1
|
Silva GN, Brandão VG, Perez MV, Sobrinho SL, Villardi JGDCC, Sacramento PMD, Ribeiro LCP, Alvim Fiorelli RK. Immunotherapeutic Properties of Dexmedetomidine on Pain Management and Cardiovascular Function in Videolaparoscopic Cholecystectomies: A Randomized, Two-Arm, Double-Blinded, Placebo-Controlled Trial. Surg Innov 2024; 31:137-147. [PMID: 38383315 DOI: 10.1177/15533506241234591] [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] [Indexed: 02/23/2024]
Abstract
BACKGROUND Laparoscopy represented one of the most innovative surgical techniques approached in the surgery field. Dexmedetomidine association with general anesthesia promotes the response control to trauma by altering the neuroinflammatory reflex, provides better clinical outcomes in the postoperative period and reduces the excessive use of drugs with risk for addiction. This trial aims to evaluate the potential drug treatment of dexmedetomidine on organic function, with the targets in neuroinflammation, perioperative pain control and blood pressure measurements in a medium-sized surgical model. METHODS Fifty-two patients were randomized in two groups: Sevoflurane and Dexmedetomidine - A (dexmedetomidine infusion [1 μg/kg loading, .2-.5 μg/kg/h thereafter]) vs Sevoflurane and Saline .9% - B. Three blood samples were collected at three times: before surgery, 4 to 6 hours after surgery and 24 hours postoperatively. The primary outcome was inflammatory and endocrine mediators dosage analisys. Finally, we evaluated pain and opioid use as secondary outcomes, also the hemodynamic values. RESULTS In Dexmedetomidine group A, a reduction of Interleukin 6 was found during 4-6 hours after surgery. A reduction of IL-10 was noted in the measurement of its values 24 hours after the procedure, with statistical significance. Also, systolic and diastolic blood pressure, as well heart rate were attenuated, and there was a lower incidence of pain and opioid consumption in the first postoperative hour (P < .0001) in the anesthetic recovery room. CONCLUSIONS Dexmedetomidine provided anti-inflammatory activity, sympatholytic effect and analgesia with cardiovascular safety. It reinforces the therapeutic nature of highly selective α2-adrenergic agonists when combined within anesthetic interventions.
Collapse
Affiliation(s)
- Gustavo Nascimento Silva
- Department of Anesthesiology, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Virna Guedes Brandão
- Department of Anesthesiology, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Marcelo Vaz Perez
- Department of Surgery and Anesthesia, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Sandoval Lage Sobrinho
- Department of General and Specialized Surgery, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | | | | | | | - Rossano Kepler Alvim Fiorelli
- Department of General and Specialized Surgery, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| |
Collapse
|
2
|
Zhang Q, Silver M, Chen YJ, Wolf J, Hayek J, Alagkiozidis I. Comparison of Minimally Invasive Surgery with Open Surgery for Type II Endometrial Cancer: An Analysis of the National Cancer Database. Healthcare (Basel) 2023; 11:3122. [PMID: 38132012 PMCID: PMC10743283 DOI: 10.3390/healthcare11243122] [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: 10/13/2023] [Revised: 11/19/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE Prior studies comparing minimally invasive surgery with open surgery among patients with endometrial cancer have reported similar survival outcomes and improved perioperative outcomes with minimally invasive surgery (MIS). However, patients with Type II endometrial cancer were underrepresented in these studies. We sought to compare the overall survival and surgical outcomes between open surgery and MIS in a large cohort of women with Type II endometrial cancer. METHODS Using data from the National Cancer Database, we identified a cohort of women who underwent hysterectomy for type II endometrial cancer (serous, clear cell, and carcinosarcoma) between January 2010 and December 2014. The primary outcome was a comparison of the overall survival for MIS with that for the open approach. The secondary outcomes included a comparison of the length of hospital stay, readmission within 30 days of discharge, and 30- and 90-day mortality. Outcomes were compared between the cohorts using the Mann-Whitney U test, Pearson's chi-square test, or Fisher's exact test. Multivariable logistic regression with inverse propensity weighting was used to determine clinical characteristics that were statistically significant predictors of outcomes. p values < 0.05 were considered significant. RESULTS We identified 12,905 patients with Type II, Stage I-III endometrial cancer that underwent a hysterectomy. In total, 7123 of these women (55.2%) underwent MIS. The rate of MIS increased from 39% to 64% over four years. Women who underwent MIS were more often White, privately insured, older, and had a higher income. The laparotomy group had a higher rate of carcinosarcoma histology (30.9% vs. 23.6%, p < 0.001), stage III disease (38.4% vs. 27.4%, p < 0.001), and larger primary tumors (59 vs. 45 mm, p < 0.001). Lymph node dissection was more commonly performed in the MIS group (89.6% vs. 85.4%, p < 0.001). With regard to adjuvant therapy, subjection to postoperative radiation was more common in the MIS group (37% vs. 40.1%, p < 0.001), while chemotherapy was more common in the laparotomy group (37.6% vs. 33.9%, p < 0.001). The time interval between surgery and the initiation of chemotherapy was shorter in the MIS group (39 vs. 42 days, p < 0.001). According to the results of propensity-score-weighted analysis, MIS was associated with superior overall survival (101.7 vs. 86.7 months, p = 0.0003 determined using the long-rank test), which corresponded to a 10% decreased risk of all-cause mortality (HR 0.9; CI 0.857-0.954, p = 0.0002). The survival benefit was uniform across all three histology types and stages. MIS was associated with superior perioperative outcomes, including shorter length of stay (1 vs. 4 days, p < 0.001), lower 30-day readmission rates (2.5% vs. 5%), and lower 30- and 90-day postoperative mortality (0.5% vs. 1.3% and 1.5% vs. 3.6%, respectively; p < 0.001 for both). The increased adoption of MIS from 2010 to 2014 corresponds to a decrease in 90-day postoperative mortality (2.8% to 2.2%, r = -0.89; p = 0.04) and overall mortality (51% to 38%, r = -0.95; p = 0.006). CONCLUSIONS In a large cohort of patients from the National Cancer Database, MIS was associated with improved overall survival and superior perioperative outcomes compared to open surgery among women with Type II endometrial cancer. A decrease in postoperative mortality and a shorter interval between surgery and the initiation of chemotherapy may contribute to the survival benefit of MIS. A racial and economic disparity in the surgical management of Type II endometrial cancer was identified, and further investigation is warranted to narrow this gap and improve patient outcomes.
Collapse
Affiliation(s)
- Qi Zhang
- Department of Gynecologic Oncology, Maimonides Medical Center, Brooklyn, NY 11220, USA
| | - Michael Silver
- Department of Gynecologic Oncology, Maimonides Medical Center, Brooklyn, NY 11220, USA
| | - Yi-Ju Chen
- Department of Gynecologic Oncology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (Y.-J.C.); (J.W.); (J.H.)
| | - Jennifer Wolf
- Department of Gynecologic Oncology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (Y.-J.C.); (J.W.); (J.H.)
| | - Judy Hayek
- Department of Gynecologic Oncology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (Y.-J.C.); (J.W.); (J.H.)
| | - Ioannis Alagkiozidis
- Department of Gynecologic Oncology, Maimonides Medical Center, Brooklyn, NY 11220, USA
- Department of Gynecologic Oncology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; (Y.-J.C.); (J.W.); (J.H.)
| |
Collapse
|
3
|
Chang CS, Lai YL, Choi CH, Kim TJ, Lee JW, Kim BG, Cheng WF, Chen YL, Lee YY. Comparison of Minimally Invasive and Open Surgery for the Treatment of Endometrial Cancer with a High Risk of Recurrence: A Propensity Score Matching Study in Korea and Taiwan. Ann Surg Oncol 2023; 30:6855-6864. [PMID: 37386310 DOI: 10.1245/s10434-023-13695-x] [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: 01/11/2023] [Accepted: 05/22/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND This study compared oncologic outcomes between minimally invasive surgery (MIS) and open surgery for the treatment of endometrial cancer with a high risk of recurrence. METHODS This study included patients with endometrial cancer who underwent primary surgery at two tertiary centers in Korea and Taiwan. Low-grade advanced-stage endometrial cancer (endometrioid grade 1 or 2) or endometrial cancer with aggressive histology (endometrioid grade 3 or non-endometrioid) at any stage was considered to have a high risk of recurrence. We conducted 1:1 propensity score matching between the MIS and open surgery groups to adjust for the baseline characteristics. RESULTS Of the total of 582 patients, 284 patients were included in analysis after matching. Compared with open surgery, MIS did not show a difference in disease-free survival [hazard ratio (HR) 1.09; 95% confidence interval (CI) 0.67-1.77, P = 0.717] or overall survival (HR 0.67; 95% CI 0.36-1.24, P = 0.198). In the multivariate analysis, non-endometrioid histology, tumor size, tumor cytology, depth of invasion, and lymphovascular space invasion were risk factors for recurrence. There was no association between the surgical approach and either recurrence or mortality in the subgroup analysis according to stage and histology. CONCLUSIONS MIS did not compromise survival outcomes for patients with endometrial cancer with a high risk of recurrence when compared with open surgery.
Collapse
Affiliation(s)
- Chi-Son Chang
- Department of Obstetrics and Gynecology, Gynecologic Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong-si, Korea
| | - Yen-Ling Lai
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chel Hun Choi
- Department of Obstetrics and Gynecology, Gynecologic Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae-Joong Kim
- Department of Obstetrics and Gynecology, Gynecologic Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong-Won Lee
- Department of Obstetrics and Gynecology, Gynecologic Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byoung-Gie Kim
- Department of Obstetrics and Gynecology, Gynecologic Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wen-Fang Cheng
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Li Chen
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Obstetrics and Gynecology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan.
| | - Yoo-Young Lee
- Department of Obstetrics and Gynecology, Gynecologic Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
4
|
Bahall V, De Barry L, Singh K. Optimizing Total Laparoscopic Hysterectomy for the Geriatric Population: A Practical Case Study and Comprehensive Literature Review. Cureus 2023; 15:e46265. [PMID: 37908921 PMCID: PMC10615228 DOI: 10.7759/cureus.46265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 11/02/2023] Open
Abstract
Elderly patients represent a large cohort of patients requiring gynaecological surgery for benign and malignant indications. In recent years, several conventional gynaecological procedures have shifted towards minimally invasive alternatives such as laparoscopy, hysteroscopy, and robotic surgery. A recent Surveillance, Epidemiology, and End Results (SEER) analysis compared the outcomes of 25,000 women undergoing laparotomy versus laparoscopic approach to hysterectomy and found that laparoscopy is associated with a shorter duration of hospitalization (three days versus five days), less postoperative complications (76%), less requirement for blood transfusion, reduced operational costs, faster recovery, and an overall safer surgical experience. Although geriatric patients are affected by age-related comorbidities, physiologic changes, and altered pharmacodynamics and pharmacokinetics of administered drugs, these patients benefit most from minimally invasive surgery. In this paper, we present a comprehensive account of the interdisciplinary perioperative approaches employed to accomplish a total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection in an 82-year-old patient who was diagnosed with grade I endometrial adenocarcinoma and multiple age-related medical comorbidities.
Collapse
Affiliation(s)
- Vishal Bahall
- Department of Obstetrics and Gynaecology, The University of the West Indies, St. Augustine, TTO
- Department of Obstetrics and Gynaecology, San Fernando General Hospital, San Fernando, TTO
| | - Lance De Barry
- Department of Obstetrics and Gynaecology, San Fernando General Hospital, San Fernando, TTO
| | - Keevan Singh
- Anaesthesia and Intensive Care Unit, Department of Clinical and Surgical Sciences, The University of the West Indies, San Fernando, TTO
| |
Collapse
|
5
|
You X, Wang Y, Zheng Y, Yang F, Wang Q, Min L, Wang K, Wang N. Efficacy of transumbilical laparoendoscopic single-site surgery versus multi-port laparoscopic surgery for endometrial cancer: a retrospective comparison study. Front Oncol 2023; 13:1181235. [PMID: 37700843 PMCID: PMC10495218 DOI: 10.3389/fonc.2023.1181235] [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: 03/07/2023] [Accepted: 07/28/2023] [Indexed: 09/14/2023] Open
Abstract
Background Although single-port laparoscopy surgery has been evaluated for several years, it has not been widely adopted by gynecologic oncologists. The objective was to compare the perioperative outcomes and survival of endometrial cancer (EC) patients undergoing transumbilical laparoendoscopic single-site surgery (TU-LESS) with multi-port laparoscopic surgery (MLS). Materials and methods This is a retrospective comparative monocentric study including patients treated between December 2017 and October 2021. The perioperative outcomes and survival of EC patients who had surgery via TU-LESS or MLS were compared, by propensity matching. Results A total of 156 patients were included (TU-LESS vs. MLS: 78 vs. 78). The conversion rate of TU-LESS and MLS was 5.13% and 2.56%, respectively (P=0.681). The operation time was comparable between the two groups [207.5min (180-251) vs. 197.5min (168.8-225), P=0.095]. There was no significant difference between the two groups in exhaustion time, perioperative complications, or postoperative complications. While, the TU-LESS group had a shorter out-of-bed activity time [36 hours (24-48) vs. 48 hours (48-72), P<0.001] and a lower visual analog pain scale 36 hours after surgery [1 (1-2) vs. 2 (1-2), P<0.001] than the MLS group. The length of hospital stay was similar in the two groups [5(4-6) vs. 5(4-5), P=0.599]. Following surgery, 38.5% of the TU-LESS patients and 41% of the MLS patients got adjuvant therapy (P=0.744). The median follow-up time for TU-LESS and MLS cohorts was 45 months (range: 20-66) and 43 months (range: 18-66), respectively. One TU-LESS patient and one MLS patient died following recurrence. The 4-year overall survival was similar in both groups (98.3% vs. 98.5%, P=0.875). Conclusion TU-LESS is a feasible and safe option with comparable perioperative outcomes and survival of MLS in endometrial cancer. With the growing acceptance of sentinel lymph node biopsy, TU-LESS of endometrial cancer may be a viable option for patients and surgeons.
Collapse
Affiliation(s)
- Xiaolin You
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanyun Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Molecular Translational Medicine, Center for Translational Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying Zheng
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fan Yang
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiao Wang
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ling Min
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Kana Wang
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Na Wang
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
6
|
Rei M, Costa-Santos C, Bernardes J, Costa A. Preoperative staging of uterine cancer: can transvaginal ultrasonography play a role? Front Oncol 2023; 13:1089105. [PMID: 37404747 PMCID: PMC10315648 DOI: 10.3389/fonc.2023.1089105] [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: 11/03/2022] [Accepted: 06/08/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction Preoperative staging of uterine cancer has recently been implied as an important contribution to an accurate selection of low-risk cases, ultimately avoiding unnecessary lymph node debulking. The aim of this study was to evaluate the validity of transvaginal ultrasonography (TVS) in preoperative staging of uterine cancer in comparison to pelvic magnetic resonance imaging (MRI) and permanent section. Methods We conducted a prospective longitudinal multicenter trial between 2017 and 2018. Inclusion criteria comprised cases of endometrial neoplasia histologically confirmed or strong imaging suspicion, candidates for elective surgery as primary treatment. Proportions of Agreement (PA), kappa statistic (K), sensitivity, specificity and accuracy were calculated with 95% confidence intervals (95%CI). Results Eighty-two patients were eligible for the study, presenting a mean age of 68 years (standard deviation 11). In what concerns the TVS evaluation of myometrial invasion, the subjective and objective methods of Gordon and Karlsson presented a sensitivity of 79%, 79% and 67% [95%CI 63-91; 63-91; 50-81], a specificity of 65%, 58% and 79% [95%CI 49-79; 42-73; 64-89] and an overall accuracy of 72%, 68% and 73% [95%CI 61-81; 57-78; 63-82]. MRI presented respectively a sensitivity, specificity and overall accuracy of 92%, 70% and 82% [95%CI 77-98; 52-85; 71-90]. Regarding cervical involvement, the sensitivity was respectively 31%, 50% and 67% [95%CI 9-61; 21-79; 35-90] for the subjective method, objective TVS and MRI, and the specificity was 98%, 90% and 100% [95%CI 92-100; 77-97; 94;100]. Agreement between TVS and MRI was superior in the assessment of cervical invasion, with PA ranging from 0.82 to 0.93 and K from 0.45 to 0.58, in comparison to myometrial invasion with PA ranging from 0.68 to 0.73 and K from 0.31 to 0.50. Considering the assessment of cervical involvement, as MRI showed a specificity of 100% it is not possible to increase the specificity. However, it was possible to increase the sensitivity, considering the combination of TVS with objective approach and MRI. Conclusion TVS may have a promising role as a tool for preoperative staging of endometrial carcinoma, presenting a performance that approximates to MRI, with a higher agreement in the assessment of cervical invasion.
Collapse
Affiliation(s)
- Mariana Rei
- Department of Gynecology, Instituto Português de Oncologia Francisco Gentil, Porto, Portugal
- Department of Obstetrics, Gynecology and Pediatrics, Medical School, University of Porto, Porto, Portugal
| | - Cristina Costa-Santos
- Department of Health Informatics and Decision Sciences, Medical School, University of Porto, Porto, Portugal
- Centre for Research in Health Information Systems and Technologies, CINTESIS, University of Porto, Porto, Portugal
| | - João Bernardes
- Department of Obstetrics, Gynecology and Pediatrics, Medical School, University of Porto, Porto, Portugal
- Centre for Research in Health Information Systems and Technologies, CINTESIS, University of Porto, Porto, Portugal
- Department of Obstetrics and Gynecology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Antónia Costa
- Department of Obstetrics, Gynecology and Pediatrics, Medical School, University of Porto, Porto, Portugal
- Department of Obstetrics and Gynecology, Centro Hospitalar Universitário de São João, Porto, Portugal
| |
Collapse
|
7
|
Silva GN, Brandão VG, Perez MV, Levandrowski KU, Fiorelli RKA. Effects of Dexmedetomidine on Immunomodulation and Pain Control in Videolaparoscopic Cholecystectomies: A Randomized, Two-Arm, Double-Blinded, Placebo-Controlled Trial. J Pers Med 2023; 13:jpm13040622. [PMID: 37109010 PMCID: PMC10141731 DOI: 10.3390/jpm13040622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023] Open
Abstract
Aim: Digital and robotic technology applications in laparoscopic surgery have revolutionized routine cholecystectomy. Insufflation of the peritoneal space is vital for its safety but comes at the cost of aseptic ischemia-reperfusion-induced intraabdominal organ compromise before the return of physiologic functions. Dexmedetomidine in general anesthesia promotes controlling the response to trauma by altering the neuroinflammatory reflex. This strategy may improve clinical outcomes in the postoperative period by reducing postoperative narcotic use and lowering the risk of subsequent addiction. In this study, the authors aimed to evaluate dexmedetomidine’s therapeutic and immunomodulatory potential on perioperative organ function. Methods: Fifty-two patients were randomized 1:1: group A—sevoflurane and dexmedetomidine (dexmedetomidine infusion [1 µg/kg loading, 0.2–0.5 µg/kg/h maintenance dose]), and group B—sevoflurane with saline 0.9% infusion as a placebo control. Three blood samples were collected: preoperatively (T0 h), 4–6 h after surgery (T4–6 h), and 24 h postoperatively (T24 h). The primary outcome was the level analysis of inflammatory and endocrine medications. Secondary outcome measures were the time to return to normal preoperative hemodynamic parameters, spontaneous ventilation, and postoperative narcotic requirements to control surgical pain. Results: A reduction of Interleukin 6 was found at 4–6 h after surgery in group A with a mean of 54.76 (27.15–82.37; CI 95%) vs. 97.43 (53.63–141.22); p = 0.0425) in group B patients. Systolic and diastolic blood pressure and heart rate were lower in group A patients, who also had a statistically significantly lower opioid consumption in the first postoperative hour when compared to group B patients (p < 0.0001). We noticed a similar return to spontaneous ventilation pattern in both groups. Conclusions: Dexmedetomidine decreased interleukin-6 4–6 h after surgery, likely by providing a sympatholytic effect. It provides good perioperative analgesia without respiratory depression. Implementing dexmedetomidine during laparoscopic cholecystectomy has a good safety profile and may lower healthcare expenditure due to faster postoperative recovery.
Collapse
Affiliation(s)
- Gustavo Nascimento Silva
- Department of Anesthesiology, Gaffrée e Guinle Universitary Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro 22290-240, RJ, Brazil
| | - Virna Guedes Brandão
- Department of Anesthesiology, Gaffrée e Guinle Universitary Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro 22290-240, RJ, Brazil
| | - Marcelo Vaz Perez
- Department of Surgery and Anesthesia, Federal University of São Paulo (UNIFESP), São Paulo 04021-001, SP, Brazil
| | - Kai-Uwe Levandrowski
- Center for Advanced Spine Care of Southern Arizona and Surgical Institute of Tucson, Tucson, AZ 85712, USA
- Department of Orthopedics at Hospital Universitário Gaffrée e Guinle, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro 20270-004, RJ, Brazil
| | - Rossano Kepler Alvim Fiorelli
- Department of General and Specialized Surgery, Gaffrée e Guinle Universitary Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro 22290-240, RJ, Brazil
| |
Collapse
|
8
|
Brandão VGA, Silva GN, Perez MV, Lewandrowski KU, Fiorelli RKA. Effect of Quadratus Lumborum Block on Pain and Stress Response after Video Laparoscopic Surgeries: A Randomized Clinical Trial. J Pers Med 2023; 13:jpm13040586. [PMID: 37108972 PMCID: PMC10142610 DOI: 10.3390/jpm13040586] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/01/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
Background: There are many surgical and anesthetic factors that affect pain and the endocrine–metabolic response to trauma. The ability of anesthetic agents and neuronal blockade to modify the response to surgical trauma has been widely studied in the last few years. Objective: To evaluate if the anterior quadratus lumborum block contributes to improved surgical recovery, using as parameters analgesia, pulmonary function and neuroendocrine response to trauma. Methods: We carried out a prospective, randomized, controlled, and blinded study, in which 51 patients scheduled for laparoscopic cholecystectomy. Patients were randomly selected and assigned to 2 groups. The control group received balanced general anesthesia and venous analgesia, and the intervention group was treated under general, venous analgesia and anterior quadratus lumborum block. The parameters evaluated were: demographic data, postoperative pain, respiratory muscle pressure and inflammatory response to surgical stress with the plasma dosage of IL-6 (Interleukin 6), CRP (C-Reactive protein) and cortisol. Results: Anterior quadratus lumborum block induced the slowing of IL-6 cytokine production and a decrease in cortisol release. This effect was accompanied by the significant reduction of postoperative pain scores. Conclusion: Anterior quadratus lumborum block is an important strategy for analgesia in abdominal laparoscopic surgery and contributes to reducing the inflammatory response to surgical trauma with an early return of preoperative baseline physiological functions.
Collapse
|
9
|
Survival Analysis in Endometrial Carcinomas by Type of Surgical Approach: A Matched-Pair Study. Cancers (Basel) 2022; 14:cancers14041081. [PMID: 35205829 PMCID: PMC8870025 DOI: 10.3390/cancers14041081] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 11/18/2022] Open
Abstract
Simple Summary We carried out a retrospective cohort study of 1382 women diagnosed with endometrial cancer (EC). A total of 684 (49.5%) were operated on by minimally invasive surgery (MIS), 233 (34%) by robotic-assisted laparoscopy (RAL), 451 (66%) by conventional laparoscopy (LPS), and 698 (50.5%) by open surgery (OP). Disease-free (DFS), overall (OS), and specific survival related to EC (SS) outcomes were significantly higher for MIS compared to OP. When matched by age, BMI, co-morbidities, ASA score, histological type, grade, myometrial invasion, and FIGO stage, the DFS, OS, and SS amounts were similar between the MIS and OP groups. The surgical approach for women with EC does not impact disease-free or overall survival amounts when matched by homogeneous groups, but laparoscopy seems to offer a higher specific overall survival rate compared to the open surgery approach. Abstract (1) Background: This study aimed to analyze the impact of surgical approach on survival rates in women diagnosed with endometrial cancer. (2) Methods: A retrospective multicenter cohort of 1382 women diagnosed with EC was performed. A total of 684 (49.5%) women underwent minimally invasive surgery, 233 (34%) underwent robotic-assisted laparoscopy (RAL), 451 (66%) underwent conventional laparoscopy (LPS), and 698 (50.5%) underwent open surgery (OP). Sociodemographic features, tumor characteristics, and survival rates were analyzed in the whole sample and in a matched-pair model. (3) Results: Women operated on by OP were significantly older, presented more comorbidities, and had more aggressive tumors. Disease-free (DFS), overall (OS), and specific survival related to EC (SS) amounts were significantly higher for MIS compared to OP (p < 0.001). When matched by age, body mass index, comorbidities, ASA score, histological type, grade, myometrial invasion, and FIGO stage, 798 patients were selected. DFS, OS, and SS amounts were similar between the MIS and OP groups. (4) Conclusions: The surgical approach for women with EC does not impact DFS or OS amounts when matched by homogeneous groups.
Collapse
|
10
|
Madhok B, Nanayakkara K, Mahawar K. Safety considerations in laparoscopic surgery: A narrative review. World J Gastrointest Endosc 2022; 14:1-16. [PMID: 35116095 PMCID: PMC8788169 DOI: 10.4253/wjge.v14.i1.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/11/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic surgery has many advantages over open surgery. At the same time, it is not without its risks. In this review, we discuss steps that could enhance the safety of laparoscopic surgery. Some of the important safety considerations are ruling out pregnancy in women of the childbearing age group; advanced discussion with the patient regarding unexpected intraoperative situations, and ensuring appropriate equipment is available. Important perioperative safety considerations include thromboprophylaxis; antibiotic prophylaxis; patient allergies; proper positioning of the patient, stack, and monitor(s); patient appropriate pneumoperitoneum; ergonomic port placement; use of lowest possible intra-abdominal pressure; use of additional five-millimetre (mm) ports as needed; safe use of energy devices and laparoscopic staplers; low threshold for a second opinion; backing out if unsafe to proceed; avoiding hand-over in the middle of the procedure; ensuring all planned procedures have been performed; inclusion of laparoscopic retrieval bags and specimens in the operating count; avoiding 10-15 mm ports for placement of drains; appropriate port closures; and use of long-acting local anaesthetic agents for analgesia. Important postoperative considerations include adequate analgesia; early ambulation; careful attention to early warning scores; and appropriate discharge advice.
Collapse
Affiliation(s)
- Brij Madhok
- Upper GI Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, United Kingdom
| | - Kushan Nanayakkara
- Upper GI Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, United Kingdom
| | - Kamal Mahawar
- Department of General Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland SR4 7TP, United Kingdom
| |
Collapse
|
11
|
Nagai T, Shimada M, Tokunaga H, Ishikawa M, Yaegashi N. Clinical issues of surgery for uterine endometrial cancer in Japan. Jpn J Clin Oncol 2022; 52:346-352. [PMID: 35032166 DOI: 10.1093/jjco/hyab211] [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: 08/24/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The mainstay of treatment for uterine endometrial cancer is surgery, and recurrent-risk cases require multidisciplinary treatment, including surgery, chemotherapy and radiation therapy. METHODS The standard surgery for uterine endometrial cancer is hysterectomy and bilateral salpingooophorectomy, with additional retroperitoneal lymph node dissection and omentectomy, depending on the case. The appropriate treatment is determined based on the risk classification, such as the depth of invasion into the myometrium, diagnosis of histological type and grade, and risk assessment of lymph node metastasis. RESULTS Recently, minimally invasive surgery has been widely used not only in low-risk patients but also in intermediate- and high-risk patients. In low-risk patients, the possibility of ovarian preservation is discussed from a healthcare perspective for young women. Determining the need for retroperitoneal lymph node dissection based on sentinel lymph node evaluation may contribute in minimizing the incidence of post-operative lymphedema while ensuring accurate diagnosis of lymph node metastasis. Recently, many studies using sentinel lymph nodes have been reported for patients with uterine endometrial cancer, and the feasibility of sentinel lymph node mapping surgery has been proven. Unfortunately, sentinel lymph node biopsy and sentinel lymph node mapping surgery have not been widely adopted in surgery for uterine cancer in Japan. In addition, the search for biomarkers, such as RNA sequencing using The Cancer Genome Atlas, metabolic profile and lipidomic profile for early detection and prognostic evaluation, has been actively pursued. CONCLUSIONS Gynecologic oncologists expect to be able to provide uterine endometrial cancer patients with appropriate treatment that preserves their quality of life without compromising oncologic outcomes in the near future.
Collapse
Affiliation(s)
- Tomoyuki Nagai
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Muneaki Shimada
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Hideki Tokunaga
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Mitsuya Ishikawa
- Department of Gynecology, National Cancer Center Hospital, Tokyo, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| |
Collapse
|
12
|
Minimally Invasive Compared With Open Hysterectomy in High-Risk Endometrial Cancer. Obstet Gynecol 2021; 138:828-837. [PMID: 34735382 DOI: 10.1097/aog.0000000000004606] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/26/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare disease-free survival between minimally invasive surgery and open surgery in patients with high-risk endometrial cancer. METHODS We conducted a multicentric, propensity-matched study of patients with high-risk endometrial cancer who underwent hysterectomy, bilateral salpingo-oophorectomy, and staging between January 1999 and June 2016 at two centers. High-risk endometrial cancer included grade 3 endometrioid, serous, clear cell, undifferentiated carcinoma or carcinosarcoma with any myometrial invasion. Patients were categorized a priori into two groups based on surgical approach, propensity scores were calculated based on potential confounders and groups were matched 1:1 using nearest neighbor technique. Cox hazard regression analysis and Kaplan-Meier curves evaluated the association of surgical technique with survival. RESULTS Of 626 eligible patients, 263 (42%) underwent minimally invasive surgery and 363 (58%) underwent open surgery. In the matched cohort, there were no differences in disease-free survival rates at 5 years between open (53.4% [95% CI 45.6-60.5%]) and minimally invasive surgery (54.6% [95% CI 46.6-61.8]; P=.82). Minimally invasive surgery was not associated with worse disease-free survival (hazard ratio [HR] 0.85, 95% CI 0.63-1.16; P=.30), overall survival (HR 1.04, 95% CI 0.73-1.48, P=.81), or recurrence rate (HR 0.99; 95% CI 0.69-1.44; P=.99) compared with open surgery. Use of uterine manipulator was not associated with worse disease-free survival (HR 1.01, 95% CI 0.65-1.58, P=.96), overall survival (HR 1.18, 95% CI 0.71-1.96, P=.53), or recurrence rate (HR 1.12, 95% CI 0.67-1.87; P=.66). CONCLUSION There was no difference in oncologic outcomes comparing minimally invasive and open surgery among patients with high-risk endometrial cancer.
Collapse
|
13
|
Functional Changes of the Genitourinary and Gastrointestinal Systems before and after the Treatment of Endometrial Cancer-A Systematic Review. J Clin Med 2021; 10:jcm10235579. [PMID: 34884279 PMCID: PMC8658546 DOI: 10.3390/jcm10235579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 12/30/2022] Open
Abstract
Simple Summary Endometrial cancer is currently one of the most common gynecological cancer and accounts for around 5% of all female cancers. The treatment strategy most often includes surgery and adjuvant radiation therapy. Thanks to the high effectiveness of used treatment methods, the patients can live longer lives. Unfortunately their quality of life can be negatively affected by side effects resulting from weakening pelvic floor such as urinary incontinence, pelvic organ prolapse and fecal incontinence. In our paper we analyzed the studies published between 2010 and 2020 that touch upon the prevalence and management of pelvic floor dysfunction in endometrial cancer patients. Our results show increase in the incidence of pelvic floor disorders after various forms of endometrial cancer treatment and the need for more good quality research in the subject to be able to provide patients with holistic care focused on minimizing treatment side effects and prioritizing their quality of life. Abstract The incidence of endometrial cancer (EC), which coexists with such civilization diseases as diabetes, obesity or hypertension, is constantly increasing. Treatment includes surgery as well as brachytherapy, teletherapy, rarely chemotherapy or hormone therapy. Due to the good results of the treatment, the occurrence of side effects of therapy becomes a problem for the patients. One of the large groups of side effects includes the pelvic organ prolapse, urinary and fecal incontinence. The aim of this study was to present current knowledge on the occurrence of pelvic floor dysfunction in women treated for EC. A literature review was conducted in the PubMED and WoS databases, including articles on pelvic floor dysfunction in women with EC. PRISMA principles were followed in the research methodology. A total of 1361 publications were retrieved. Based on the inclusion and exclusion criteria, 24 papers were eligible for the review. Mostly retrospective studies based on different questionnaires were evaluated. No prospective studies were found in which, in addition to subjective assessment, clinical examination and objective assessment of urinary incontinence were used. Studies show a significant increase in the incidence of pelvic floor disorders, including urinary incontinence, after various forms of EC treatment. We believe that assessment of complications after endometrial cancer treatment is clinically relevant. The review emphasizes the importance of programming prospective studies to prevent and address these disorders at each stage of oncologic treatment.
Collapse
|
14
|
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.
Collapse
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;
| |
Collapse
|
15
|
Liang L, Yang B, Wu Y, Sun L. Osthole suppresses the proliferation and induces apoptosis via inhibiting the PI3K/AKT signaling pathway of endometrial cancer JEC cells. Exp Ther Med 2021; 22:1171. [PMID: 34504616 DOI: 10.3892/etm.2021.10605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 03/19/2021] [Indexed: 12/31/2022] Open
Abstract
Osthole, a natural product extracted mainly from fruits of Fructus Cnidii, possesses multiple pharmacological functions, including anti-inflammatory, anti-convulsant and anticancer effects. However, the effects of osthole in endometrial cancer (EC) is not fully understood. In the present study, EC cell lines, including JEC, KLE and Ishikawa cells and normal human cervical epithelial cells (HcerEpic) were applied to detect the anticancer effect of osthole. The present study demonstrated that osthole inhibited the proliferation of JEC, KLE and Ishikawa cells, but had no cytotoxic effect on HcerEpic. Furthermore, treatment of osthole induced JEC cell apoptosis, while osthole promoted the release of pro-apoptotic proteins, Bax and activated the cleaved caspase-3, caspase-9 and PARP. Additionally, osthole significantly increased the expression of PETN and decreased the phosphorylated form of PI3K and AKT in a concentration-dependent manner. Furthermore, osthole treatment suppressed the JEC tumor cell growth in a nude mouse xenograft model in vivo, and neither renal toxicity nor hepatotoxicity was induced by the indicated concentration. Taken together, the results of the present study suggested that osthole may be a novel and potential therapeutic agent of EC.
Collapse
Affiliation(s)
- Lei Liang
- Department of Gynecology and Obstetrics, The 980th Hospital of the Joint Logistic Support Force of the Chinese People's Liberation Army, Shijiazhuang, Hebei 050082, P.R. China
| | - Bo Yang
- Department of Gynecology and Obstetrics, The 980th Hospital of the Joint Logistic Support Force of the Chinese People's Liberation Army, Shijiazhuang, Hebei 050082, P.R. China
| | - Yuanyuan Wu
- Department of Gynecology and Obstetrics, The 980th Hospital of the Joint Logistic Support Force of the Chinese People's Liberation Army, Shijiazhuang, Hebei 050082, P.R. China
| | - Li Sun
- Department of Gynecology and Obstetrics, The 980th Hospital of the Joint Logistic Support Force of the Chinese People's Liberation Army, Shijiazhuang, Hebei 050082, P.R. China
| |
Collapse
|
16
|
Gueli Alletti S, Perrone E, Fedele C, Cianci S, Pasciuto T, Chiantera V, Uccella S, Ercoli A, Vizzielli G, Fagotti A, Gallotta V, Cosentino F, Costantini B, Restaino S, Monterossi G, Rosati A, Turco LC, Capozzi VA, Fanfani F, Scambia G. A Multicentric Randomized Trial to Evaluate the ROle of Uterine MANipulator on Laparoscopic/Robotic HYsterectomy for the Treatment of Early-Stage Endometrial Cancer: The ROMANHY Trial. Front Oncol 2021; 11:720894. [PMID: 34568050 PMCID: PMC8461311 DOI: 10.3389/fonc.2021.720894] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/09/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This prospective randomized trial aimed to assess the impact of the uterine manipulator in terms of lymph vascular space invasion (LVSI) in patients undergoing minimally invasive staging for early-stage endometrial cancer. METHODS In this multicentric randomized trial, enrolled patients were randomly allocated in two groups according to the no use (arm A) or the use (arm B) of the uterine manipulator. Inclusion criteria were G1-G2 early-stage endometrial cancer at preoperative evaluation. The variables collected included baseline demographic characteristics, perioperative data, final pathology report, adjuvant treatment, and follow-up. RESULTS In the study, 154 patients (76 in arm A and 78 in arm B) were finally included. No significant differences were recorded regarding the baseline characteristics. A statistically significant difference was found in operative time for the laparoscopic staging (p=0.005), while no differences were reported for the robotic procedures (p=0.419). The estimated blood loss was significantly lower in arm A (p=0.030). No statistically significant differences were recorded between the two study groups in terms of peritoneal cytology, LVSI (p=0.501), and pattern of LVSI (p=0.790). No differences were detected in terms of overall survival and disease-free survival (p=0.996 and p=0.480, respectively). Similarly, no differences were recorded in the number of recurrences, 6 (7.9%) in arm A and 4 (5.2%) in arm B (p=0.486). The use of the uterine manipulator had no impact on DFS both at univariable and multivariable analyses. CONCLUSIONS The intrauterine manipulator does not affect the LVSI in early-stage endometrial cancer patients undergoing laparoscopic/robotic staging. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov, identifier (NCT: 02762214).
Collapse
Affiliation(s)
- Salvatore Gueli Alletti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Obstetrics and Gynecology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuele Perrone
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Camilla Fedele
- Institute of Obstetrics and Gynecology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Cianci
- Department of Human Pathology of Adult and Childhood “G. Barresi,” Unit of Gynecology and Obstetrics, University of Messina, Messina, Italy
| | - Tina Pasciuto
- STAR Center (Statistics Technology Archiving Research), Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, ARNAS Civico Di Cristina Benfratelli, Università di Palermo, Palermo, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, AOUI Verona, Università di Verona, Verona, Italy
| | - Alfredo Ercoli
- Division of Obstetrics and Gynecology, Università degli studi di Messina, Policlinico G. Martino, Messina, Italy
| | - Giuseppe Vizzielli
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Obstetrics and Gynecology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Obstetrics and Gynecology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio Gallotta
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Obstetrics and Gynecology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Cosentino
- Division of Gynecologic Oncology, Gemelli-Molise, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Barbara Costantini
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Obstetrics and Gynecology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Restaino
- Department of Maternal and Child Health, University-Hospital of Udine, Udine, Italy
| | - Giorgia Monterossi
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Rosati
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luigi Carlo Turco
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vito Andrea Capozzi
- Department of Gynecology and Obstetrics of Parma, University of Parma, Parma, Italy
| | - Francesco Fanfani
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Obstetrics and Gynecology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Obstetrics and Gynecology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
17
|
Capozzi VA, Monfardini L, Sozzi G, Armano G, Rosati A, Gueli Alletti S, Cosentino F, Ercoli A, Cianci S, Berretta R. Subcutaneous Vulvar Flap Viability Evaluation With Near-Infrared Probe and Indocyanine Green for Vulvar Cancer Reconstructive Surgery: A Feasible Technique. Front Surg 2021; 8:721770. [PMID: 34434959 PMCID: PMC8380961 DOI: 10.3389/fsurg.2021.721770] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/05/2021] [Indexed: 01/02/2023] Open
Abstract
Introduction: Vulvar cancer is a rare condition affecting older women and accounts for 3-5% of all gynecological cancers. Primary surgical treatment involves the removal of a large amount of tissue for which reconstructive surgery is often necessary with a high rate of postoperative complications. Despite several techniques for the evaluation of vulvar flap viability have been proposed, many methods cannot be performed during surgery and require expensive devices often missing in a gynecological clinic. This study aims to verify the feasibility and the safety of the vulvar flap viability evaluation through a near-infrared endoscopic probe and Indocyanine green (ICG) tracer in a small group of patients and to evaluate long-term vulvar flap outcomes. Methods: Patients with primary vulvar cancer who required surgical treatment and subsequent vulvar flap reconstructive surgery were prospectively included in the study. A 25 mg ICG vial diluted in 20 ml of saline solution was intravenously infused before closing the skin edges of the flaps. All patients were given 0.2 mg/kg body weight of intravenous ICG. After 10-15 min, a near-infrared endoscopic probe was used to evaluate the vulvar flap viability. Results: Of the 18 patients who underwent radical vulvectomy for vulvar cancer during the study period, 15 were included in the analysis. All packaged surgical flaps showed tracer uptake on the surgical margin. No intro-operative complications were recorded neither surgery-related nor to dye infusion. No surgical infection, dehiscence, or necrosis was recorded. Conclusions: Vulvar flap viability assessment using Indocyanine green and a laparoscopic infrared probe is a feasible method. All cases included in the analysis showed a dye uptake on the surgical edge of the flap. Further, prospective studies are needed to confirm the method in clinical practice and to evaluate its superiority over simple subjective clinical evaluation.
Collapse
Affiliation(s)
| | | | - Giulio Sozzi
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - Giulia Armano
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Andrea Rosati
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Salvatore Gueli Alletti
- Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Cosentino
- Department of Medicine and Health Science "V.Tiberio", Università degli Studi del Molise, Campobasso, Italy
| | - Alfredo Ercoli
- Department of Human Pathology of the Adult and of the Childhood "Gaetano Barresi", Università di Messina, Messina, Italy
| | - Stefano Cianci
- Department of Human Pathology of the Adult and of the Childhood "Gaetano Barresi", Università di Messina, Messina, Italy
| | - Roberto Berretta
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| |
Collapse
|
18
|
Larish A, Mariani A, Langstraat C. Controversies in the Management of Early-stage Serous Endometrial Cancer. In Vivo 2021; 35:671-680. [PMID: 33622859 DOI: 10.21873/invivo.12307] [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: 08/03/2020] [Revised: 12/02/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Early-stage uterine serous carcinoma (USC) has one of the highest recurrence rates and mortality among early-stage uterine epithelial cancers. Research into the clinical management of USC has begun to progress, guided by surgical and pathological advances. This article summarizes the available literature regarding diagnosis, management, and possible future uses of molecular analysis of women with early-stage USC. MATERIALS AND METHODS PubMed was searched for all pertinent English language research articles published from January 1, 2006 through March 1, 2020 which included a study population of women diagnosed with stage 1 USC. Due to the scarcity of prospective or large-scale data, studies were not limited by design or numbers of patients. Studies performed at earlier dates were incorporated to provide context. RESULTS A total of 86 studies were included in the review. Multiple well-designed studies have confirmed the safety of a minimally invasive surgical approach for surgical management of USC. The role of sentinel node biopsy has been validated with both prospective and retrospective multi-center data. Stage I USC is associated with a highly variable risk of recurrence, even following completion of adjuvant chemoradiation. This aggressive phenotype has been linked to high numbers of somatic copy number alterations, tumor protein 53, and phosphatidylinositol 3 kinase mutations, which have been shown to be predictive of prognosis. CONCLUSION Early-stage USC demonstrates a lack of predictable recurrence patterns, with reports noting distant recurrence in patients with disease confined to polyps. Unless no residual tumor is found on hysterectomy, chemotherapy and radiotherapy should be discussed and individualized by stage and treatment goals.
Collapse
Affiliation(s)
- Alyssa Larish
- Department of Obstetrics and Gynecology. Mayo Clinic, Rochester, MN, U.S.A.
| | - Andrea Mariani
- Department of Obstetrics and Gynecology. Mayo Clinic, Rochester, MN, U.S.A
| | - Carrie Langstraat
- Department of Obstetrics and Gynecology. Mayo Clinic, Rochester, MN, U.S.A
| |
Collapse
|
19
|
Richards L, Healey M, Cheng C, Reddington C, Robson-Hamond C, Dior U. Risk Factors and Outcomes of Conversion to Open Surgery in Benign Gynecologic Laparoscopies: A Case-Control Study. J Minim Invasive Gynecol 2021; 28:1786-1794. [PMID: 33892186 DOI: 10.1016/j.jmig.2021.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To describe cases of conversion from gynecologic laparoscopy to open surgery and to assess risk factors for conversion and conversion outcomes. DESIGN A retrospective case-control study. SETTING Tertiary referral hospital in Melbourne, Australia. PATIENTS Eighty-five cases of conversion from laparoscopy to laparotomy and 170 controls matched by age, surgical date, and gynecologic unit from 2006 to 2017. INTERVENTIONS Demographic, clinical, and surgical data were collected and compared between the study groups. Logistic regression was performed to identify preoperative and intraoperative risk factors for conversion. MEASUREMENTS AND MAIN RESULTS Rate of conversion during the study period was 0.7%. The most common indication for conversion was unexpected surgical complexity (67% of cases), which included severe adhesive disease, specimen size, severe pathology, and inadequate views. Factors that were significantly associated with risk of conversion in multivariate analysis were previous pelvic inflammatory disease (adjusted odds ratio [aOR] 5.16; 95% confidence interval [CI], 1.35-19.71; p = .02), previous open surgery (aOR 3.62; 95% CI, 1.52-8.58; p <.01), history of endometriosis (aOR 2.96; 95% CI, 1.17-7.50; p = .02), and elevated body mass index (aOR 1.07; 95% CI, 1.01-1.13; p = .02). As compared with current surgery for endometriosis, odds of conversion were higher in surgeries for emergency indications (aOR 5.40; 95% CI, 1.53-18.98; p <.01), uterine pathologies (aOR 3.34; 95% CI, 1.10-10.12; p = .03), and adnexal pathologies (aOR 2.76; 95% CI, 1.19-6.40; p = .02). With the inclusion of intraoperative factors, surgical adhesions were also found to be associated with conversion (aOR 3.19; 95% CI, 1.30-7.85; p = .01). Most skilled laparoscopic surgeon level as defined by the Australasian Gynaecological Endoscopy and Surgery Society was not associated with conversion risk. Conversion to laparotomy was associated with a higher rate of intraoperative and postoperative complications and prolonged length of stay. CONCLUSION Conversion to laparotomy is a rare but very important clinical outcome measure of laparoscopic surgery. Understanding the factors contributing to conversion and perioperative outcomes may help clinicians to identify and counsel patients before surgery and to reduce surgical morbidity.
Collapse
Affiliation(s)
- Lucy Richards
- Gynaecology 2 Unit (Endometriosis and Pelvic Pain), Royal Women's Hospital, Melbourne (all authors).
| | - Martin Healey
- Gynaecology 2 Unit (Endometriosis and Pelvic Pain), Royal Women's Hospital, Melbourne (all authors); Department of Obstetrics and Gynecology, University of Melbourne, Parkville (Drs. Healey and Cheng), Victoria, Australia
| | - Claudia Cheng
- Gynaecology 2 Unit (Endometriosis and Pelvic Pain), Royal Women's Hospital, Melbourne (all authors); Department of Obstetrics and Gynecology, University of Melbourne, Parkville (Drs. Healey and Cheng), Victoria, Australia
| | - Charlotte Reddington
- Gynaecology 2 Unit (Endometriosis and Pelvic Pain), Royal Women's Hospital, Melbourne (all authors)
| | - Caitlin Robson-Hamond
- Gynaecology 2 Unit (Endometriosis and Pelvic Pain), Royal Women's Hospital, Melbourne (all authors)
| | - Uri Dior
- Gynaecology 2 Unit (Endometriosis and Pelvic Pain), Royal Women's Hospital, Melbourne (all authors); Hadassah-Hebrew University Medical Center, Jerusalem, Israel (Dr. Dior)
| |
Collapse
|
20
|
Capozzi VA, Riemma G, Rosati A, Vargiu V, Granese R, Ercoli A, Cianci S. Surgical complications occurring during minimally invasive sentinel lymph node detection in endometrial cancer patients. A systematic review of the literature and metanalysis. Eur J Surg Oncol 2021; 47:2142-2149. [PMID: 33820674 DOI: 10.1016/j.ejso.2021.03.253] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/13/2021] [Accepted: 03/24/2021] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Endometrial cancer (EC) is the most common gynecological cancer. Sentinel lymph node (SLN) technique has been adopted worldwide and showed lower morbidity and superimposable survival outcomes than the systematic lymphadenectomy (LND). Although these encouraging results, no meta-analyzes were performed on surgical complications during SLN research among patients undergoing laparoscopic (L) versus robotic surgery (R). The present review aims to report surgical complications during laparoscopic versus robotic SLN technique. METHODS The Preferred Reporting Items for Systematic reviews and Meta-Analyzes (PRISMA) and the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines have been followed for the present meta-analysis. RESULTS Six studies, including 769 participants, were included. L-LND resulted in a significantly higher risk of operative complications relative to L-SLN (RR 2.10 [95% CI 1.37 to 3.21]). The risk of complications was comparable between R-SLN and L-SLN (RR 2.32 [95% CI 0.04-121.02]) and between R-LND and L-LND (RR 2.17 [95% CI 0.04-126.69]). According to the SUCRA analysis, L-SLN and R-SLN had the highest chances of being ranked first among proposed surgical procedures (SUCRA 48.9% and 28.4% respectively). CONCLUSIONS Our study reported a lower surgical complications rate in patients undergoing L-SLN technique compared to L-LND. A lower rate of surgical complications was also reported for the R-SLN technique compared to the R-LND. Both laparoscopic and robotic SLN surgical techniques were found to be safe surgical procedures.
Collapse
Affiliation(s)
- Vito Andrea Capozzi
- Department of Gynecology and Obstetrics, University of Parma, 43125, Parma, Italy.
| | - Gaetano Riemma
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - Andrea Rosati
- Dipartimento per le Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Department of Gynecology and Obstetrics, Roma, Italy
| | - Virginia Vargiu
- Dipartimento per le Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Department of Gynecology and Obstetrics, Roma, Italy
| | - Roberta Granese
- Dipartimento di Ginecologia Oncologica e Chirurgia Ginecologica Miniinvasiva, Università degli studi di Messina, Policlinico G. Martino, Messina, Italy
| | - Alfredo Ercoli
- Dipartimento di Ginecologia Oncologica e Chirurgia Ginecologica Miniinvasiva, Università degli studi di Messina, Policlinico G. Martino, Messina, Italy
| | - Stefano Cianci
- Dipartimento di Ginecologia Oncologica e Chirurgia Ginecologica Miniinvasiva, Università degli studi di Messina, Policlinico G. Martino, Messina, Italy
| |
Collapse
|
21
|
Affiliation(s)
- Stefano Cianci
- Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy -
| |
Collapse
|
22
|
Januszek SM, Wita-Popow B, Kluz M, Janowska M, Januszek R, Wróbel A, Rogowski A, Malinowski KP, Zuzak T, Kluz T. Risk Factors for Surgical Treatment of Endometrial Cancer Using Traditional and Laparoscopic Methods. J Clin Med 2021; 10:429. [PMID: 33499336 PMCID: PMC7865410 DOI: 10.3390/jcm10030429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/08/2021] [Accepted: 01/15/2021] [Indexed: 11/22/2022] Open
Abstract
Surgical treatment is the most important part of therapy for endometrial cancer. The aim of the study was to define factors having the most significant impact on surgical treatment of endometrial cancer when using traditional and laparoscopic methods. In the study, we evaluated 75 females who were treated for endometrial cancer via laparoscopic surgery in 2019 and used a historical control of 70 patients treated by laparotomy in 2011. The evaluated risk factors included the method of surgery, type of lymphadenectomy, patient's age, various obesity parameters, histological grading, cancer clinical staging, pelvic dimensions, previous abdominal surgeries, comorbidities, and number of deliveries. The duration of hospitalization, operation time, loss of hemoglobin, and procedure-related complications were used as parameters of perioperative outcomes. Multivariable linear regression analysis confirmed the following factors as being predictors of worse perioperative outcomes: laparotomy, abdominal obesity (waist circumstance and waist-to-hip ratio), range of lymphadenectomy, prior abdominal surgeries, and larger pelvic dimensions. Abdominal obesity is a significant risk factor in the treatment of endometrial cancer. Laparotomy continues to be utilized frequently in the management of endometrial cancer in Poland as well as elsewhere, and adopting a minimally invasive approach is likely to be beneficial for patient outcome.
Collapse
Affiliation(s)
- Sławomir M. Januszek
- Department of Gynecology and Obstetrics, Fryderyk Chopin University Hospital No. 1, 35-055 Rzeszów, Poland; (B.W.-P.); (M.J.); (T.Z.); (T.K.)
| | - Barbara Wita-Popow
- Department of Gynecology and Obstetrics, Fryderyk Chopin University Hospital No. 1, 35-055 Rzeszów, Poland; (B.W.-P.); (M.J.); (T.Z.); (T.K.)
| | - Marta Kluz
- Department of Pathology, Fryderyk Chopin University Hospital No. 1, 35-055 Rzeszów, Poland;
| | - Magdalena Janowska
- Department of Gynecology and Obstetrics, Fryderyk Chopin University Hospital No. 1, 35-055 Rzeszów, Poland; (B.W.-P.); (M.J.); (T.Z.); (T.K.)
| | - Rafał Januszek
- Department of Clinical Rehabilitation, University of Physical Education, 31-571 Kraków, Poland;
| | - Andrzej Wróbel
- Second Department of Gynecology, Medical University of Lublin, Jaczewskiego 8, 20-954 Lublin, Poland;
| | - Artur Rogowski
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University in Warsaw, 01-938 Warsaw, Poland;
- Department of Obstetrics and Gynecology, Mother and Child Institute, 01-211 Warsaw, Poland
| | - Krzysztof P. Malinowski
- Faculty of Health Sciences, A Institute of Public Health, Jagiellonian University Medical College, 31126 Kraków, Poland;
| | - Tomasz Zuzak
- Department of Gynecology and Obstetrics, Fryderyk Chopin University Hospital No. 1, 35-055 Rzeszów, Poland; (B.W.-P.); (M.J.); (T.Z.); (T.K.)
| | - Tomasz Kluz
- Department of Gynecology and Obstetrics, Fryderyk Chopin University Hospital No. 1, 35-055 Rzeszów, Poland; (B.W.-P.); (M.J.); (T.Z.); (T.K.)
- Department of Gynecology and Obstetrics, Institute of Medical Sciences, Medical College of Rzeszow University, 35-310 Rzeszów, Poland
| |
Collapse
|
23
|
Carugno J, Marbin SJ, LaganÀ AS, Vitale SG, Alonso L, DI Spiezio Sardo A, Haimovich S. New development on hysteroscopy for endometrial cancer diagnosis: state of the art. Minerva Med 2021; 112:12-19. [PMID: 33438376 DOI: 10.23736/s0026-4806.20.07123-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Endometrial cancer (EC) is the most common gynecologic cancer diagnosed in developed countries and represents the second most frequent gynecologic cancer-related cause of death following ovarian cancer. There are 2 subtypes of EC. Type I tumors (endometrioid adenocarcinoma) representing 85-90% of the cases. They are likely to be low-grade tumors and are thought to have a link to estrogen exposure. Type II tumors represent 10-15% of EC. They are characterized as high-grade carcinomas, with serous or clear cell histology type, and carry poor prognoses. The benefits of hysteroscopy in achieving a targeted endometrial biopsy under direct visualization over blind biopsy techniques are widely accepted. Hysteroscopic endometrial biopsy is performed under direct visualization and is the only technique that allows for the selective biopsy of targeted areas of the endometrium. There is no screening protocol for the early detection of EC. Among the general population, advanced age, obesity, nulliparity and the use of exogenous hormones are known as risk factors for EC. There are additional situations that portend an increased risk of EC that deserve special consideration such as in patients diagnosed with Lynch Syndrome, using tamoxifen, obese, or the young patient with a desire for future fertility. We presented a narrative review of the current role of hysteroscopy for the diagnosis of endometrial cancer.
Collapse
Affiliation(s)
- Jose Carugno
- Miller School of Medicine, Unit of Minimally Invasive Gynecology, Division of Obstetrics, Department of Gynecology and Reproductive Sciences, University of Miami, Miami, FL, USA -
| | - Staci J Marbin
- Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Antonio S LaganÀ
- Department of Obstetrics and Gynecology, Filippo del Ponte Hospital, University of Insubria, Varese, Italy
| | - Salvatore G Vitale
- Unit of Obstetrics and Gynecology, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Luis Alonso
- Unit of Gynecology Endoscopy, Gutenberg Center, Malaga, Spain
| | | | - Sergio Haimovich
- Rappaport Faculty of Medicine, Hillel Yaffe Medical Center, Technion, Israel
| |
Collapse
|
24
|
Update on extended prophylaxis for venous thromboembolism following surgery for gynaecological cancers. THROMBOSIS UPDATE 2021. [DOI: 10.1016/j.tru.2021.100038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
|
25
|
Pelligra S, Scaletta G, Cianci S, Gueli Alletti S, Restaino S, Fagotti A, Scambia G, Fanfani F. Update on new imaging technologies in sentinel node detection. ACTA ACUST UNITED AC 2020; 72:404-412. [PMID: 33306284 DOI: 10.23736/s0026-4784.20.04707-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In most cancers, lymph node status is the most critical factor impacting the evolution of the disease and the overall survival. Identifying potential nodal metastasis allows the oncologist to adjust the stage and, consequently, the patient's treatment. For this reason, a precise evaluation of the regional nodes is mandatory. In gynecological cancers, pelvic, paraaortic, and inguinal nodes are the region most frequently interested by metastasis. In the past years, comprehensive lymphadenectomy was the standard of care for endometrial, cervical, ovarian, and vulvar cancers. However, after introducing the sentinel lymph node (SNL) biopsy in breast cancers, this technique has gained much more interest in gynecology oncology. Several studies have shown that SLN allows an evaluation of the node status without the complications related to the lymphadenectomy that impacts the patient's quality of life. In this review, we discuss the role of SNL biopsy in gynecological cancers and the technique's evolution over the years. Moreover, we debate the OSNA method for SLN analysis that is recently introduced for uterine cancer.
Collapse
Affiliation(s)
- Silvia Pelligra
- Department of Women's and Children's Health Sciences and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Giuseppe Scaletta
- Department of Women's and Children's Health Sciences and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy -
| | - Stefano Cianci
- Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Salvatore Gueli Alletti
- Department of Women's and Children's Health Sciences and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Stefano Restaino
- Department of Women's and Children's Health Sciences and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Anna Fagotti
- Department of Women's and Children's Health Sciences and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Department of Women's and Children's Health Sciences and Public Health, Sacred Heart Catholic University, Rome, Italy
| | - Giovanni Scambia
- Department of Women's and Children's Health Sciences and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Department of Women's and Children's Health Sciences and Public Health, Sacred Heart Catholic University, Rome, Italy
| | - Francesco Fanfani
- Department of Women's and Children's Health Sciences and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy.,Department of Women's and Children's Health Sciences and Public Health, Sacred Heart Catholic University, Rome, Italy
| |
Collapse
|
26
|
Capozzi VA, Rosati A, Uccella S, Riemma G, Tarascio M, Torella M, De Franciscis P, Colacurci N, Cianci S. Role of uterine manipulator during laparoscopic endometrial cancer treatment. Transl Cancer Res 2020; 9:7759-7766. [PMID: 35117378 PMCID: PMC8799210 DOI: 10.21037/tcr-20-2094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/06/2020] [Indexed: 01/22/2023]
Abstract
Endometrial cancer (EC) is the most frequent gynecologic malignancy with 61,000 new cases diagnosed per year in the USA. Gynecologic Oncology Group (GOG) LAP2 randomized study demonstrated a superimposable 5-year overall survival between laparotomic and laparoscopic approaches in EC treatment. In this context the uterine manipulator (UM) represents a valuable tool in order to increase the ergonomics of surgical gesture during a laparoscopic total hysterectomy. Despite the proven safety of the minimally invasive approach in EC treatment, neither the indication whether to use or not, nor the recommendation concerning a specific type of UM are provided by international guidelines. This narrative review aims to collect all the main findings in the literature about UM use to investigate its safety in EC patients. Based on the analysis of the literature research, the main results were categorized into two manipulator-related problems: the iatrogenic LVSI, and the retrograde tumor spillage. LVSI is defined as the presence of tumor cells within an endothelium-lined space. An electronic search was performed using the following keywords: 'uterine manipulator', and 'endometrial cancer'. The electronic database search provided a total of 93 studies. Of whom, 12 case reports, 5 studies not in English language, and 65 works not fitting the review scope were excluded from the analysis. Eleven studies were considered eligible for the purpose of the study. The most recent studies have highlighted the safety of the uterine manipulator in the early-stage EC laparoscopic treatment. All types of manipulators are considered to be fairly safe but its application should be tailored according to tumor dimension and grade of myometrial infiltration.
Collapse
Affiliation(s)
| | - Andrea Rosati
- Unità Operativa Ginecologia Oncologica, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Univeristario A. Gemelli, IRCCS, Rome, Italy
| | - Stefano Uccella
- Nuovo Ospedale degli Infermi Dipartimento di Oncologia di Biella, Ponderano, Italy
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mattia Tarascio
- Azienda Sanitaria Provinciale di Catania- via S. Maria La Grande, Catania, Italy
| | - Marco Torella
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Pasquale De Franciscis
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nicola Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Stefano Cianci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| |
Collapse
|
27
|
Garzon S, Uccella S, Zorzato PC, Bosco M, Franchi MP, Student V, Mariani A. Fertility-sparing management for endometrial cancer: review of the literature. Minerva Med 2020; 112:55-69. [PMID: 33205638 DOI: 10.23736/s0026-4806.20.07072-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Primary surgery is effective in low-risk endometrial cancer (EC). However, in young women, this approach compromises fertility. Therefore, fertility-sparing management in the case of atypical endometrial hyperplasia, or grade 1 EC limited to the endometrium can be considered. EVIDENCE ACQUISITION We performed a literature review to identify studies involving women with EC or atypical hyperplasia who underwent fertility-sparing management. We conducted multiple bibliographic databases research from their inception to May 2020. EVIDENCE SYNTHESIS Oral therapy with medroxyprogesterone acetate and megestrol acetate is recommended based on extensive experience, although without consensus on dosages and treatment length. The pooled complete response rate, recurrence rate, and pregnancy rate of EC were 76.3%, 30.7% and 52.1%, respectively. Endometrial hyperplasia was associated with better outcomes. LNG-IUSs appears an alternative treatment, particularly in patients who do not tolerate oral therapy. In a randomized controlled trial, megestrol acetate plus metformin guaranteed an earlier complete response rate than megestrol acetate alone for endometrial hyperplasia. Hysteroscopic resection followed by progestogens is associated with a higher complete response rate, live birth rate, and lower recurrence rate than oral progestogens alone. Pooled complete response, recurrence, and live birth rates were 98.1%, 4.8% and 52.6%. CONCLUSIONS Fertility preservation appears feasible in young patients with grade 1 EC limited to the endometrium or atypical endometrial hyperplasia. Progestins are the mainstay of such management. The addition of Metformin and hysteroscopic resection seems to provide some improvements. However, fertility preservation is not the standard approach for staging and treatment, potentially worsening oncologic outcomes.
Collapse
Affiliation(s)
- Simone Garzon
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, MN, USA -
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, University Hospital of Verona, University of Verona, Verona, Italy
| | - Pier Carlo Zorzato
- Department of Obstetrics and Gynecology, University Hospital of Verona, University of Verona, Verona, Italy
| | - Mariachiara Bosco
- Department of Obstetrics and Gynecology, University Hospital of Verona, University of Verona, Verona, Italy
| | - Massimo P Franchi
- Department of Obstetrics and Gynecology, University Hospital of Verona, University of Verona, Verona, Italy
| | - Vladimir Student
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, MN, USA
| | - Andrea Mariani
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, MN, USA
| |
Collapse
|
28
|
Capozzi VA, Rosati A, Rumolo V, Ferrari F, Gullo G, Karaman E, Karaaslan O, HacioĞlu L. Novelties of ultrasound imaging for endometrial cancer preoperative workup. Minerva Med 2020; 112:3-11. [PMID: 33205640 DOI: 10.23736/s0026-4806.20.07125-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Endometrial cancer (EC) is the most frequent gynecological cancer. Transvaginal ultrasound (TVU) plays a leading role in the preoperative workup and often is the first diagnostic instrumental examination. Despite expert hands' ultrasound is recommended to assess myometrial invasion in early stage EC, this method is a strictly operator-dependent examination, and varying degrees of sensitivity and specificity have been reported. The present review aims to provide an update of ultrasound imaging in the preoperative work-up for EC patients. EVIDENCE ACQUISITION A double-blind search was performed from May to September 2020. The following keywords: "ultrasound," "transvaginal ultrasound" and "endometrial cancer" were searched in Pubmed search engines, Scopus, and Web of Science. The Prisma statement was followed for the selection of the articles included. EVIDENCE SYNTHESIS The initial search provided 958 studies, of which 11 were included in the analysis. non-English articles, not relevant to the purposes of this study, case reports and articles with fewer than 40 cases were excluded. CONCLUSIONS TVU sensitivity and specificity in myometrial infiltration and cervical invasion is comparable to MRI but has lower costs, greater patient tolerability, and does not require contrast agents. An expert operator should perform the ultrasound examination in patients with suspected EC The presence of myometrial lesions, such as leiomyomas, could lower the diagnostic accuracy of ultrasound, so special attention should be paid to patients with concomitant uterine lesions.
Collapse
Affiliation(s)
- Vito A Capozzi
- Department of Gynecology and Obstetrics, University of Parma, Parma, Italy
| | - Andrea Rosati
- Division of Gynecologic Oncology, Department of Women and Children's Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Valerio Rumolo
- Division of Gynecologic Oncology, Department of Women and Children's Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Federico Ferrari
- Department of Women's and Reproductive Health, University of Oxford, Headington, Oxford, UK
| | - Giuseppe Gullo
- Department of Obstetrics and Gynecology, AOOR Villa Sofia Cervello, IVF Public Center, Palermo, Italy
| | - Erbil Karaman
- Department of Gynecology and Obstetrics, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey -
| | - Onur Karaaslan
- Department of Gynecology and Obstetrics, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Latif HacioĞlu
- Department of Gynecology and Obstetrics, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| |
Collapse
|
29
|
Zorzato PC, Bosco M, Franchi MP, Mariani A, Cianci S, Garzon S, Uccella S. Sentinel lymph node for endometrial cancer treatment: review of the literature. Minerva Med 2020; 112:70-80. [PMID: 33198443 DOI: 10.23736/s0026-4806.20.07117-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Endometrial cancer is the most common gynecologic malignancy and in two thirds of patients it is apparently uterine confined at presentation. Lymph nodal status represents one of the main prognostic factors. Nodal evaluation with sentinel lymph node (SLN) mapping has gained more ground in clinical practice after the publication of different studies demonstrating the feasibility and accuracy of this technique. However, at the moment there are no RCTs available evaluating the long-term oncologic safety of SLN technique compared to LND. This review aims at summarizing the available evidence on oncologic outcomes between SLN mapping alone and LND. Differences in operative complications and long-term complications were also analyzed. EVIDENCE ACQUISITION The literature search was conducted in the PubMed database and it focused on comparative studies published from inception to September 2020 analyzing differences in oncological outcomes or complications between nodal evaluation with SLN technique alone and nodal evaluation with lymphadenectomy. Comparative studies with more than 10 cases, published in English, were included. EVIDENCE SYNTHESIS A total of 5 retrospective comparative studies have been identified reporting data on oncologic outcomes of patients who underwent SLN mapping alone vs. LND. Non significative difference has been reported in terms of overall survival and recurrence free survival between the two groups. Six studies evaluated differences in terms of complications between the two techniques. A total of 2302 patients were identified. Postoperative complications were detected in 9.6% and 7.7% of patients who underwent lymphadenectomy and SLN mapping respectively and no significant difference was noted (P=0.3). Looking at major postoperative complications the rate in the LND group was significantly higher than in the SLN group (3.6% vs. 1.5%, P=0.02). Two of these six studies reported data on lymphatic long-term complications. The prevalence of lymphedema ranged from 0% to 1.3% in the SLN group and from 10% to 18% in the LND group. The absolute difference reported (13.35%) was similar to the one found in literature. CONCLUSIONS SLN mapping in apparently uterine confined disease has been demonstrated to be a feasible and accurate technique for nodal evaluation and high-quality evidence support this. Moreover, SLN mapping resulted to be associated with less major postoperative and long-term complications when compared to LDN. Conversely, high-quality evidence is not available on long-term oncologic safety of this technique compared to the standard LND. Randomized trials are requested to provide reliable data on this aspect.
Collapse
Affiliation(s)
- Pier C Zorzato
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata (AOUI) Verona, Verona, Italy
| | - Mariachiara Bosco
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata (AOUI) Verona, Verona, Italy
| | - Massimo P Franchi
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata (AOUI) Verona, Verona, Italy
| | - Andrea Mariani
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Stefano Cianci
- Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata (AOUI) Verona, Verona, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, Azienda Ospedaliera Universitaria Integrata (AOUI) Verona, Verona, Italy -
| |
Collapse
|
30
|
Morotti M, Soleymani Majd H, Casarin J, Alazzam M, Damato S. Histomolecular features of high-grade endometrial cancers. Minerva Med 2020; 112:20-30. [PMID: 33104303 DOI: 10.23736/s0026-4806.20.07082-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
High-grade endometrial cancers (ECs) are an aggressive subset of ECs accounting for 70-80% of EC-related deaths. Currently, staging surgery, together with chemotherapy or radiotherapy, is the primary treatment strategy for these cancers. The widespread use of next-generation sequencing has led to a refined understanding of EC's genomics with important information for diagnosis and therapy for individual patients (precision medicine). However, advances in the genomics assessment of high-grade tumors have been slower due to their lower incidence than low-grade EC. This article will briefly introduce the current state of knowledge of the genomics of G3 endometrioid EC, serous uterine cancer, clear cell uterine carcinoma and uterine carcinosarcoma and discuss its implications for diagnosis and targeted therapy.
Collapse
Affiliation(s)
- Matteo Morotti
- Department of Gynecological Oncology, Oxford University Hospital NHS Foundation Trust, Oxford, UK -
| | - Hooman Soleymani Majd
- Department of Gynecological Oncology, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Jvan Casarin
- Department of Obstetrics and Gynecology, Filippo Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Moiad Alazzam
- Department of Gynecological Oncology, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Stephen Damato
- Department of Cellular Pathology, Oxford University Hospitals, Oxford, UK
| |
Collapse
|
31
|
Cianci S, Rosati A, Capozzi VA, Tarascio M, Uccella S, Palumbo M, Caruso S. Quality of life and sexual functioning of patient affected by endometrial cancer. Minerva Med 2020; 112:81-95. [PMID: 33104302 DOI: 10.23736/s0026-4806.20.07081-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Thanks to timely diagnosis and medical advancement the number of endometrial cancer (EC) patients achieving long term survival is constantly increasing and here comes the necessity to move forward with the understanding of post-treatment sexual adjustment and with the strategies to enhance sexual functioning (SF) and quality of life (QoL) in this population. In this scenario we designed this study aiming to summarize and analyze the available scientific evidence regarding QoL and especially SF in patients affected by EC who underwent surgical and adjuvant treatment. EVIDENCE ACQUISITION A preliminary research was conducted using Pubmed database with specific keywords combinations regarding SF, QoL and endometrial cancer. The main findings considered in the present review were: the study design, the number of patients included in each study, the information about pathology (histology and stage of disease), the questionnaires administered and the principal results concerning SF and QoL. EVIDENCE SYNTHESIS A total of thirteen studies, between 2009 and 2018, treating the aspects of SF and QoL in patients affected by EC were extracted. The principal findings of different studies were organized in the following sections: 1) overall SF in EC patients (reasons for sexual inactivity); 2) impact of EC on SF when compared to benign gynecological disease or healthy controls-focus on surgery; 3) minimally invasive surgery versus classical laparotomic approach and SF of EC patients; 4) surgery alone versus VBT versus EBRT and SF of EC patients; 5) focus on RT; 6) the mutual correlation between sociodemographic, relational, psychological, clinical/metabolic factors and the SF of EC patients. CONCLUSIONS Considering the widespread diffusion of female sexual dysfunction among EC patients and the relatively good prognosis, especially in early stage disease, it undoubtedly looms the need for proactive countermeasures to maximize the sexual well-being and QoL of these patients. A wide range of intervention in a multi-modal physical and mental perspective should be considered.
Collapse
Affiliation(s)
- Stefano Cianci
- Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy -
| | - Andrea Rosati
- Department of Obstetrics and Gynecology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Vito A Capozzi
- Department of Gynecology and Obstetrics, University of Parma, Parma, Italy
| | | | - Stefano Uccella
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Marco Palumbo
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Salvatore Caruso
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| |
Collapse
|
32
|
Capozzi VA, Merisio C, Rolla M, Pugliese M, Morganelli G, Cianciolo A, Gambino G, Armano G, Sozzi G, Riccò M, Berretta R. Confounding factors of transvaginal ultrasound accuracy in endometrial cancer. J OBSTET GYNAECOL 2020; 41:779-784. [DOI: 10.1080/01443615.2020.1799342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Vito Andrea Capozzi
- Department of Gynecology and Obstetrics of Parma, University of Parma, Parma, Italy
| | - Carla Merisio
- Department of Gynecology and Obstetrics of Parma, University of Parma, Parma, Italy
| | - Martino Rolla
- Department of Gynecology and Obstetrics of Parma, University of Parma, Parma, Italy
| | - Martina Pugliese
- Department of Gynecology and Obstetrics of Parma, University of Parma, Parma, Italy
| | - Giovanni Morganelli
- Department of Gynecology and Obstetrics of Parma, University of Parma, Parma, Italy
| | - Alessandra Cianciolo
- Department of Gynecology and Obstetrics of Parma, University of Parma, Parma, Italy
| | - Giulia Gambino
- Department of Gynecology and Obstetrics of Parma, University of Parma, Parma, Italy
| | - Giulia Armano
- Department of Gynecology and Obstetrics of Parma, University of Parma, Parma, Italy
| | - Giulio Sozzi
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - Matteo Riccò
- Service for Health and Safety on the Workplaces, AUSL - I.R.C.C.S. di Reggio Emilia, Reggio Emilia, Italy
| | - Roberto Berretta
- Department of Gynecology and Obstetrics of Parma, University of Parma, Parma, Italy
| |
Collapse
|
33
|
He S, Fang X, Xia X, Hou T, Zhang T. Targeting CDK9: A novel biomarker in the treatment of endometrial cancer. Oncol Rep 2020; 44:1929-1938. [PMID: 32901849 PMCID: PMC7551504 DOI: 10.3892/or.2020.7746] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 07/21/2020] [Indexed: 12/18/2022] Open
Abstract
Endometrial cancer is one of the three major malignant tumors of the female reproductive system. Although cyclin-dependent kinase 9 (CDK9) has a definitive pathogenic role in various types of cancer, little is known concerning its function in endometrial cancer. Our study was conducted to evaluate the expression and therapeutic potential of CDK9 in endometrial cancer. CDK9 expression was determined by immunohistochemistry in endometrial cancer tissues constructed with paired primary, metastatic, and recurrent tumor tissues from 32 endometrial cancer patients. Small interfering RNA (siRNA) and inhibitors of CDK9 were used to evaluate the effect of CDK9 inhibition on the anti-apoptotic activity and proliferation in endometrial cancer cells. Colony formation assay and wound-healing assays were adopted to assess clonal formation and migratory capacity. The results of the immunohistochemistry demonstrated that CDK9 was highly expressed in the human endometrial cancer cell lines; moreover, it was elevated in metastatic and recurrent endometrial tumor tissue compared when compared with that in patient-matched primary endometrial tumor tissue. Knockdown of CDK9 with siRNA and inhibition of CDK9 activity with the inhibitor suppressed cell proliferation and promoted apoptosis in endometrial cancer. In conclusion, our results provide evidence that CDK9 may be a potential prognostic biomarker and a promising therapeutic target for the treatment of endometrial cancer in the future.
Collapse
Affiliation(s)
- Shasha He
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410000, P.R. China
| | - Xiaoling Fang
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410000, P.R. China
| | - Xiaomeng Xia
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410000, P.R. China
| | - Tao Hou
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410000, P.R. China
| | - Tingting Zhang
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410000, P.R. China
| |
Collapse
|
34
|
Pedra Nobre S, Mueller JJ, Gardner GJ, Long Roche K, Brown CL, Soslow RA, Alektiar KM, Sonoda Y, Broach VA, Jewell EL, Zivanovic O, Chi DS, Abu-Rustum NR, Leitao MM. Comparison of minimally invasive versus open surgery in the treatment of endometrial carcinosarcoma. Int J Gynecol Cancer 2020; 30:1162-1168. [PMID: 32690592 DOI: 10.1136/ijgc-2020-001573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this study was to compare perioperative and oncologic outcomes between minimally invasive and open surgery in the treatment of endometrial carcinosarcoma. METHODS We retrospectively identified all patients with newly diagnosed endometrial carcinosarcoma who underwent primary surgery via any approach at our institution from January 2009 to January 2018. Patients with known bulky disease identified on preoperative imaging were excluded. The χ2 and Mann-Whitney U tests were used to compare categorical and continuous variables, respectively. Kaplan-Meier curves were used to estimate survival, and compared using the log rank test. RESULTS We identified 147 eligible patients, of whom 37 (25%) underwent an open approach and 110 (75%) underwent minimally invasive surgery. Within the minimally invasive group, 92 (84%) of 110 patients underwent a robotic procedure and 14 (13%) underwent a laparoscopic procedure. Four minimally invasive cases (4%) were converted to open procedures. Median age, body mass index, operative time, stage, complication grade, and use of adjuvant treatment were clinically and statistically similar between groups. Median length of hospital stay in the open group was 4 days (range 3-21) compared with 1 day (range 0-6) in the minimally invasive group (p<0.001). The rates of any 30-day complication were 46% in the open and 8% in the minimally invasive group (p<0.001). The rates of grade 3 or higher complications were 5.4% and 1.8%, respectively (p=0.53). Median follow-up for the entire cohort was 30 months (range 0.4-121). Two-year progression-free survival rates were 52.8% (SE±8.4) in the open group and 58.5% (SE±5.1) in the minimally invasive group (p=0.7). Two-year disease-specific survival rates were 66.1% (SE±8.0) and 81.4% (SE±4.1), respectively (p=0.8). CONCLUSIONS In patients with clinical stage I endometrial carcinosarcoma, minimally invasive compared with open surgery was not associated with poor oncologic outcomes, but with a shorter length of hospital stay and a lower rate of overall complications.
Collapse
Affiliation(s)
- Silvana Pedra Nobre
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jennifer J Mueller
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ginger J Gardner
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kara Long Roche
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Carol L Brown
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert A Soslow
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kaled M Alektiar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vance A Broach
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elizabeth L Jewell
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|