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Ito H, Moritake T, Isaka K. Does the use of a uterine manipulator in robotic surgery for early‐stage endometrial cancer affect oncological outcomes? Int J Med Robot 2022; 18:e2443. [DOI: 10.1002/rcs.2443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/18/2022] [Accepted: 07/17/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroe Ito
- Department of Obstetrics and Gynecology Tokyo Medical University Hospital Shinjuku‐ku Japan
| | - Tetsuya Moritake
- Department of Obstetrics and Gynecology Tokyo Medical University Hospital Shinjuku‐ku Japan
- Department of Obstetrics and Gynrcology Sugawara Hospital Saitama Japan
| | - Keiichi Isaka
- Department of Obstetrics and Gynecology Tokyo Medical University Hospital Shinjuku‐ku Japan
- Robotic Surgery Center Tokyo International Ohori Hospital Mitaka Japan
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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).
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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
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Seidman JD, Krishnan J. High-grade Pelvic Serous Carcinoma Within the Fallopian Tube Lumen: Real or Artifact? Int J Gynecol Pathol 2019; 39:460-467. [PMID: 31789680 DOI: 10.1097/pgp.0000000000000649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tumor cells are occasionally observed in the lumen in histologic sections of the fallopian tube from women with gynecologic cancer. There is some evidence that this finding may be important in endometrial cancer, but its significance is unknown in women with extrauterine pelvic serous carcinomas (tubo-ovarian high-grade serous carcinoma). Fallopian tube sections from 213 women with extrauterine pelvic serous carcinoma were reviewed, and luminal tumor cells were correlated with clinical and pathologic features. Intraluminal tumor cells were found in 84 patients (39%). The presence or absence of luminal tumor cells correlated significantly with serous tubal intraepithelial carcinoma (52% and 33%, respectively, P=0.004), tubal lymphatic invasion (32% and 12%, respectively, P=0.0002), and number of tube sections reviewed (6.6 and 4.9 for lumen-positive and lumen-negative cases, respectively, P=0.0056). There was no correlation with the presence of ascites, peritoneal cytopathologic findings, lymph node metastases, or FIGO stage. In the setting of pelvic serous carcinoma, a substantial portion of fallopian tube tissue is often distorted, fibrotic, and difficult to identify. Since the identification of luminal tumor cells, serous tubal intraepithelial carcinoma and tubal lymphatic invasion all depend on identification of fallopian tube tissue, these correlates with luminal tumor cells could be a result of a higher likelihood of their observation when tubal tissue can be more readily identified and may not necessarily reflect a biologically important phenomenon. It remains unclear whether and in what proportion this finding reflects an artifact of specimen handling.
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Parkash V, Fadare O. Endometrial Carcinoma: Grossing, Frozen Section Evaluation, Staging, and Sentinel Lymph Node Evaluation. Surg Pathol Clin 2019; 12:329-342. [PMID: 31097107 DOI: 10.1016/j.path.2019.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This article gives an overview of the pathologic assessment of resection specimens removed for uterine carcinoma. Areas of controversy and recent developments in pathologic staging are addressed. This includes assessment of myometrial invasion in the setting of adenomyosis, fallopian tube involvement, and vascular invasion. An overview of the role and evaluation of sentinel node assessments in the staging of endometrial carcinoma is provided.
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Affiliation(s)
- Vinita Parkash
- Department of Pathology and Obstetrics and Gynecology, Yale School of Medicine, PO Box 208070, New Haven, CT 06510, USA.
| | - Oluwole Fadare
- Department of Pathology, Anatomic Pathology Division, University of California San Diego Health, 9300 Campus Point Drive, Suite 1-200, MC 7723, La Jolla, CA 92037, USA
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