020-05404-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 03/06/2020] [Indexed: 12/22/2022]
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11
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Cusimano MC, Simpson AN, Dossa F, Liani V, Kaur Y, Acuna SA, Robertson D, Satkunaratnam A, Bernardini MQ, Ferguson SE, Baxter NN. Laparoscopic and robotic hysterectomy in endometrial cancer patients with obesity: a systematic review and meta-analysis of conversions and complications. Am J Obstet Gynecol 2019; 221:410-428.e19. [PMID: 31082383 DOI: 10.1016/j.ajog.2019.05.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE DATA Robotic assistance may facilitate completion of minimally invasive hysterectomy, which is the standard of care for the treatment of early-stage endometrial cancer, in patients for whom conventional laparoscopy is challenging. The aim of this systematic review was to assess conversion to laparotomy and perioperative complications after laparoscopic and robotic hysterectomy in patients with endometrial cancer and obesity (body mass index, ≥30 kg/m2). STUDY We systematically searched MEDLINE, EMBASE, and Evidence-Based Medicine Reviews (January 1, 2000, to July 18, 2018) for studies of patients with endometrial cancer and obesity (body mass index, ≥30 kg/m2) who underwent primary hysterectomy. STUDY APPRAISAL AND SYNTHESIS METHODS We determined the pooled proportions of conversion, organ/vessel injury, venous thromboembolism, and blood transfusion. We assessed risk of bias with the Institute of Health Economics Quality Appraisal Checklist for single-arm studies, and Newcastle-Ottawa Quality Scale for double-arm studies. RESULTS We identified 51 observational studies that reported on 10,800 patients with endometrial cancer and obesity (study-level body mass index, 31.0-56.3 kg/m2). The pooled proportions of conversion from laparoscopic and robotic hysterectomy were 6.5% (95% confidence interval, 4.3-9.9) and 5.5% (95% confidence interval, 3.3-9.1), respectively, among patients with a body mass index of ≥30 kg/m2, and 7.0% (95% confidence interval, 3.2-14.5) and 3.8% (95% confidence interval, 1.4-9.9) among patients with body mass index of ≥40 kg/m2. Inadequate exposure because of adhesions/visceral adiposity was the most common reason for conversion for both laparoscopic (32%) and robotic hysterectomy (61%); however, intolerance of the Trendelenburg position caused 31% of laparoscopic conversions and 6% of robotic hysterectomy conversions. The pooled proportions of organ/vessel injury (laparoscopic, 3.5% [95% confidence interval, 2.2-5.5]; robotic hysterectomy, 1.2% [95% confidence interval, 0.4-3.4]), venous thromboembolism (laparoscopic, 0.5% [95% confidence interval, 0.2-1.2]; robotic hysterectomy, 0.5% [95% confidence interval, 0.1-2.0]), and blood transfusion (laparoscopic, 2.8% [95% confidence interval, 1.5-5.1]; robotic hysterectomy, 2.1% [95% confidence interval, 1.6-3.8]) were low and not appreciably different between arms. CONCLUSION Robotic and laparoscopic hysterectomy have similar rates perioperative complications in patients with endometrial cancer and obesity, but robotic hysterectomy may reduce conversions because of positional intolerance in patients with morbid obesity. Existing literature is limited by selection and confounding bias, and randomized trials are needed to inform practice standards in this population.
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Affiliation(s)
- Maria C Cusimano
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Andrea N Simpson
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics & Gynecology, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Valentina Liani
- Faculty of Medicine and Surgery, University of Trieste, Trieste TS Italy
| | - Yuvreet Kaur
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Deborah Robertson
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics & Gynecology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Abheha Satkunaratnam
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics & Gynecology, North York General Hospital, Toronto, Ontario, Canada
| | - Marcus Q Bernardini
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada; Division of Gynecologic Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Sarah E Ferguson
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada; Division of Gynecologic Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Nancy N Baxter
- Department of Surgery, Toronto, Ontario, Canada; Division of General Surgery, St. Michael's Hospital, Toronto, Ontario, Canada.
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12
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Armfield NR, Janda M, Obermair A. Obesity in total laparoscopic hysterectomy for early stage endometrial cancer: health gain and inpatient resource use. Int J Qual Health Care 2019; 31:283-288. [PMID: 30060080 DOI: 10.1093/intqhc/mzy162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/22/2018] [Accepted: 07/20/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To explore relationships between BMI (morbid/severe obesity; BMI ≥ 35 kg/m2 vs. non morbid/severe obesity; BMI < 35 kg/m2), postoperative health gain and hospital resource use for women who receive a Total Laparoscopic Hysterectomy (TLH) for early stage endometrial cancer. DESIGN Secondary analysis of RCT data (LACE Study; Total Abdominal Hysterectomy vs. TLH). SETTING 20 tertiary gynaecological cancer centres in Australia, New Zealand and Hong Kong. POPULATION About 404 women who received TLH to treat early stage endometrial cancer. METHODS For women with BMI < 35 vs. BMI ≥ 35 kg/m2, we compared (i) postoperative health gain, using utility scores derived from responses to the EQ-5D-3L health-related quality of life instrument, and (ii) inpatient hospital resource use, using adverse events, surgery duration and postoperative length of stay as indicators, to 6 months post-surgery. MAIN OUTCOME MEASURES Health gain, resource use. RESULTS Mean postoperative health gain was 0.07 units, and did not vary by BMI. Women with a BMI ≥ 35 had an increased rate of severe postoperative AEs (BMI ≥ 35 RR = 1.95, P = 0.02), and the surgery took on average 9.6 min longer (BMI < 35 kg/m2 122.5 min 95% CI 117.4-127.8; BMI ≥ 35 kg/m2 132.1 min 95% CI 126.3-138.2; P = 0.02). CONCLUSION While postoperative health gain for women with BMI ≥ 35 was similar to that of women with lower BMI, the gain was achieved at the expense of greater resource use. Further work could definitively quantify the excess cost of TLH for obese patients with endometrial cancer, and investigate the potential for non-surgical treatment options, at least for those women at high risk of postoperative AEs.
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Affiliation(s)
- N R Armfield
- Faculty of Medicine, Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - M Janda
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - A Obermair
- Faculty of Medicine, Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.,Queensland Centre for Gynaecological Cancer, Brisbane, Queensland, Australia
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13
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How many patients enter endometrial cancer surgery with psychotropic medication prescriptions, and how many receive a new prescription perioperatively? Gynecol Oncol 2019; 152:339-345. [DOI: 10.1016/j.ygyno.2018.11.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 11/19/2022]
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14
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Galaal K, Donkers H, Bryant A, Lopes AD. Laparoscopy versus laparotomy for the management of early stage endometrial cancer. Cochrane Database Syst Rev 2018; 10:CD006655. [PMID: 30379327 PMCID: PMC6517108 DOI: 10.1002/14651858.cd006655.pub3] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND This is an update of a previous Cochrane Review published in 2012, Issue 9.Surgery for endometrial cancer (hysterectomy with removal of both fallopian tubes and ovaries) is performed through laparotomy. It has been suggested that the laparoscopic approach is associated with a reduction in operative morbidity. Over the last two decades there has been a steady increase of the use of laparoscopy for endometrial cancer. This review investigated the evidence of benefits and harms of laparoscopic surgery compared with laparotomy for presumed early stage endometrial cancer. OBJECTIVES To compare overall survival (OS) and disease free survival (DFS) for laparoscopic surgery versus laparotomy in women with presumed early stage endometrial cancer. SEARCH METHODS For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 5) in the Cochrane Library, MEDLINE via Ovid (April 2012 to June 2018) and Embase via Ovid (April 2012 to June 2018). We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of included studies. The trial registers included NHMRC Clinical Trials Register, UKCCCR Register of Cancer Trials, Meta-Register and Physician Data Query Protocol. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing laparoscopy and laparotomy for early stage endometrial cancer. DATA COLLECTION AND ANALYSIS We independently abstracted data and assessed risk of bias. We used hazard ratios (HRs) for OS and recurrence free survival (RFS), risk ratios (RR) for severe adverse events and mean differences (MD) for continuous outcomes in women who received laparoscopy or laparotomy with 9% confidence intervals (CI). These were pooled in random-effects meta-analyses. MAIN RESULTS We identified one new study in this update of the review. The review contains nine RCTs comparing laparoscopy with laparotomy for the surgical management of early stage endometrial cancer.All nine studies met the inclusion criteria and assessed 4389 women at the end of the studies. Six studies assessing 3993 participants with early stage endometrial cancer found no significant difference in the risk of death between women who underwent laparoscopy and women who underwent laparotomy (HR 1.04, 95% 0.86 to 1.25; moderate-certainty evidence) and five studies assessing 3710 participants found no significant difference in the risk of recurrence between the laparoscopy and laparotomy groups (HR 1.14, 95% CI 0.90 to 1.43; moderate-certainty evidence). There was no significant difference in the rate of perioperative death; women requiring a blood transfusion; and bladder, ureteric, bowel and vascular injury. However, one meta-analysis of three studies found that women in the laparoscopy group lost significantly less blood than women in the laparotomy group (MD -106.82 mL, 95% CI -141.59 to -72.06; low-certainty evidence). A further meta-analysis of two studies, which assessed 3344 women and included one very large trial of over 2500 participants, found that there was no clinical difference in the risk of severe postoperative complications in women in the laparoscopy and laparotomy groups (RR 0.78, 95% CI 0.44 to 1.38). Most studies were at moderate risk of bias. All nine studies reported hospital stay and results showed that on average, laparoscopy was associated with a significantly shorter hospital stay. AUTHORS' CONCLUSIONS This review found low to moderate-certainty evidence to support the role of laparoscopy for the management of early endometrial cancer. For presumed early stage primary endometrioid adenocarcinoma of the endometrium, laparoscopy is associated with similar OS and DFS. Furthermore, laparoscopy is associated with reduced operative morbidity and hospital stay. There is no significant difference in severe postoperative morbidity between the two modalities.The certainty of evidence for OS and RFS was moderate and was downgraded for unclear risk of bias profiles and imprecision in effect estimates. However, most studies used adequate methods of sequence generation and concealment of allocation so studies were not prone to selection bias. Adverse event outcomes were downgraded for the same reasons and additionally for low event rates and low power thus these outcomes provided low-certainty evidence.
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Affiliation(s)
- Khadra Galaal
- Princess Alexandra Wing, Royal Cornwall HospitalGynaecological OncologyTruroUKTR1 3LJ
| | - Hannah Donkers
- Princess Alexandra Wing, Royal Cornwall HospitalGynaecological OncologyTruroUKTR1 3LJ
| | - Andrew Bryant
- Newcastle UniversityInstitute of Health & SocietyMedical School New BuildRichardson RoadNewcastle upon TyneUKNE2 4AX
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15
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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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16
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Higgs P, Janda M, Asher R, Gebski V, Forder P, Obermair A. Pelvic floor functional outcomes after total abdominal vs total laparoscopic hysterectomy for endometrial cancer. Am J Obstet Gynecol 2018; 218:419.e1-419.e14. [PMID: 29305254 DOI: 10.1016/j.ajog.2017.12.233] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/15/2017] [Accepted: 12/27/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pelvic floor functioning is an important concern for women requiring a hysterectomy for endometrial cancer. The incidence of pelvic floor symptoms has not been reported in women who have undergone a hysterectomy for early-stage endometrial cancer. OBJECTIVE We sought to evaluate pelvic floor function in women who have had surgical treatment for early-stage endometrial cancer as part of the multinational Laparoscopic Approach to Cancer of the Endometrium trial and to compare patients' outcomes who had total abdominal vs total laparoscopic hysterectomy. STUDY DESIGN A multinational, phase III, randomized noninferiority trial compared disease-free survival of patients who had total abdominal hysterectomy vs total laparoscopic hysterectomy. This substudy analyzes the results from a self-administered validated questionnaire on pelvic floor symptoms (Pelvic Floor Distress Inventory) administered preoperatively, and at follow-up visits 6, 18, 30, 42, and 54 months postoperatively. RESULTS Overall, 381 patients with endometrial cancer were included in the analysis (total abdominal hysterectomy, n = 195; total laparoscopic hysterectomy, n = 186). At 6 months postsurgery both groups experienced an improvement in Pelvic Floor Distress Inventory scores compared to presurgical pelvic floor well-being (total abdominal hysterectomy: mean change -11.17; 95% confidence interval, -17.11 to -5.24; total laparoscopic hysterectomy: mean change -10.25; 95% confidence interval, -16.31 to -4.19). The magnitude of change from baseline in pelvic floor symptoms did not differ between both treatment groups up to 54 months postsurgery. CONCLUSION These findings suggest that pelvic floor function in terms of urinary, bowel, and prolapse symptoms are unlikely to deteriorate following abdominal or laparoscopic hysterectomy and are reassuring for women undergoing hysterectomy for early-stage endometrial cancer.
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Affiliation(s)
- Peta Higgs
- Department of Urogynecology, Buderim Private Hospital, Buderim, Australia
| | - Monika Janda
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Rebecca Asher
- National Health and Medical Research Council Clinical Trials Center, University of Sydney, Sydney, Australia
| | - Val Gebski
- Research Center for Generational Health and Aging, University of Newcastle, Newcastle, Australia
| | - Peta Forder
- Research Center for Generational Health and Aging, University of Newcastle, Newcastle, Australia
| | - Andreas Obermair
- Queensland Center for Gynecological Cancer and Faculty of Medicine, University of Queensland, Brisbane, Australia.
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17
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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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Adoption of Minimally Invasive Surgery and Decrease in Surgical Morbidity for Endometrial Cancer Treatment in the United States. Obstet Gynecol 2018; 131:304-311. [DOI: 10.1097/aog.0000000000002428] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Marcos-Sanmartín J, López Fernández JA, Sánchez-Payá J, Piñero-Sánchez ÓC, Román-Sánchez MJ, Quijada-Cazorla MA, Candela-Hidalgo MA, Martínez-Escoriza JC. Does the Type of Surgical Approach and the Use of Uterine Manipulators Influence the Disease-Free Survival and Recurrence Rates in Early-Stage Endometrial Cancer? Int J Gynecol Cancer 2016; 26:1722-1726. [PMID: 27518143 PMCID: PMC5084631 DOI: 10.1097/igc.0000000000000808] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The purpose of this study was to compare the long-term safety, disease-free survival, and recurrence rate of total laparoscopic hysterectomy using uterine manipulator and abdominal hysterectomy in the surgical treatment in early-stage endometrial cancer. STUDY DESIGN This was a cohort study of 147 patients with clinical endometrial cancer (laparoscopic surgery group, 77 women; laparotomy group, 70 women). Data were evaluated and analyzed by intention-to-treat principle, and survival data of stage I endometrial cancer (129 patients; 66 from laparoscopic surgery group and 60 from laparotomy group) were estimated by using the Kaplan-Meier curves. RESULTS After a follow-up period of 60 months for both laparoscopic surgery and laparotomy groups, no significant difference in the cumulative recurrence rates (7.4% and 13.1%, P = 0.091) and overall survival (97.1% and 95.1%, P = 0.592) was detected between both groups of stage I endometrial cancer. Conversion to laparotomy occurred in 10.4% (8/77) of the laparoscopic procedures. Laparoscopic hysterectomy was associated with less use of pain medication (P = 0.001) and a shorter hospital stay (P < 0.001), but the procedure took longer than laparotomic hysterectomy (P < 0.001). The proportion of patients with intraoperative and long-term complications was not significantly different between both groups. The use of uterine manipulators did not have increased recurrence rate in patients treated with laparoscopic approach. CONCLUSIONS The laparoscopic surgery approach to early-stage endometrial cancer using uterine manipulators is as safe and effective as the laparotomic approach.
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Affiliation(s)
- Josefa Marcos-Sanmartín
- Departments of *Obstetrics and Gynecology and †Public Health, Hospital General Universitari D’Alacant, Alicante, Spain
| | - José Antonio López Fernández
- Departments of *Obstetrics and Gynecology and †Public Health, Hospital General Universitari D’Alacant, Alicante, Spain
| | - José Sánchez-Payá
- Departments of *Obstetrics and Gynecology and †Public Health, Hospital General Universitari D’Alacant, Alicante, Spain
| | - Óscar Cruz Piñero-Sánchez
- Departments of *Obstetrics and Gynecology and †Public Health, Hospital General Universitari D’Alacant, Alicante, Spain
| | - María José Román-Sánchez
- Departments of *Obstetrics and Gynecology and †Public Health, Hospital General Universitari D’Alacant, Alicante, Spain
| | | | - María Amparo Candela-Hidalgo
- Departments of *Obstetrics and Gynecology and †Public Health, Hospital General Universitari D’Alacant, Alicante, Spain
| | - Juan Carlos Martínez-Escoriza
- Departments of *Obstetrics and Gynecology and †Public Health, Hospital General Universitari D’Alacant, Alicante, Spain
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Backes FJ, Fowler JM. Late side effects of robotic surgery. Gynecol Oncol 2016; 140:375-6. [PMID: 26905434 DOI: 10.1016/j.ygyno.2016.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Floor J Backes
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Jeffrey M Fowler
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine and James Comprehensive Cancer Center, Columbus, OH, USA.
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Baker J, Janda M, Gebski V, Forder P, Hogg R, Manolitsas T, Obermair A. Lower preoperative quality of life increases postoperative risk of adverse events in women with endometrial cancer: Results from the LACE trial. Gynecol Oncol 2015; 137:102-5. [DOI: 10.1016/j.ygyno.2015.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 02/07/2015] [Indexed: 11/15/2022]
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Belavy D, Janda M, Baker J, Obermair A. Epidural analgesia is associated with an increased incidence of postoperative complications in patients requiring an abdominal hysterectomy for early stage endometrial cancer. Gynecol Oncol 2013; 131:423-9. [DOI: 10.1016/j.ygyno.2013.08.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 08/19/2013] [Accepted: 08/23/2013] [Indexed: 11/25/2022]
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Nam JH, Park JY. The Modern Surgical Strategy for Endometrial Cancer: Laparoscopic Surgery. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2013. [DOI: 10.1007/s13669-012-0031-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Graves N, Janda M, Merollini K, Gebski V, Obermair A. The cost-effectiveness of total laparoscopic hysterectomy compared to total abdominal hysterectomy for the treatment of early stage endometrial cancer. BMJ Open 2013; 3:bmjopen-2012-001884. [PMID: 23604345 PMCID: PMC3641468 DOI: 10.1136/bmjopen-2012-001884] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To summarise how costs and health benefits will change with the adoption of total laparoscopic hysterectomy compared to total abdominal hysterectomy for the treatment of early stage endometrial cancer. DESIGN Cost-effectiveness modelling using the information from a randomised controlled trial. PARTICIPANTS Two hypothetical modelled cohorts of 1000 individuals undergoing total laparoscopic hysterectomy and total abdominal hysterectomy. OUTCOME MEASURES Surgery costs; hospital bed days used; total healthcare costs; quality-adjusted life years; and net monetary benefits. RESULTS For 1000 individuals receiving total laparoscopic hysterectomy surgery, the costs were $509 575 higher, 3548 hospital fewer bed days were used and total health services costs were reduced by $3 746 221. There were 39.13 more quality-adjusted life years for a 5 year period following surgery. CONCLUSIONS The adoption of total laparoscopic hysterectomy is almost certainly a good decision for health services policy makers. There is 100% probability that it will be cost saving to health services, a 86.8% probability that it will increase health benefits and a 99.5% chance that it returns net monetary benefits greater than zero.
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Affiliation(s)
- Nicholas Graves
- Institute of Health Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Monika Janda
- Institute of Health Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Katharina Merollini
- Institute of Health Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Val Gebski
- Sydney Medical School, NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Andreas Obermair
- Queensland Centre for Gynaecological Cancer, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Renaud MC, Plante M, Roy M. The technicity index: a useful performance indicator for minimally invasive surgery in the management of endometrial cancer. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2012; 34:1180-1183. [PMID: 23231801 DOI: 10.1016/s1701-2163(16)35466-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Minimally invasive surgery is the surgical approach of choice for the management of numerous non-oncologic and oncologic conditions. The Technicity Index (TI) is defined in this study as the ratio of minimally invasive hysterectomies to abdominal hysterectomies performed during the studied time period. The TI indicates, in this context, the level of surgical technique and can thus be used as a health care indicator. The objective of this study was to evaluate whether the TI of the surgical management of endometrial cancer had significantly increased over three different time periods in our gynaecologic oncology division. METHODS The TI was calculated from the data recorded in a surgical management system from July 1999 to June 2011. The study period was divided into three equal time periods (P1: July 1999 to June 2003; P2: July 2003 to June 2007; P3: July 2007 to June 2011). The z-score was used to compare the TI in each period, with P = 0.05 indicating the level of significance. RESULTS The TIs in the first two time periods were comparable (P = 0.96); however, the difference between each of the first two time periods and the third (P1 vs. P3 and P2 vs. P3) was statistically significant (P < 0.001 for each). CONCLUSION The TI for the surgical management of endometrial cancer increased more significantly from 2007 to 2011 than in the previous eight years. The TI could be used as a performance indicator and as an incentive to promote minimally invasive surgery in the surgical management of endometrial cancer.
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Affiliation(s)
- Marie-Claude Renaud
- Department of Obstetrics and Gynecology, CHUQ-Hotel-Dieu de Québec, Quebec, QC
| | - Marie Plante
- Department of Obstetrics and Gynecology, Laval University, Quebec, QC
| | - Michel Roy
- Department of Obstetrics and Gynecology, CHUQ-Hotel-Dieu de Québec, Quebec, QC
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Galaal K, Bryant A, Fisher AD, Al-Khaduri M, Kew F, Lopes AD. Laparoscopy versus laparotomy for the management of early stage endometrial cancer. Cochrane Database Syst Rev 2012:CD006655. [PMID: 22972096 DOI: 10.1002/14651858.cd006655.pub2] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Traditionally, surgery for endometrial cancer (hysterectomy with removal of both fallopian tubes and ovaries) is performed through laparotomy. It has been suggested that the laparoscopic approach is associated with a reduction in operative morbidity. Over the last 10 to 15 years there has been a steady increase of laparoscopy for endometrial cancer. This review investigates the evidence of benefits and harms of laparoscopic surgery compared with laparotomy for presumed early stage endometrial cancer. OBJECTIVES To compare the overall survival (OS) and disease-free survival (DFS) for laparoscopic surgery versus laparotomy in women with presumed early stage endometrial cancer. SEARCH METHODS We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) Issue 3, 2012, MEDLINE, EMBASE and CINAHL up to April 2012. We also searched registers of clinical trials, abstracts of scientific meetings, and reference lists of included studies. Trial registers we searched included NHMRC Clinical Trials Register, UKCCCR Register of Cancer Trials, Meta-Register and Physician Data Query Protocol, as well as abstracts of scientific meetings. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing laparoscopy and laparotomy for early stage endometrial cancer. DATA COLLECTION AND ANALYSIS We independently abstracted data and assessed risk of bias. Hazard ratios (HRs) were used for OS and recurrence-free survival (RFS), risk ratios (RR) for severe adverse events and the mean difference (MD) method was used for continuous outcomes in women who received laparoscopy or laparotomy and these were then pooled in random-effects meta-analyses. MAIN RESULTS Eight RCTs comparing laparoscopy with laparotomy for the surgical management of early stage endometrial cancer were identified.All eight trials met the inclusion criteria, 3644 women were assessed at the end of the trials. Three trials assessing 359 participants with early stage endometrial cancer, found no statistically significant difference in the risk of death and disease or recurrence between women who underwent laparoscopy and those who underwent laparotomy (HR = 1.14, 95% confidence interval (CI): 0.62 to 2.10) and HR = 1.13, 95% CI: 0.90 to 1.42 for OS and RFS respectively). There was no statistically significant difference in the rate of peri-operative death, women requiring a blood transfusion, and bladder, ureteric, bowel and vascular injury. However, a meta-analysis of two trials found that women in the laparoscopy group lost significantly less blood than those in the laparotomy group (MD = -106.82 mL, 95% CI: -141.59 to -72.06). A further meta-analysis of two trials, which assessed 2923 women and included one very large trial of over 2500 participants, found that the rate of severe post-operative adverse events was significantly lower in the laparoscopy group compared with the laparotomy group (RR = 0.58, 95% CI: 0.37 to 0.91). The large trial did not give a breakdown of these severe post-operative adverse events into different adverse event categories. Most trials were at moderate risk of bias. Hospital stay was reported in all of the trials and results show that on average, laparoscopy was associated with a significantly shorter hospital stay. AUTHORS' CONCLUSIONS This review has found evidence to support the role of laparoscopy for the management of early endometrial cancer.For presumed early stage primary endometrioid adenocarcinoma of the endometrium, laparoscopy is associated with similar overall and disease-free survival. Laparoscopy is associated with reduced operative morbidity and hospital stay. There is no significant difference in severe post-operative morbidity between the two modalities.
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Affiliation(s)
- Khadra Galaal
- Gynaecological Oncology, Princess Alexandra Wing, Royal Cornwall Hospital, Truro, UK.
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Obermair A, Janda M, Baker J, Kondalsamy-Chennakesavan S, Brand A, Hogg R, Jobling TW, Land R, Manolitsas T, Nascimento M, Neesham D, Nicklin JL, Oehler MK, Otton G, Perrin L, Salfinger S, Hammond I, Leung Y, Sykes P, Ngan H, Garrett A, Laney M, Ng TY, Tam K, Chan K, Wrede DH, Pather S, Simcock B, Farrell R, Robertson G, Walker G, McCartney A, Gebski V. Improved surgical safety after laparoscopic compared to open surgery for apparent early stage endometrial cancer: Results from a randomised controlled trial. Eur J Cancer 2012; 48:1147-53. [PMID: 22548907 DOI: 10.1016/j.ejca.2012.02.055] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 02/15/2012] [Accepted: 02/20/2012] [Indexed: 11/24/2022]
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Risk factors to predict the incidence of surgical adverse events following open or laparoscopic surgery for apparent early stage endometrial cancer: results from a randomised controlled trial. Eur J Cancer 2012; 48:2155-62. [PMID: 22503396 DOI: 10.1016/j.ejca.2012.03.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 03/12/2012] [Accepted: 03/12/2012] [Indexed: 11/23/2022]
Abstract
AIMS To identify risk factors for major adverse events (AEs) and to develop a nomogram to predict the probability of such AEs in patients who have surgery for apparent early stage endometrial cancer. METHODS We used data from 753 patients who were randomised to either total laparoscopic hysterectomy or total abdominal hysterectomy in the LACE trial. Serious adverse events that prolonged hospital stay or postoperative adverse events (using common terminology criteria 3+, CTCAE V3) were considered major AEs. We analysed pre-surgical characteristics that were associated with the risk of developing major AEs by multivariate logistic regression. We identified a parsimonious model by backward stepwise logistic regression. The six most significant or clinically important variables were included in the nomogram to predict the risk of major AEs within 6weeks of surgery and the nomogram was internally validated. RESULTS Overall, 132 (17.5%) patients had at least one major AE. An open surgical approach (laparotomy), higher Charlson's medical co-morbidities score, moderately differentiated tumours on curettings, higher baseline Eastern Cooperative Oncology Group (ECOG) score, higher body mass index and low haemoglobin levels were associated with AE and were used in the nomogram. The bootstrap corrected concordance index of the nomogram was 0.63 and it showed good calibration. CONCLUSIONS Six pre-surgical factors independently predicted the risk of major AEs. This research might form the basis to develop risk reduction strategies to minimise the risk of AEs among patients undergoing surgery for apparent early stage endometrial cancer.
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Nicklin J, Janda M, Gebski V, Jobling T, Land R, Manolitsas T, McCartney A, Nascimento M, Perrin L, Baker JF, Obermair A. The utility of serum CA-125 in predicting extra-uterine disease in apparent early-stage endometrial cancer. Int J Cancer 2011; 131:885-90. [DOI: 10.1002/ijc.26433] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 08/24/2011] [Indexed: 12/24/2022]
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Surgical treatment of endometrial cancer and atypical hyperplasia: a trend shift from laparotomy to laparoscopy. Obstet Gynecol Int 2011; 2011:829425. [PMID: 21785602 PMCID: PMC3140043 DOI: 10.1155/2011/829425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 05/25/2011] [Accepted: 05/26/2011] [Indexed: 11/25/2022] Open
Abstract
Background. Laparoscopic hysterectomy has proved to be a safe alternative to open surgery in women with benign indications. Few studies compare laparotomy and laparoscopy in gynecologic oncology, and the objective of this study was to analyze the feasibility and development of laparoscopic surgery in endometrial cancer patients. Material and Methods. Records from all women having a hysterectomy due to premalignant or malignant endometrial changes during the years 2002–2009 were examined retrospectively. Results. A total of 521 hysterectomies were performed during the study period. Laparoscopy was performed in about 20% of the cases in the first two years, increasing to 83% in the last year of the period. Moreover, the laparoscopic technique was increasingly applied in older women, more obese women and in women with high-risk preoperative diagnosis, without increasing the complication rate. Conclusions. As for benign indications, laparoscopic hysterectomy in endometrial cancer patients should be preferred whenever possible.
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Quality of life after total laparoscopic hysterectomy versus total abdominal hysterectomy for stage I endometrial cancer (LACE): a randomised trial. Lancet Oncol 2010; 11:772-80. [PMID: 20638899 DOI: 10.1016/s1470-2045(10)70145-5] [Citation(s) in RCA: 223] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Camanni M, Bonino L, Delpiano EM, Migliaretti G, Berchialla P, Deltetto F. Laparoscopy and body mass index: feasibility and outcome in obese patients treated for gynecologic diseases. J Minim Invasive Gynecol 2010; 17:576-82. [PMID: 20619751 DOI: 10.1016/j.jmig.2010.04.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 03/19/2010] [Accepted: 03/19/2010] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE To compare feasibility and surgical outcome of laparoscopic gynecologic surgery between obese, overweight, normal-weight, and underweight women. DESIGN Retrospective case control study (Canadian Task Force classification II-3). SETTING Surgery Unit of Minimally Invasive Gynaecology. PATIENTS A total of 503 women who underwent laparoscopic procedures for both benign disease and malignancies. INTERVENTIONS Four main categories of gynecologic disease were identified: uterine fibroids, benign adnexal masses, endometriosis, and endometrial cancer (stage I). For each category patients were divided into 4 groups: underweight (BMI <18.5 kg/m(2)), normal-weight (BMI 18.5-24.9 kg/m(2)), overweight (BMI 25-29.9 kg/m(2)), and obese (BMI ≥30 kg/m(2)). MEASUREMENTS AND MAIN RESULTS Selected outcomes were duration of surgery, rate of laparotomy conversion, intraoperative and postoperative complications, and duration of hospital stay. No statistical difference regarding demographic data, surgical and medical history, and intraoperative findings was present between groups. No laparotomy conversion occurred. Regarding duration of surgery, we found no statistical difference among the BMI groups with regard to benign diseases, whereas pelvic lymphadenectomy in obese patients with endometrial cancer had a statistically significant longer duration than in the control group (122 +/- 47 min vs 65 +/- 21 min, p <.001). The postoperative complication rate was 0.01%: 3 cases of blood transfusion and 1 case of hemoperitoneum among myomectomies; 1 ureteral fistula in surgery for pelvic endometriosis; and 1 case of postoperative lymphocele in endometrial cancer group. No statistically significant difference was found in duration of hospital stay among the BMI groups in any of the categories of disease. For each category we conducted an analysis to identify any possible risk factors other than BMI in the surgical outcomes. CONCLUSION Laparoscopic approach in the various applications of gynecologic surgery does not appear to be significantly influenced by BMI in terms of surgical outcomes, laparotomy conversion rate, intraoperative and postoperative complications rate, and duration of hospital stay. The technical difficulties can be solved if skilled surgeons and anesthetists are available.
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Affiliation(s)
- Marco Camanni
- GINTEAM, Unit of Minimally Invasive Gynaecology, Turin, Italy
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[Endometrial cancer: survey of surgical practice in france in 2008]. ACTA ACUST UNITED AC 2010; 39:409-17. [PMID: 20542646 DOI: 10.1016/j.jgyn.2010.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 05/03/2010] [Accepted: 05/04/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Endometrial cancer is the most common gynecologic malignancy. We aimed to assess the management of this disease among French surgeons as regards to the French guidelines. MATERIALS AND METHODS Six hundred questionnaires were given to surgeons during two national French Meetings in 2008. They focused on the surgeon (age, gender, center of work, number of treated cancers individually and in the center) and on the disease (initial work-up, surgical management). Three case reports related to endometrial cancer were proposed to assess the conformity of the French guidelines (two case reports about endometrioid carcinomas stages IB and II and one about serous papillary adenocarcinoma). RESULTS Nineteen percent of surgeons (n=114) answered the questionnaire. The French Guidelines were respected in less than 60 % in the answers of the three case reports (only 13.3 % of the answers were conformed in all the three cases). The surgeons who respected the recommendations took care of more than five treated patients per year (92.9 % versus 57.8 %, P=0.01), they were younger (41 year versus 49 years, P=0.01), and the post-graduation delay was shorter (9.1 versus 20.5 years, P=0.002). The center where the surgeon worked was not a determinant factor for treatment. The surgical procedures were mostly transverse laparotomy in 35.4 %. Peritoneal cytology and lymphadenectomy were provided in 69.9 % and 74.7 % of cases, respectively. CONCLUSION Despite the limits of our study based on volunteer answers of surgeons to a questionnaire, our results highlight the efforts of learned societies and medical authorities should be used to standardize the treatment of cancer. A reflection should be conducted on the basis of initial training and throughout a professional career to provide patients optimal care of their pathology.
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Khaskheli M, Baloch S, Baloch AS. Gynecological Malignancies: A Continuing Threat in the Developing World. J Gynecol Surg 2010. [DOI: 10.1089/gyn.2009.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mehrunisa Khaskheli
- Department of Gynecology and Obstetrics, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh, Pakistan
| | - Shahla Baloch
- Department of Gynecology and Obstetrics, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh, Pakistan
| | - Aneela Sheeba Baloch
- Department of Radiology, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh, Pakistan
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The laparoscopic-assisted vaginal approach to early endometrial cancer. Arch Gynecol Obstet 2010; 282:177-83. [PMID: 20309570 DOI: 10.1007/s00404-010-1416-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2009] [Accepted: 02/23/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION For the surgical treatment of endometrial cancer laparotomy still is regarded as the gold standard. Over the past decade, the laparoscopic approach has gained equivalence in FIGO stage I carcinomas. RESULTS Laparoscopic-assisted vaginal hysterectomy and bilateral salpingooophorectomy plus pelvic/paraaortic lymphadenectomy have shown short-term advantages such as reduced blood loss and shorter hospitalization without reducing oncological safety or outcome. This has already been confirmed by numerous smaller studies and recent randomized controlled trials with sufficient numbers of patients are being published. CONCLUSION Further acceptance of the technique is necessary to enable every gynecological oncologist to individualize treatment by offering minimal access options.
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Ghezzi F, Cromi A, Uccella S, Siesto G, Giudici S, Serati M, Franchi M. Laparoscopic versus open surgery for endometrial cancer: a minimum 3-year follow-up study. Ann Surg Oncol 2010; 17:271-278. [PMID: 19826876 DOI: 10.1245/s10434-009-0720-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2009] [Indexed: 09/19/2023]
Abstract
BACKGROUND The paucity of long-term oncologic results published in the literature still prevents the scientific community from cementing the place of laparoscopy as the procedure of choice for managing endometrial cancer. We present the outcomes of consecutive patients with endometrial cancer managed laparoscopically with >3-year follow-up. METHODS Data from 117 consecutive women undergoing surgery for treatment of a clinical stage I endometrial cancer and who achieved at least 3-year follow-up were prospectively analyzed. These cases were compared with a historical cohort of 122 consecutive patients with endometrial cancer who had undergone surgery through laparotomy. RESULTS The laparoscopy and laparotomy groups were similar with regard to baseline patient characteristics, surgical stage, proportion of tumors with unfavorable histology and high grade, as well as patterns of adjuvant therapy. The median (range) follow-up of surviving patients was 52 (36-84) months in the laparoscopic cohort and 80 (36-151) months in the laparotomy cohort. Women who underwent laparoscopy and those who underwent laparotomy had similar 3-year recurrence-free survival rates (91.4% vs. 88.5%, P = 0.52), as well as similar 3-year overall survival rates (94.0% vs. 93.4%, P = 1.0). Multivariate analysis showed that advanced surgical stage, unfavorable histology, and patient age >65 years significantly affect survival, regardless of the surgical approach used. CONCLUSIONS Cancer control in women with endometrial cancer does not appear to be worsened by laparoscopic surgery. In the absence of level I evidence to establish long-term recurrence and survival equivalence, analysis of series as they mature is crucial to fully evaluate disease control afforded by laparoscopy.
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MESH Headings
- Adenocarcinoma, Clear Cell/mortality
- Adenocarcinoma, Clear Cell/pathology
- Adenocarcinoma, Clear Cell/surgery
- Adenocarcinoma, Mucinous/mortality
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/surgery
- Aged
- Carcinoma, Papillary/mortality
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/surgery
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Cohort Studies
- Cystadenocarcinoma, Serous/mortality
- Cystadenocarcinoma, Serous/pathology
- Cystadenocarcinoma, Serous/surgery
- Endometrial Neoplasms/mortality
- Endometrial Neoplasms/pathology
- Endometrial Neoplasms/surgery
- Female
- Follow-Up Studies
- Humans
- Laparoscopy
- Laparotomy
- Middle Aged
- Neoplasm Staging
- Prospective Studies
- Retrospective Studies
- Survival Rate
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
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39
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Capmas P, Bats AS, Bensaid C, Huchon C, Scarabin C, Nos C, Lécuru F. Place de la cœlioscopie dans le traitement des cancers de l’endomètre à un stade précoce (stade I). ACTA ACUST UNITED AC 2009; 38:537-44. [DOI: 10.1016/j.jgyn.2009.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Revised: 08/24/2009] [Accepted: 09/09/2009] [Indexed: 11/28/2022]
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40
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Costs and effects of abdominal versus laparoscopic hysterectomy: systematic review of controlled trials. PLoS One 2009; 4:e7340. [PMID: 19806210 PMCID: PMC2752190 DOI: 10.1371/journal.pone.0007340] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 09/09/2009] [Indexed: 11/19/2022] Open
Abstract
Objective Comparative evaluation of costs and effects of laparoscopic hysterectomy (LH) and abdominal hysterectomy (AH). Data sources Controlled trials from Cochrane Central register of controlled trials, Medline, Embase and prospective trial registers. Selection of studies Twelve (randomized) controlled studies including the search terms costs, laparoscopy, laparotomy and hysterectomy were identified. Methods The type of cost analysis, perspective of cost analyses and separate cost components were assessed. The direct and indirect costs were extracted from the original studies. For the cost estimation, hospital stay and procedure costs were selected as most important cost drivers. As main outcome the major complication rate was taken. Findings Analysis was performed on 2226 patients, of which 1013 (45.5%) in the LH group and 1213 (54.5%) in the AH group. Five studies scored ≥10 points (out of 19) for methodological quality. The reported total direct costs in the LH group ($63,997) were 6.1% higher than the AH group ($60,114). The reported total indirect costs of the LH group ($1,609) were half of the total indirect in the AH group ($3,139). The estimated mean major complication rate in the LH group (14.3%) was lower than in the AH group (15.9%). The estimated total costs in the LH group were $3,884 versus $3,312 in the AH group. The incremental costs for reducing one patient with major complication(s) in the LH group compared to the AH group was $35,750. Conclusions The shorter hospital stay in the LH group compensates for the increased procedure costs, with less morbidity. LH points in the direction of cost effectiveness, however further research is warranted with a broader costs perspective including long term effects as societal benefit, quality of life and survival.
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41
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Gadducci A, Spirito N, Baroni E, Tana R, Genazzani AR. The fertility-sparing treatment in patients with endometrial atypical hyperplasia and early endometrial cancer: a debated therapeutic option. Gynecol Endocrinol 2009; 25:683-91. [PMID: 19562604 DOI: 10.1080/09513590902733733] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Fertility-sparing treatment may represent a realist option for accurately selected young patients with endometrial atypical hyperplasia or well differentiated, early endometrial cancer. Oral progestins, and especially medroxyprogesterone acetate (MPA) and megestrol acetate with different doses and schedules, represent the most commonly used hormone agents in this clinical setting. Approximately three fourths of the women achieve a histologically documented complete response, with an mean response time of 12 weeks, but about one third of these subsequently developed a recurrence after a mean time of 20 months. The expression of receptor for progesterone receptor (PR), PTEN gene, DNA mismatch repair gene MLH1 and phospho-AKT on tissue specimens may be useful for selecting patients fit for a conservative management. Several successful pregnancies have occurred after a fertility-sparing treatment of endometrial atypical hyperplasia or endometrial cancer, more frequently with assisted reproductive technologies. The implementation of in vitro fertilisation techniques not only increases the chance of conception, but it may also decrease the interval to conception. The opportunity of a demolitive surgery after delivery or after childbearing being no longer required is a still debated issue. Large multicenter trials are strongly warranted to better define the selection criteria for a conservative treatment, endocrine regimen of choice, the optimal dosing, the duration of treatment and follow-up protocols. In any case, the patient should be accurately informed about the relatively high recurrence rates after complete response to hormone treatment and expectations for pregnancy.
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Affiliation(s)
- Angiolo Gadducci
- Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, via Roma 56, Pisa 56127, Italy.
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42
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Palomba S, Falbo A, Russo T, Zullo F. Updating of a recent meta-analysis of randomized controlled trials to assess the safety and the efficacy of the laparoscopic surgery for treating early stage endometrial cancer. Gynecol Oncol 2009; 114:135-6. [DOI: 10.1016/j.ygyno.2009.03.025] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 03/15/2009] [Accepted: 03/23/2009] [Indexed: 11/25/2022]
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43
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Role of robotic surgery in endometrial cancer. Curr Treat Options Oncol 2009; 10:33-43. [PMID: 19353274 DOI: 10.1007/s11864-009-0086-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Accepted: 01/16/2009] [Indexed: 10/20/2022]
Abstract
OPINION STATEMENT Uterine cancer is the most common gynecologic cancer in women in the United States with an estimated number of 40,100 women diagnosed in 2008, the great majority of which belongs to endometrial classification. The traditional approach to treatment of endometrial cancer has been primarily surgery via an open, laparotomy incision. Minimally invasive approaches with smaller incisions, i.e., laparoscopy for the management of endometrial cancer was initially reported in 1992; however, its adoption has been slow due to the prolonged learning curve needed to become proficient in such a technique. Robotic-assisted surgery, a further advancement of traditional laparoscopy, using computer-based controls has been developed enabling the performance of complex procedures that otherwise had been too difficult to accomplish in a minimally invasive fashion. Robotic-assisted laparoscopic radical prostatectomy is one such example that has gained rapid acceptance in recent years. Although the use of robotic-assisted laparoscopy for endometrial cancer is still in its early phase, this approach is anticipated to become similarly, a common approach to the management of endometrial cancer in the future.
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44
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Abstract
BACKGROUND Endometrial cancer is the most common gynecologic malignancy in the United States. Surgical staging is an integral component in the treatment of this disease. Minimally invasive surgical techniques have been utilized with increasing frequency in its management. METHODS This article reviews the use of minimally invasive surgery for the treatment of endometrial cancer. RESULTS Prospective trials and retrospective analyses have demonstrated the safety and feasibility of laparoscopy in performing hysterectomy, bilateral salpingo-oophorectomy, and pelvic and periaortic lymphadenectomy for surgical staging in endometrial cancer. The use of minimally invasive techniques does not appear to have an adverse impact on survival, and it improves quality of life in the postoperative period. Robotic surgery has been used in the management of this disease with promising preliminary results. CONCLUSIONS Laparoscopy is a safe and effective approach for surgical staging of selected patients with endometrial cancer. Further studies and cost-benefit analyses are required to determine if the use of robotics improves outcomes over standard laparoscopy and can extend the benefits of minimally invasive surgery to a larger proportion of patients with this common gynecologic malignancy.
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Affiliation(s)
- Marcia M Humphrey
- Gynecologic Oncology Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
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Ju W, Myung SK, Kim Y, Choi HJ, Kim SC. Comparison of Laparoscopy and Laparotomy for Management of Endometrial Carcinoma: A Meta-analysis. Int J Gynecol Cancer 2009; 19:400-6. [DOI: 10.1111/igc.0b013e3181a1caf8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background:This meta-analysis was performed to investigate the outcome of laparoscopic surgery for endometrial carcinoma compared with laparotomy.Methods:We searched the MEDLINE (PubMed), EMBASE, and Cochrane Review databases in September 2007. Three independent evaluators selected the articles according to predetermined selection criteria.Results:Thirteen comparative studies (5 prospective and 8 retrospective) that met the selection criteria were included. In a fixed-effects meta-analysis, the overall survival and therecurrence rate showed no significant differences between the laparoscopy and the laparotomy groups, with odds ratios of 0.84 (95% confidence interval, 0.64-1.62) and 0.90 (95% confidence interval, 0.49-1.16), respectively. However, the complication rate was lower in the laparoscopy group than in the laparotomy group with an odds ratio of 0.43 (95% confidence interval, 0.32-0.58).Conclusions:The survival outcome and recurrence rate after laparoscopic surgery for endometrial carcinoma were similar to those in the laparotomy procedures. However, the complication rate was lower after laparoscopy compared with laparotomy.
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Le T, Menard C, Samant R, Choan E, Hopkins L, Faught W, Fung-Kee-Fung M. Longitudinal assessments of quality of life in endometrial cancer patients: effect of surgical approach and adjuvant radiotherapy. Int J Radiat Oncol Biol Phys 2009; 75:795-802. [PMID: 19250764 DOI: 10.1016/j.ijrobp.2008.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2008] [Revised: 11/11/2008] [Accepted: 11/14/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE Adjuvant radiotherapy (RT) is often considered for endometrial cancer. We studied the effect of RT and surgical treatment on patients' quality of life (QOL). METHODS AND MATERIALS All patients referred to the gynecologic oncology clinics with biopsy findings showing endometrial cancer were recruited. QOL assessments were performed using the European Organization for Research and Treatment of Cancer QOL questionnaire-C30, version 3. Assessments were obtained at study entry and at regular 3-month intervals for a maximum of 2 years. Open-ended telephone interviews were done every 6 months. Linear mixed regression models were built using QOL domain scores as dependent variables, with the predictors of surgical treatment and adjuvant RT type. RESULTS A total of 40 patients were recruited; 80% of the surgeries were performed by laparotomy. Significant improvements were seen in most QOL domains with increased time from treatment. Adjuvant RT resulted in significantly more severe bowel symptoms and improvement in insomnia compared with conservative follow-up. No significant adverse effect from adjuvant RT was seen on the overall QOL. Bowel symptoms were significantly increased in patients treated with laparotomy compared with laparoscopy in the patients treated with whole pelvic RT. Qualitatively, about one-half of the patients noted improvements in their overall QOL during follow-up, with easy fatigability the most prevalent. CONCLUSION No significant adverse effect was seen on patients' overall QOL with adjuvant pelvic RT after the recovery period. The acute adverse effects on patients' QOL significantly improved with an increasing interval from diagnosis.
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Affiliation(s)
- Tien Le
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Ottawa, 501 Smyth Road, Ottawa, Ontario, Canada.
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Laparoscopic treatment for endometrial cancer: A meta-analysis of randomized controlled trials (RCTs). Gynecol Oncol 2009; 112:415-21. [DOI: 10.1016/j.ygyno.2008.09.014] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 09/09/2008] [Accepted: 09/13/2008] [Indexed: 11/23/2022]
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de la Orden SG, Reza MM, Blasco JA, Andradas E, Callejo D, Pérez T. Laparoscopic Hysterectomy in the Treatment of Endometrial Cancer: A Systematic Review. J Minim Invasive Gynecol 2008; 15:395-401. [PMID: 18602044 DOI: 10.1016/j.jmig.2008.04.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Revised: 04/24/2008] [Accepted: 04/25/2008] [Indexed: 11/17/2022]
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Gadducci A, Tana R, Cosio S, Fanucchi A, Genazzani AR. Molecular target therapies in endometrial cancer: from the basic research to the clinic. Gynecol Endocrinol 2008; 24:239-49. [PMID: 18569027 DOI: 10.1080/09513590801953556] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Molecular targeted therapies represent an interesting field of pharmacological research in endometrial cancer. The loss of PTEN (phosphatase and tensin homolog deleted on chromosome 10) function, with consequent activation of the PI3K (phosphatidylinositol-3-kinase)-AKT (serine/threonine-specific protein kinase)-mTOR (mammalian target of rapamycin) signaling pathway, occurs in 32-83% of endometrioid-type endometrial carcinomas, thus suggesting a role for mTOR inhibition in this malignancy. Some analogues of rapamycin (CCI-799, RAD-001, AP-23573) have been developed and tested in different tumors including endometrioid-type endometrial carcinoma. For example, AP-23573 achieved a clinical benefit response in 33% of 27 heavily pretreated patients, and CCI-799 obtained a 26% partial response rate and a 63% stable disease rate in 19 patients. Overexpression of ErbB-2 (epidermal growth factor type II receptor) has been detected in 18-80% of uterine papillary serous carcinomas (UPSCs), thus providing a biological rationale for the use of trastuzumab in these aggressive tumors. UPSC often overexpresses claudin-3 and claudin-4, which represent the epithelial receptors for Clostridium perfringens enterotoxin (CPE). CPE-mediated therapy might be a novel treatment modality for UPSC resistant to chemotherapy. A better understanding of the signaling transduction pathways that are dysregulated in endometrioid-type endometrial carcinoma and UPSC will allow the development of novel molecular targeted therapies.
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Affiliation(s)
- Angiolo Gadducci
- Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy.
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Vascular “Pseudo Invasion” in Laparoscopic Hysterectomy Specimens: A Diagnostic Pitfall. Am J Surg Pathol 2008; 32:560-5. [DOI: 10.1097/pas.0b013e31816098f0] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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