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Horala A, Szubert S, Nowak-Markwitz E. Range of Resection in Endometrial Cancer-Clinical Issues of Made-to-Measure Surgery. Cancers (Basel) 2024; 16:1848. [PMID: 38791927 PMCID: PMC11120042 DOI: 10.3390/cancers16101848] [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: 03/29/2024] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
Endometrial cancer (EC) poses a significant health issue among women, and its incidence has been rising for a couple of decades. Surgery remains its principal treatment method and may have a curative, staging, or palliative aim. The type and extent of surgery depends on many factors, and the risks and benefits should be carefully weighed. While simple hysterectomy might be sufficient in early stage EC, modified-radical hysterectomy is sometimes indicated. In advanced disease, the evidence suggests that, similarly to ovarian cancer, optimal cytoreduction improves survival rate. The role of lymphadenectomy in EC patients has long been a controversial issue. The rationale for systematic lymphadenectomy and the procedure of the sentinel lymph node biopsy are thoroughly discussed. Finally, the impact of the molecular classification and new International Federation of Gynecology and Obstetrics (FIGO) staging system on EC treatment is outlined. Due to the increasing knowledge on the pathology and molecular features of EC, as well as the new advances in the adjuvant therapies, the surgical management of EC has become more complex. In the modern approach, it is essential to adjust the extent of the surgery to a specific patient, ensuring an optimal, made-to-measure personalized surgery. This narrative review focuses on the intricacies of surgical management of EC and aims at summarizing the available literature on the subject, providing an up-to-date clinical guide.
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Affiliation(s)
- Agnieszka Horala
- Division of Gynaecological Oncology, Department of Gynaecology, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (S.S.); (E.N.-M.)
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Vizza E, Bruno V, Cutillo G, Mancini E, Sperduti I, Patrizi L, Certelli C, Zampa A, Giannini A, Corrado G. Prognostic Role of the Removed Vaginal Cuff and Its Correlation with L1CAM in Low-Risk Endometrial Adenocarcinoma. Cancers (Basel) 2021; 14:cancers14010034. [PMID: 35008194 PMCID: PMC8750504 DOI: 10.3390/cancers14010034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/12/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: The aim of our study was to investigate the role of the excised vaginal cuff length as a prognostic factor in terms of DFS and recurrence rate/site, in low-risk endometrial cancer (EC) patients. Moreover, we correlated the recurrence with the expression of L1CAM. Material and Methods: From March 2001 to November 2016, a retrospective data collection was conducted of women undergoing surgical treatment for low-risk EC according to ESMO-ESGO-ESTRO consensus guidelines. Patients were divided into three groups according to their vaginal cuff length: V0 without vaginal cuff, V1 with a vaginal cuff shorter than 1.5 cm and V2 with a vaginal cuff longer than or equal to 1.5 cm. Results: 344 patients were included in the study: 100 in the V0 group, 179 in the V1 group and 65 in the V2 group. The total recurrence rate was 6.1%: the number of patients with recurrence was 8 (8%), 10 (5.6%) and 3 (4.6%), in the V0, V1 and V2 group, respectively. No statistically significant difference was found in the recurrence rate among the three groups. Although the DFS was higher in the V2 group, the result was not significant. L1CAM was positive in 71.4% of recurrences and in 82% of the distant recurrences. Conclusions: The rate of recurrence in patients with EC at low risk of recurrence does not decrease as the length of the vaginal cuff removed increases. Furthermore, the size of the removed vaginal cuff does not affect either the site of recurrence or the likelihood of survival.
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Affiliation(s)
- Enrico Vizza
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (V.B.); (G.C.); (E.M.); (C.C.); (A.Z.)
- Correspondence: ; Tel.: +39-06-52666973
| | - Valentina Bruno
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (V.B.); (G.C.); (E.M.); (C.C.); (A.Z.)
| | - Giuseppe Cutillo
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (V.B.); (G.C.); (E.M.); (C.C.); (A.Z.)
| | - Emanuela Mancini
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (V.B.); (G.C.); (E.M.); (C.C.); (A.Z.)
| | - Isabella Sperduti
- Scientific Direction, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy;
| | - Lodovico Patrizi
- Department of Surgery, Section of Gynaecology and Obstetrics, Tor Vergata University, 00133 Rome, Italy;
| | - Camilla Certelli
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (V.B.); (G.C.); (E.M.); (C.C.); (A.Z.)
| | - Ashanti Zampa
- Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS “Regina Elena” National Cancer Institute, 00144 Rome, Italy; (V.B.); (G.C.); (E.M.); (C.C.); (A.Z.)
| | - Andrea Giannini
- Department of Medical and Surgical Sciences and Translational Medicine, “Sapienza University”, Rome 00185, Italy;
| | - Giacomo Corrado
- Dipartimento Scienze della Salute della Donna, del Bambino, e di Sanità Pubblica, Ginecologia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
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Hasegawa T, Furugori M, Kubota K, Asai-Sato M, Yashiro-Kawano A, Kato H, Oi Y, Shigeta H, Segawa K, Kitagawa M, Mine Y, Saji H, Numazaki R, Maruyama Y, Ohnuma E, Taniguchi H, Sugiura K, Miyagi E, Matsunaga T. Does the extension of the type of hysterectomy contribute to the local control of endometrial cancer? Int J Clin Oncol 2019; 24:1129-1136. [PMID: 31069549 PMCID: PMC6687671 DOI: 10.1007/s10147-019-01458-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine the necessity and sufficiency of different types of hysterectomy for the surgical treatment of endometrial cancer. METHODS This was a multicenter collaborative study conducted by 11 institutions. Among patients with stage I-III endometrial cancer who underwent surgery as the initial treatment (only chemotherapy was provided if adjuvant therapy was needed) from 2001 to 2012, we retrospectively examined the type of hysterectomy, clinicopathological factors, recurrence rate over a maximum period of 5 years, and the site of recurrence. The local recurrence rate was examined by univariate and multivariate analyses. RESULTS Among 1335 patients, 982 (73.6%) underwent simple hysterectomy (SH) and 353 (26.4%) underwent modified radical hysterectomy (mRH) and were observed for a mean duration of 51.8 months. No significant difference was observed in the rate of local recurrence between the SH and mRH groups (p = 0.928). In multivariate analysis, clinicopathological factors independently associated with localized recurrence included postmenopausal status [hazard ratio (HR) 5.036, 95% confidence interval (CI) 1.506-16.841, p = 0.009], with stages II (HR 3.337, 95% CI 1.701-6.547, p < 0.001) and III (HR 2.445, 95% CI 1.280-4.668, p = 0.007), vs stage I and histological type 2 (HR 1.610, 95% CI 0.938-2.762, p = 0.001). CONCLUSIONS For endometrial cancer patients requiring surgery, the selection of a more extensive type of hysterectomy did not reduce the rate of local recurrence. Therefore, there is little significance in performing mRH in such cases.
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Affiliation(s)
- Tetsuya Hasegawa
- Yamato Municipal Hospital, 8-3-6 Fukaminishi, Yamato, Kanagawa 242-8602 Japan
| | - Megumi Furugori
- Yamato Municipal Hospital, 8-3-6 Fukaminishi, Yamato, Kanagawa 242-8602 Japan
| | - Kazumi Kubota
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Mikiko Asai-Sato
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Aiko Yashiro-Kawano
- Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa 241-8515 Japan
| | - Hisamori Kato
- Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa 241-8515 Japan
| | - Yuka Oi
- Yokohama Municipal Citizen’s Hospital, 56 Okazawa-chou, Hodogaya-ku, Yokohama, Kanagawa 240-8555 Japan
| | - Hiroyuki Shigeta
- Yokohama Municipal Citizen’s Hospital, 56 Okazawa-chou, Hodogaya-ku, Yokohama, Kanagawa 240-8555 Japan
| | - Keiko Segawa
- Saiseikai Yokohamashi Nanbu Hospital, 3-2-10 Kounanndai, Kounan-ku, Yokohama, Kanagawa 234-0054 Japan
| | - Masakazu Kitagawa
- Yokohama City University Medical Center, 4-57 UraFune-cho, Minami-ku, Yokohama, Kanagawa 232-0024 Japan
| | - Yuko Mine
- Fujisawa City Hospital, 2-6-1 Fujisawa, Fujisawa, Kanagawa 251-8550 Japan
| | - Haruya Saji
- Fujisawa City Hospital, 2-6-1 Fujisawa, Fujisawa, Kanagawa 251-8550 Japan
| | - Reiko Numazaki
- Yokohama Minamikyosai Hospital, 1-21-1 Mutsuurahigashi, Kanazawa-ku, Yokohama, Kanagawa 236-0037 Japan
| | - Yasuyo Maruyama
- Odawara Municipal Hospital, 46 Hisano, Odawara, Kanagawa 250-8558 Japan
| | - Emi Ohnuma
- Yokohama Rosai Hospital, 3211 Kodukue-chou, Kouhoku-ku, Yokohama, Kanagawa 222-0036 Japan
| | - Hanako Taniguchi
- Yokosuka Kyosai Hospital, 1-16 Yonegahamadouri, Yokosuka, Kanagawa 238-8558 Japan
| | - Ken Sugiura
- Yokosuka Kyosai Hospital, 1-16 Yonegahamadouri, Yokosuka, Kanagawa 238-8558 Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Tatsuya Matsunaga
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
| | - Yokohama City University Gynecologic Oncology Research Group (YCUGO-ReG)
- Yamato Municipal Hospital, 8-3-6 Fukaminishi, Yamato, Kanagawa 242-8602 Japan
- Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004 Japan
- Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa 241-8515 Japan
- Yokohama Municipal Citizen’s Hospital, 56 Okazawa-chou, Hodogaya-ku, Yokohama, Kanagawa 240-8555 Japan
- Saiseikai Yokohamashi Nanbu Hospital, 3-2-10 Kounanndai, Kounan-ku, Yokohama, Kanagawa 234-0054 Japan
- Yokohama City University Medical Center, 4-57 UraFune-cho, Minami-ku, Yokohama, Kanagawa 232-0024 Japan
- Fujisawa City Hospital, 2-6-1 Fujisawa, Fujisawa, Kanagawa 251-8550 Japan
- Yokohama Minamikyosai Hospital, 1-21-1 Mutsuurahigashi, Kanazawa-ku, Yokohama, Kanagawa 236-0037 Japan
- Odawara Municipal Hospital, 46 Hisano, Odawara, Kanagawa 250-8558 Japan
- Yokohama Rosai Hospital, 3211 Kodukue-chou, Kouhoku-ku, Yokohama, Kanagawa 222-0036 Japan
- Yokosuka Kyosai Hospital, 1-16 Yonegahamadouri, Yokosuka, Kanagawa 238-8558 Japan
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Abstract
Based on two randomized trials and a meta-analysis, the recommendations of the National Cancer Institute (INCa) have validated the absence of systematic pelvic lymphadenectomy for patients with endometrial cancer at low risk (type 1 histology stage IA grade 1-2) and intermediate (type 1 histology stage IA grade 3 and IB grade 1-2) but without taking into account the contribution of the sentinel node (SN) procedure. The senti-endo trial assessing the role of the SN procedure in patients with early stages endometrial cancer showed that the detection rate by hemi-pelvis right and left were 77 and 76%, respectively. The detection rate per patient was 89%. Among patients with at least a SN detected, the detection was unilateral in 34 cases (31%) and bilateral in 77 cases (69%). Of the 111 patients with at least a SN detected, 19 had lymph node metastases (17%). Considering the hemi-pelvis right and left as a unit, no false negative case was observed, hence the sensitivity and NPV was 100%. Considering the NPV per patient, three false negative cases were observed. Among the 57 patients at low risk, six (11%) had lymph node metastases on SN with negative non sentinel nodes. Of the 33 patients at intermediate risk, five (15%) had lymph node metastases on SN with negative non sentinel nodes. Senti-endo results emphasize the contribution of the SN procedure to assess the nodal status in patients with low or intermediate risk group raising the issue on new definition of the recommendations of INCa.
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Signorelli M, Lissoni AA, Cormio G, Katsaros D, Pellegrino A, Selvaggi L, Ghezzi F, Scambia G, Zola P, Grassi R, Milani R, Giannice R, Caspani G, Mangioni C, Floriani I, Rulli E, Fossati R. Modified Radical Hysterectomy Versus Extrafascial Hysterectomy in the Treatment of Stage I Endometrial Cancer: Results From the ILIADE Randomized Study. Ann Surg Oncol 2009; 16:3431-41. [DOI: 10.1245/s10434-009-0736-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Indexed: 11/18/2022]
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