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Koek RCG, Wenzel H, Jonges GN, Lok CAR, Zweemer R, Gerestein CG. Oncological outcomes after laparotomic, laparoscopic, and robot-assisted laparoscopic staging for early-stage high-intermediate or high-risk endometrial cancer. Int J Gynecol Cancer 2024:ijgc-2024-005510. [PMID: 39019491 DOI: 10.1136/ijgc-2024-005510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024] Open
Abstract
OBJECTIVES To compare oncological outcomes in patients with early-stage high-intermediate or high-risk endometrial cancer undergoing surgical staging by laparotomy, conventional laparoscopy, or robot-assisted laparoscopy. METHODS Patients diagnosed between 2015 and 2021 with stage I-II (International Federation of Gynecology and Obstetrics 2009), high-intermediate or high-risk endometrial cancer who underwent staging surgery, were identified in the Netherlands Cancer Registry. Five-year disease-free survival and overall survival were calculated using the Kaplan-Meier method, and differences between groups were evaluated using log-rank testing. Additionally, survival analyses were stratified by histological subtype. The effect of surgical modality on risk of recurrence and all-cause death was assessed by performing Cox regression analysis with inverse probability treatment weighting. RESULTS In total 941 patients met the inclusion criteria, of whom 399 (42.4%) underwent staging surgery by laparotomy, 273 (29.0%) by laparoscopy, and 269 (28.6%) by robot-assisted laparoscopy. Baseline characteristics were comparable between the three groups. No difference in disease-free survival (75.0% vs 71.2% vs 79.0% p=0.35) or overall survival (72.7% vs 72.3% vs 71.2% p=0.98) was observed between patients after laparotomy, laparoscopy, or robot-assisted laparoscopy, respectively. Subanalyses based on histological subtype showed comparable disease-free survival and overall survival between surgical approaches. After correcting for possible confounders by means of inverse probability treatment weighting, there was no significantly increased risk of recurrence or risk of all-cause death after laparoscopy or robot-assisted laparoscopy. CONCLUSION Laparoscopic and robot-assisted laparoscopic staging surgery in women with early-stage high-intermediate or high-risk endometrial cancer are safe alternatives to laparotomic staging surgery.
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Affiliation(s)
- Ruben C G Koek
- Department of Gynaecological Oncology, UMC Utrecht, Utrecht, The Netherlands
| | - Hans Wenzel
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | | | - Christianne A R Lok
- Department of Gynaecologic Oncology, Netherlands Cancer Institute, Amsterdam, Noord-Holland, The Netherlands
| | - Ronald Zweemer
- Department of Gynaecological Oncology, UMC Utrecht, Utrecht, The Netherlands
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Lamiman K, Silver M, Goncalves N, Kim M, Alagkiozidis I. Impact of Robotic Assistance on Minimally Invasive Surgery for Type II Endometrial Cancer: A National Cancer Database Analysis. Cancers (Basel) 2024; 16:2584. [PMID: 39061223 PMCID: PMC11274470 DOI: 10.3390/cancers16142584] [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: 05/28/2024] [Revised: 07/13/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
The objective of this study is to compare the overall survival (OS) and surgical outcomes between conventional laparoscopy and robot-assisted laparoscopy (RAL) in women with type II endometrial cancer. We identified a large cohort of women who underwent hysterectomy for type II endometrial cancer between January 2010 and December 2014 using the National Cancer Database (NCDB). The primary outcome was to compare the OS of conventional laparoscopy versus RAL. Secondary outcomes included the length of hospital stay, 30-day readmission rate, 90-day mortality, rates of lymph node retrieval, rates of node positivity, and rates of conversion to laparotomy. Cohorts were compared and multivariable logistic regression was used to determine characteristics with statistically significant predictors of outcome. We identified 7168 patients with stage I-III type II endometrial cancer who had minimally invasive surgery as primary treatment between 2010 and 2014. A total of 5074 patients underwent RAL. Women who underwent RAL were less likely to have stage III disease (26.4% vs. 29.9%, p = 0.008) and had smaller primary tumors (4.6 vs. 4.1 cm, p < 0.001). In a multivariable model, there was no difference in OS between conventional laparoscopy and RAL. With regard to postoperative outcomes, RAL was associated with a decreased risk for conversion to laparotomy (2.7% vs. 12%, p < 0.001), a shorter hospital stay (1 vs. 2 days, p < 0.001), a decreased 90-day mortality (1.3% vs. 2.2%, p = 0.004), and an increased number of lymph nodes sampled (14 vs. 12, p < 0.001). In multivariable analysis, the use of RAL was independently associated with a reduced rate of conversion to laparotomy. In conclusion, there was no difference in OS between conventional laparoscopy and RAL in type II endometrial cancer in a large retrospective cohort of patients from the NCDB. RAL was associated with a decreased risk of conversion to laparotomy.
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Affiliation(s)
- Kelly Lamiman
- Department of Gynecologic Oncology, Maimonides Medical Center, Brooklyn, NY 11220, USA (N.G.)
| | - Michael Silver
- Department of Gynecologic Oncology, Maimonides Medical Center, Brooklyn, NY 11220, USA (N.G.)
| | - Nicole Goncalves
- Department of Gynecologic Oncology, Maimonides Medical Center, Brooklyn, NY 11220, USA (N.G.)
| | - Michael Kim
- Department of Obstetrics and Gynecology, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY 11215, USA
| | - Ioannis Alagkiozidis
- Department of Gynecologic Oncology, Maimonides Medical Center, Brooklyn, NY 11220, USA (N.G.)
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Imai K, Hirooka-Nakama J, Hotta Y, Shigeta H. A Review of Laparoscopic Para-aortic Lymphadenectomy for Early-stage Endometrial Cancer: Extraperitoneal Approach May Have the Advantage over Intraperitoneal Approach. Gynecol Minim Invasive Ther 2024; 13:10-18. [PMID: 38487605 PMCID: PMC10936721 DOI: 10.4103/gmit.gmit_25_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/29/2023] [Accepted: 09/21/2023] [Indexed: 03/17/2024] Open
Abstract
The importance of lymphadenectomy, including para-aortic nodes, for the accurate staging of endometrial cancer, is well established. Although the therapeutic role of lymph node resection in endometrial cancer is still under debate, some studies support its usefulness for survival benefit. To predict the necessity of lymphadenectomy, several preoperative scoring systems have been proposed as being effective. For endometrial cancer, there is a trend towards minimally invasive surgery, including para-aortic lymphadenectomy. For para-aortic lymphadenectomy, there are two different approaches: the extraperitoneal approach and the transperitoneal approach. The extraperitoneal approach has advantages over the transperitoneal approach in terms of better access to the left aortic nodes, no interference of the bowel, and possibly better options for obese or elderly patients. However, the extraperitoneal approach may have a longer learning curve than the transperitoneal approach. Robot-assisted extraperitoneal para-aortic lymphadenectomy is feasible and safe and may be suitable for patients irrespective of their baseline characteristics.
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Affiliation(s)
- Kazuaki Imai
- Department of Obstetrics and Gynecology, Yokohama Municipal Citizen’s Hospital, Japan
| | - Junko Hirooka-Nakama
- Department of Obstetrics and Gynecology, Yokohama Municipal Citizen’s Hospital, Japan
| | - Yuichiro Hotta
- Department of Obstetrics and Gynecology, Yokohama Municipal Citizen’s Hospital, Japan
| | - Hiroyuki Shigeta
- Department of Obstetrics and Gynecology, Yokohama Municipal Citizen’s Hospital, Japan
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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.
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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.
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Minimally Invasive Compared With Open Surgery in High-Risk Endometrial Cancer: A Systematic Review and Meta-analysis. Obstet Gynecol 2023; 141:59-68. [PMID: 36701610 DOI: 10.1097/aog.0000000000004995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/28/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To compare outcomes between minimally invasive surgery and open surgery in patients with high-risk endometrial cancer. DATA SOURCES A cohort study of all patients who underwent surgery for high-risk endometrial cancer between 1999 and 2016 at Mayo Clinic (Rochester, Minnesota) and a literature search of MEDLINE, EMBASE, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, and Scopus of all published studies until December 2020. METHODS OF STUDY SELECTION The systematic review identified 2,332 patients (14 studies, all retrospective except a subanalysis of a randomized comparison) and the cohort study identified 542 additional patients. Articles were included if reporting original data on overall survival and disease-free survival among patients with high-risk endometrial cancer, defined as International Federation of Gynecology and Obstetrics grade 3 endometrioid, serous, clear cell, mixed histology, or uterine carcinosarcoma. Studies that did not report at least one of the main outcomes, those in which one surgical technique (robotic or laparoscopic surgery) was missing in the comparison analysis with open surgery, and case reports were excluded. Additional data were extracted from a retrospective cohort of patients from Mayo. A random-effect model was used for meta-analysis. TABULATION, INTEGRATION, AND RESULTS This systematic review and meta-analysis was registered in PROSPERO. Literature search and data extraction were performed independently by two reviewers, as well as quality assessment using GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology, and the Newcastle-Ottawa Scale. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Meta-analysis showed that disease-free survival and overall survival in patients with high-risk endometrial cancer who underwent minimally invasive surgery were not statistically different from those of patients who underwent open abdominal surgery (relative risk [RR] 0.93, 95% CI 0.82-1.05, I2 20%, P=.23; and RR 0.92, 95% CI 0.77-1.11, I2 31%, P=.12, respectively). Subgroup analysis by stage (early vs advanced) did not identify a difference between surgical approaches. CONCLUSION Minimally invasive surgery and open surgery had similar disease-free survival and overall survival in patients with high-risk endometrial cancer. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021275535.
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Zhou X, Wei S, Shao Q, Zhang J, Zhao R, Shi R, Zhang W, Dong K, Shu W, Wang H. Laparoscopic vs. open procedure for intermediate‑ and high‑risk endometrial cancer: a minimum 4-year follow-up analysis. BMC Cancer 2022; 22:1203. [PMID: 36418995 PMCID: PMC9682682 DOI: 10.1186/s12885-022-10301-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The long-term oncologic outcomes after laparoscopic and open procedures for patients with intermediate‑ and high‑risk endometrial cancer (EC) remain unclear. Accordingly, laparoscopy cannot still be recommended as the standard choice for intermediate‑ and high‑risk EC. This retrospective study aimed to assess the perioperative and long-term oncologic outcomes of laparoscopy and open surgery in patients with intermediate- and high‑risk ECs within a minimum 4-year follow-up. METHODS We included 201 patients who underwent laparoscopic or open procedures for intermediate‑ and high‑risk EC between 2010 and 2017. Between-procedure comparisons of perioperative and oncological outcomes were performed using the independent t-test or Pearson's chi-squared test and the Kaplan-Meier method, respectively. RESULTS Finally, there were 136 intermediate‑ and 65 high‑risk endometrial tumors in the laparoscopic and open groups, respectively. There were no between-group differences in all baseline characteristics. Compared with the open group, the laparoscopic group had a significantly longer mean operating time (p = 0.005) and a lower mean estimated blood loss (EBL) (p = 0.031). There was a higher possibility of postoperative complication in the open group than in the laparoscopic group (p = 0.048). There were no significant between-group differences in pathological outcomes as well as the recurrence-free survival and overall survival rates (p = 0.626 and p = 0.148, respectively). CONCLUSIONS Among patients with intermediate‑ and high‑risk EC, laparoscopic surgery has an advantage over the open surgery in reducing EBL and the rate of postoperative complications without weakening the oncological control. There were no between-procedure differences in the recurrence-free and overall survival rates.
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Affiliation(s)
- Xing Zhou
- grid.33199.310000 0004 0368 7223Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Sitian Wei
- grid.33199.310000 0004 0368 7223Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Qingchun Shao
- grid.33199.310000 0004 0368 7223Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Jun Zhang
- grid.33199.310000 0004 0368 7223Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Rong Zhao
- grid.33199.310000 0004 0368 7223Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Rui Shi
- grid.33199.310000 0004 0368 7223Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Wei Zhang
- grid.33199.310000 0004 0368 7223Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Kejun Dong
- grid.33199.310000 0004 0368 7223Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Wan Shu
- grid.33199.310000 0004 0368 7223Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Hongbo Wang
- grid.33199.310000 0004 0368 7223Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
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Prognosis and Efficacy of Laparoscopic Surgery on Patients with Endometrial Carcinoma: Systematic Evaluation and Meta-Analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9384134. [PMID: 36238475 PMCID: PMC9553337 DOI: 10.1155/2022/9384134] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 11/30/2022]
Abstract
Objective The prognosis and efficacy of laparoscopic surgery (LPS) and open surgery or robotic surgery (RS) on endometrial carcinoma (EC) patients were compared. Methods Data as of May 2021 were retrieved from databases like PubMed, Embase, Cochrane Library, and Web of Science. The study involved randomized controlled trials (RCTs), cohort studies, or case-control studies for comparing the effects of LPS and open surgery or robotic surgery (RS) on EC treatment. The primary outcomes included duration of operation, blood loss, length of stay (LOS), postoperative complications, and recurrence rate. Secondary outcomes included 3-year progression-free survival (PFS) rate/disease-free survival (DFS) rate and 3-year overall survival (OS) rate. Results A total of 24 studies were involved, and all of them were cohort studies except 1 RCT and 1 case-control study. There was no significant difference in duration of operation between LPS and open surgery (MD = −0.06, 95% CI: -0.37 to 0.25) or RS (MD = −0.15, 95% CI: -1.27 to 0.96). In comparison with the open surgery, LPS remarkably reduced blood loss (MD = −0.43, 95% CI: -0.58 to -0.29), LOS (MD = −0.71, 95% CI: -0.92 to -0.50), and the complication occurrence rate (RR = 0.83, 95% CI: 0.73 to 0.95). However, LPS and RS saw no difference in blood loss (MD = 0.01, 95% CI: -0.77 to 0.79). Besides, in comparison with RS, LPS prominently shortened the LOS (MD = 0.26, 95% CI: 0.12 to 0.40) but increased the complication occurrence rate (RR = 1.74, 95% CI: 1.57 to 1.92). In contrast to open surgery or RS, LPS saw no difference in occurrence rate (RR = 0.75, 95% CI: 0.56 to 1.01; RR = 0.97, 95% CI: 0.62 to 1.53), 3-year PFS/DFS (RR = 0.99, 95% CI: 0.90 to 1.09; RR = 1.30, 95% CI: 0.87 to 1.96), and 3-year OS (RR = 0.97, 95% CI: 0.91 to 1.04; RR = 1.21, 95% CI: 0.91 to 1.60). Conclusion In sum, LPS was better than open surgery, which manifested in the aspects of less blood loss, shorter LOS, and fewer complications. LPS, therefore, was the most suitable option for EC patients. Nevertheless, LPS had no advantage over RS, and sufficient prospective RCTs are needed to further confirm its strengths.
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Shui C, Ran L, Tian Y, Qin L, Gu X, Xu H, Hu C, Zhang LL, Xu Y, Cheng C, Huan W. Survival after laparoscopy versus laparotomy for apparent early-stage uterine clear cell carcinoma: Results of a large multicenter cohort study. Front Oncol 2022; 12:975485. [PMID: 36132126 PMCID: PMC9483121 DOI: 10.3389/fonc.2022.975485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/16/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To compare the long-term survival between laparoscopic surgery and open surgery in patients with apparent early-stage uterine clear cell carcinoma (UCCC). Patients and methods 254 patients with apparent early-stage UCCC were reviewed. Comparisons were made between patients who underwent laparoscopic surgery versus those who underwent open surgery. Baseline data, clinicopathological data, and oncological outcomes were analyzed. 5-year disease-free survival (DFS) rate and 5-year overall survival (OS) rate were estimated and compared using the Kaplan-Meier method and the Log-rank test. The Cox proportional hazard regression model was employed to control the confounding factors. Results 147 patients underwent laparoscopic surgery, and 107 patients were managed by open surgery. No differences in terms of recurrence rate (laparoscopy versus laparotomy: 10.9% versus 12.9%, P=0.842) and recurrence pattern were observed. For patients who underwent open surgery and patients who underwent laparoscopic surgery, the 5-year DFS rates and 5-year OS rate were 75.8% (95% CI: 65.8%-83.2%) and 69.1% (95% CI: 58.8%-77.4%), 66.0% (95% CI: 57.1%-73.5%) and 60.8% (95% CI: 52.0%-68.5%), respectively. The Cox proportional hazards regression model shown that for apparent early-stage UCCC, the approach of surgical staging was not an independent predictor for survival (laparoscopy versus laparotomy: for DFS, aHR=1.06, 95% CI=0.64-1.75, P=0.826; for OS, aHR=1.10, 95% CI=0.72-1.68, P=0.671). Conclusion For apparent early-stage UCCC, in terms of oncological survival, laparoscopic surgery was as safe as open surgery.
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Affiliation(s)
- Chengyu Shui
- Department of Obstetrics and Gynecology, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi, China
| | - Lin Ran
- Department of Obstetrics and Gynecology, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi, China
| | - Yong Tian
- Department of Obstetrics and Gynecology, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi, China
- *Correspondence: Yong Tian,
| | - Li Qin
- Department of Obstetrics and Gynecology, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi, China
| | - Xin Gu
- Department of Obstetrics and Gynecology, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi, China
| | - Hui Xu
- Department of Obstetrics and Gynecology, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi, China
| | - Cui Hu
- Department of Obstetrics and Gynecology, Mianzhu City People’s Hospital, Mianzhu, China
- Department of Obstetrics and Gynecology, Sichuan University West China Hospital (Mianzhu Hospital), Mianzhu, China
| | - Lin-Lin Zhang
- Department of Obstetrics and Gynecology, Mianzhu City People’s Hospital, Mianzhu, China
- Department of Obstetrics and Gynecology, Sichuan University West China Hospital (Mianzhu Hospital), Mianzhu, China
| | - You Xu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Chen Cheng
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Wu Huan
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Chengdu Medical College, Chengdu, China
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Kim NR, Lee AJ, Yang EJ, So KA, Lee SJ, Kim TJ, Shim SH. Minimally invasive surgery versus open surgery in high-risk histologic endometrial cancer patients: A meta-analysis. Gynecol Oncol 2022; 166:236-244. [PMID: 35725657 DOI: 10.1016/j.ygyno.2022.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/02/2022] [Accepted: 06/08/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To compare the effects of minimally invasive surgery (MIS) and open surgery (OPS) on the risk of recurrence and mortality in patients with endometrial cancer (EC) of high-risk histology (grade 3 endometrioid adenocarcinoma, papillary serous carcinoma [PS], clear cell carcinoma [CC], and carcinosarcoma) using meta-analysis. MATERIAL AND METHODS We systematically reviewed published studies comparing MIS and OPS in EC patients with high-risk histology until January 2022. The endpoints were recurrence and mortality rate. Study design features that may have affected participant selection, recurrence/death detection, and manuscript publication were assessed. For pooled estimates of the effect of MIS on recurrence/mortality, the random- or fixed-effects meta-analytical models were used after assessing the cross-study heterogeneity. RESULT Nine observational studies (eight retrospective and one prospective) fulfilled our search criteria (MIS, 8877 patients; OPS, 5751 patients). The fixed-effects model-based meta-analysis indicated that MIS did not significantly increase the risk of recurrence (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.71-1.05; p = 0.13) and mortality (HR, 0.86; 95% CI, 0.79-0.93; p < 0.001) when compared with OPS. This pattern was also observed in the subgroup analyses based on the stage (early stage vs. all stage), histology (PS and CC), and MIS type (laparoscopy vs. robotic). There was no evidence of publication bias. CONCLUSION This meta-analysis of observational studies revealed that MIS did not compromise the prognosis of EC patients with high-risk histology. Well-designed randomized controlled trials could verify the results of this uncommon but deadly tumor.
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Affiliation(s)
- Nae Ry Kim
- Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - A Jin Lee
- Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Eun Jung Yang
- Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Kyeong A So
- Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sun Joo Lee
- Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Tae Jin Kim
- Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seung-Hyuk Shim
- Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea.
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Mandato VD, Palicelli A, Torricelli F, Mastrofilippo V, Leone C, Dicarlo V, Tafuni A, Santandrea G, Annunziata G, Generali M, Pirillo D, Ciarlini G, Aguzzoli L. Should Endometrial Cancer Treatment Be Centralized? BIOLOGY 2022; 11:768. [PMID: 35625496 PMCID: PMC9138425 DOI: 10.3390/biology11050768] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 05/17/2023]
Abstract
Endometrial cancer (EC) is the most common malignancy of the female genital tract in Western and emerging countries. In 2012, new cancer cases numbered 319,605, and 76,160 cancer deaths were diagnosed worldwide. ECs are usually diagnosed after menopause; 70% of ECs are diagnosed at an early stage with a favorable prognosis and a 5-year overall survival rate of 77%. On the contrary, women with advanced or recurrent disease have extremely poor outcomes because they show a low response rate to conventional chemotherapy. EC is generally considered easy to treat, although it presents a 5-year mortality of 25%. Though the guidelines (GLs) recommend treatment in specialized centers by physicians specializing in gynecologic oncology, most women are managed by general gynecologists, resulting in differences and discrepancies in clinical management. In this paper we reviewed the literature with the aim of highlighting where the treatment of EC patients requires gynecologic oncologists, as suggested by the GLs. Moreover, we sought to identify the causes of the lack of GL adherence, suggesting useful changes to ensure adequate treatment for all EC patients.
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Affiliation(s)
- Vincenzo Dario Mandato
- Unit of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.M.); (C.L.); (V.D.); (G.A.); (M.G.); (D.P.)
| | - Andrea Palicelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.P.); (A.T.); (G.S.)
| | - Federica Torricelli
- Laboratory of Translational Research, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Valentina Mastrofilippo
- Unit of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.M.); (C.L.); (V.D.); (G.A.); (M.G.); (D.P.)
| | - Chiara Leone
- Unit of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.M.); (C.L.); (V.D.); (G.A.); (M.G.); (D.P.)
| | - Vittoria Dicarlo
- Unit of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.M.); (C.L.); (V.D.); (G.A.); (M.G.); (D.P.)
| | - Alessandro Tafuni
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.P.); (A.T.); (G.S.)
- Pathology Unit, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Giacomo Santandrea
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.P.); (A.T.); (G.S.)
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Gianluca Annunziata
- Unit of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.M.); (C.L.); (V.D.); (G.A.); (M.G.); (D.P.)
| | - Matteo Generali
- Unit of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.M.); (C.L.); (V.D.); (G.A.); (M.G.); (D.P.)
| | - Debora Pirillo
- Unit of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.M.); (C.L.); (V.D.); (G.A.); (M.G.); (D.P.)
| | - Gino Ciarlini
- Unit of Surgical Gynecol Oncology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (G.C.); (L.A.)
| | - Lorenzo Aguzzoli
- Unit of Surgical Gynecol Oncology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (G.C.); (L.A.)
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11
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Hu C, Mao XG, Xu Y, Xu H, Liu Y. Oncological safety of laparoscopic surgery for women with apparent early-stage uterine clear cell carcinoma: a multicenter retrospective cohort study. J Minim Invasive Gynecol 2022; 29:968-975. [DOI: 10.1016/j.jmig.2022.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
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12
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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.
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13
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Concin N, Planchamp F, Abu-Rustum NR, Ataseven B, Cibula D, Fagotti A, Fotopoulou C, Knapp P, Marth C, Morice P, Querleu D, Sehouli J, Stepanyan A, Taskiran C, Vergote I, Wimberger P, Zapardiel I, Persson J. European Society of Gynaecological Oncology quality indicators for the surgical treatment of endometrial carcinoma. Int J Gynecol Cancer 2021; 31:1508-1529. [PMID: 34795020 DOI: 10.1136/ijgc-2021-003178] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Quality of surgical care as a crucial component of a comprehensive multi-disciplinary management improves outcomes in patients with endometrial carcinoma, notably helping to avoid suboptimal surgical treatment. Quality indicators (QIs) enable healthcare professionals to measure their clinical management with regard to ideal standards of care. OBJECTIVE In order to complete its set of QIs for the surgical management of gynecological cancers, the European Society of Gynaecological Oncology (ESGO) initiated the development of QIs for the surgical treatment of endometrial carcinoma. METHODS QIs were based on scientific evidence and/or expert consensus. The development process included a systematic literature search for the identification of potential QIs and documentation of the scientific evidence, two consensus meetings of a group of international experts, an internal validation process, and external review by a large international panel of clinicians and patient representatives. QIs were defined using a structured format comprising metrics specifications, and targets. A scoring system was then developed to ensure applicability and feasibility of a future ESGO accreditation process based on these QIs for endometrial carcinoma surgery and support any institutional or governmental quality assurance programs. RESULTS Twenty-nine structural, process and outcome indicators were defined. QIs 1-5 are general indicators related to center case load, training, experience of the surgeon, structured multi-disciplinarity of the team and active participation in clinical research. QIs 6 and 7 are related to the adequate pre-operative investigations. QIs 8-22 are related to peri-operative standards of care. QI 23 is related to molecular markers for endometrial carcinoma diagnosis and as determinants for treatment decisions. QI 24 addresses the compliance of management of patients after primary surgical treatment with the standards of care. QIs 25-29 highlight the need for a systematic assessment of surgical morbidity and oncologic outcome as well as standardized and comprehensive documentation of surgical and pathological elements. Each QI was associated with a score. An assessment form including a scoring system was built as basis for ESGO accreditation of centers for endometrial cancer surgery.
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Affiliation(s)
- Nicole Concin
- Department of Gynecology and Obstetrics; Innsbruck Medical Univeristy, Innsbruck, Austria .,Department of Gynecology and Gynecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany
| | | | - Nadeem R Abu-Rustum
- Department of Obstetrics and Gynecology, Memorial Sloann Kettering Cancer Center, New York, New York, USA
| | - Beyhan Ataseven
- Department of Gynecology and Gynecological Oncology, Evangelische Kliniken Essen-Mitte, Essen, Germany.,Department of Obstetrics and Gynaecology, University Hospital Munich (LMU), Munich, Germany
| | - David Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
| | - Christina Fotopoulou
- Department of Gynaecologic Oncology, Imperial College London Faculty of Medicine, London, UK
| | - Pawel Knapp
- Department of Gynaecology and Gynaecologic Oncology, University Oncology Center of Bialystok, Medical University of Bialystok, Bialystok, Poland
| | - Christian Marth
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
| | - Philippe Morice
- Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | - Denis Querleu
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy.,Department of Obstetrics and Gynecologic Oncology, University Hospitals Strasbourg, Strasbourg, Alsace, France
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universitätzu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Artem Stepanyan
- Department of Gynecologic Oncology, Nairi Medical Center, Yerevan, Armenia
| | - Cagatay Taskiran
- Department of Obstetrics and Gynecology, Koç University School of Medicine, Ankara, Turkey.,Department of Gynecologic Oncology, VKV American Hospital, Istambul, Turkey
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, Gynecologic Oncology, Leuven Cancer Institute, Catholic University Leuven, Leuven, Belgium
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT/UCC), Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital - IdiPAZ, Madrid, Spain
| | - Jan Persson
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund, Sweden.,Lund University, Faculty of Medicine, Clinical Sciences, Lund, Sweden
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14
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Sinha R, Nizam A, Shan W, Shih KK, Frimer M, Sakaris A, Goldberg GL. Is minimally invasive surgery for clinical stage I uterine carcinosarcoma safe? J Robot Surg 2021; 16:943-949. [PMID: 34716874 DOI: 10.1007/s11701-021-01323-3] [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: 08/12/2021] [Accepted: 10/16/2021] [Indexed: 11/29/2022]
Abstract
Minimally invasive surgery (MIS) has been a mainstay of the surgical management of uterine cancer since the mid-2000s. We aim to determine the role and safety of MIS in women with uterine carcinosarcoma (UCS). An Institutional Review Board-approved study identified all patients with UCS between January 2011 and December 2017 at our institution. Demographic and outcome measures were abstracted from the medical records and tumor registry. Cox proportional hazard models, log rank tests, and comparisons of means were used to calculate significance (p < 0.05). 129 women with UCS were identified during the study period. 62 cases (48%) were open procedures and 67 cases (52%) were MIS with the majority of the MIS group having robotic surgery. 55% of the patients had pathological stage 1 disease. Thirty-eight percent of UCS tumors were heterologous. 93% of patients received adjuvant therapy in the form of chemotherapy and/or radiation therapy. There was no difference in the recurrence-free survival (RFS) or overall survival (OS) between the open surgery and the MIS groups as well as between the heterologous and homologous UCS groups (p > 0.05). UCS represents a rare and aggressive subtype of endometrial cancer. Our data suggest that MIS is a safe surgical approach for staging in women with UCS.
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Affiliation(s)
- Risha Sinha
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra/Northwell, Northwell Health, 270-05 76th Avenue, Suite C-221, New Hyde Park, NY, 11040, USA
| | - Aaron Nizam
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra/Northwell, Northwell Health, 270-05 76th Avenue, Suite C-221, New Hyde Park, NY, 11040, USA.
| | - Weiwei Shan
- Department of Biostatistics, Northwell Health, 125 Community Dr, Manhasset, NY, 11030, USA
| | - Karin K Shih
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra/Northwell, Northwell Health, 270-05 76th Avenue, Suite C-221, New Hyde Park, NY, 11040, USA
| | - Marina Frimer
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra/Northwell, Northwell Health, 270-05 76th Avenue, Suite C-221, New Hyde Park, NY, 11040, USA
| | - Antoinette Sakaris
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra/Northwell, Northwell Health, 270-05 76th Avenue, Suite C-221, New Hyde Park, NY, 11040, USA
| | - Gary L Goldberg
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Long Island Jewish Medical Center, Zucker School of Medicine at Hofstra/Northwell, Northwell Health, 270-05 76th Avenue, Suite C-221, New Hyde Park, NY, 11040, USA
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15
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Vardar MA, Guzel AB, Taskin S, Gungor M, Ozgul N, Salman C, Kucukgoz-Gulec U, Khatib G, Taskiran C, Dünder I, Ortac F, Yuce K, Terek C, Simsek T, Ozsaran A, Onan A, Coban G, Topuz S, Demirkiran F, Takmaz O, Kose MF, Gocmen A, Seydaoglu G, Gumurdulu D, Ayhan A. Could the Long-Term Oncological Safety of Laparoscopic Surgery in Low-Risk Endometrial Cancer also Be Valid for the High-Intermediate- and High-Risk Patients? A Multi-Center Turkish Gynecologic Oncology Group Study Conducted with 2745 Endometrial Cancer Cases. (TRSGO-End-001). Curr Oncol 2021; 28:4328-4340. [PMID: 34898563 PMCID: PMC8628704 DOI: 10.3390/curroncol28060368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/10/2021] [Accepted: 10/26/2021] [Indexed: 12/16/2022] Open
Abstract
This study was conducted to compare the long-term oncological outcomes of laparotomy and laparoscopic surgeries in endometrial cancer under the light of the 2016 ESMO-ESGO-ESTRO risk classification system, with particular focus on the high–intermediate- and high-risk categories. Using multicentric databases between January 2005 and January 2016, disease-free and overall survivals of 2745 endometrial cancer cases were compared according to the surgery route (laparotomy vs. laparoscopy). The high–intermediate- and high-risk patients were defined with respect to the 2016 ESMO-ESGO-ESTRO risk classification system, and they were analyzed with respect to differences in survival rates. Of the 2745 patients, 1743 (63.5%) were operated by laparotomy, and the remaining were operated with laparoscopy. The total numbers of high–intermediate- and high-risk endometrial cancer cases were 734 (45%) patients in the laparotomy group and 307 (30.7%) patients in the laparoscopy group. Disease-free and overall survivals were not statistically different when compared between laparoscopy and laparotomy groups in terms of low-, intermediate-, high–intermediate- and high-risk endometrial cancer. In conclusion, regardless of the endometrial cancer risk category, long-term oncological outcomes of the laparoscopic approach were found to be comparable to those treated with laparotomy. Our results are encouraging to consider laparoscopic surgery for high–intermediate- and high-risk endometrial cancer cases.
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Affiliation(s)
- Mehmet Ali Vardar
- Gynecologic Oncology Department, Medical Faculty, Çukurova University, Adana 01380, Turkey; (M.A.V.); (A.B.G.); (U.K.-G.)
| | - Ahmet Baris Guzel
- Gynecologic Oncology Department, Medical Faculty, Çukurova University, Adana 01380, Turkey; (M.A.V.); (A.B.G.); (U.K.-G.)
| | - Salih Taskin
- Gynecologic Oncology Department, Medical Faculty, Ankara University, Ankara 06100, Turkey; (S.T.); (M.G.); (I.D.); (F.O.)
| | - Mete Gungor
- Gynecologic Oncology Department, Medical Faculty, Ankara University, Ankara 06100, Turkey; (S.T.); (M.G.); (I.D.); (F.O.)
- Gynecologic Oncology Department, Medical Faculty, Acıbadem University, İstanbul 34684, Turkey;
| | - Nejat Ozgul
- Gynecologic Oncology Department, Medical Faculty, Hacettepe University, Ankara 06230, Turkey; (N.O.); (C.S.); (K.Y.)
| | - Coskun Salman
- Gynecologic Oncology Department, Medical Faculty, Hacettepe University, Ankara 06230, Turkey; (N.O.); (C.S.); (K.Y.)
| | - Umran Kucukgoz-Gulec
- Gynecologic Oncology Department, Medical Faculty, Çukurova University, Adana 01380, Turkey; (M.A.V.); (A.B.G.); (U.K.-G.)
| | - Ghanim Khatib
- Gynecologic Oncology Department, Medical Faculty, Çukurova University, Adana 01380, Turkey; (M.A.V.); (A.B.G.); (U.K.-G.)
- Correspondence: ; Tel.: +90-322-3386060-3195-3196; Fax: +90-322-3386527
| | - Cagatay Taskiran
- Gynecologic Oncology Department, Medical Faculty, Gazi University, Ankara 06560, Turkey; (C.T.); (A.O.)
- Gynecologic Oncology Department, Medical Faculty, Koç University, İstanbul 34450, Turkey
| | - Ilkkan Dünder
- Gynecologic Oncology Department, Medical Faculty, Ankara University, Ankara 06100, Turkey; (S.T.); (M.G.); (I.D.); (F.O.)
| | - Firat Ortac
- Gynecologic Oncology Department, Medical Faculty, Ankara University, Ankara 06100, Turkey; (S.T.); (M.G.); (I.D.); (F.O.)
| | - Kunter Yuce
- Gynecologic Oncology Department, Medical Faculty, Hacettepe University, Ankara 06230, Turkey; (N.O.); (C.S.); (K.Y.)
| | - Cosan Terek
- Gynecologic Oncology Department, Medical Faculty, Ege University, İzmir 35040, Turkey; (C.T.); (A.O.)
| | - Tayup Simsek
- Gynecologic Oncology Department, Medical Faculty, Akdeniz University, Antalya 07070, Turkey;
| | - Aydın Ozsaran
- Gynecologic Oncology Department, Medical Faculty, Ege University, İzmir 35040, Turkey; (C.T.); (A.O.)
| | - Anil Onan
- Gynecologic Oncology Department, Medical Faculty, Gazi University, Ankara 06560, Turkey; (C.T.); (A.O.)
| | - Gonca Coban
- Gynecologic Oncology Department, Adana Training and Research Hospital, Başkent University, Adana 01250, Turkey;
| | - Samet Topuz
- Gynecologic Oncology Department, Çapa Medical Faculty, İstanbul University, İstanbul 34093, Turkey;
| | - Fuat Demirkiran
- Gynecologic Oncology Department, Medical Faculty, İstanbul University, Cerrahpaşa, İstanbul 34098, Turkey;
| | - Ozguc Takmaz
- Gynecologic Oncology Department, Medical Faculty, Acıbadem University, İstanbul 34684, Turkey;
| | - M. Faruk Kose
- Gynecologic Oncology Department, Medical Faculty, Medipol University, İstanbul 34200, Turkey;
| | - Ahmet Gocmen
- Gynecologic Oncology Department, Umraniye Training and Research Hospital, İstanbul 34760, Turkey;
| | - Gulsah Seydaoglu
- Department of Biostatistics, Medical Faculty, Çukurova University, Adana 01380, Turkey;
| | - Derya Gumurdulu
- Department of Gynecologic Pathology, Medical Faculty, Çukurova University, Adana 01380, Turkey;
| | - Ali Ayhan
- Gynecologic Oncology Department, Medical Faculty, Başkent University, Ankara 06490, Turkey;
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16
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Ahn JH, Park DC, Yoon JH, Lee SJ, Cha J, Yoo JG, Lee HN, Kim SI. Oncologic safety of minimally invasive surgery in non-endometrioid endometrial cancer. Asian J Surg 2021; 45:1253-1258. [PMID: 34663530 DOI: 10.1016/j.asjsur.2021.09.023] [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: 05/03/2021] [Revised: 07/21/2021] [Accepted: 09/20/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study was aimed to compare the oncologic outcomes of patients with non-endometrioid endometrial cancer who underwent minimally invasive surgery with the outcomes of patients who underwent open surgery. METHOD This is a retrospective, multi-institutional study of patients with non-endometrioid endometrial cancer who were surgically staged by either minimally invasive surgery or open surgery. Oncologic outcomes of the patients were compared according to surgical approach. RESULTS 113 patients met the inclusion and exclusion criteria. 57 underwent minimally invasive surgery and 56 underwent open surgery. Patients who underwent minimally invasive surgery had smaller tumors (median size, 3.3 vs. 5.2%, p = 0.0001) and a lower lymphovascular space invasion rate (29.8% vs. 48.2%, p = 0.045). In the overall population, the numbers and rate of recurrence were significantly higher in the open surgery group (p = 0.016). In multivariate analysis, disease stage and tumor size were associated with DFS in contrast to surgical procedure. CONCLUSION Minimally invasive surgery showed similar survival outcomes when compared to open surgery in non-endometrioid endometrial cancer patients, irrespective of disease stage. When minimally invasive surgery is managed by expert surgeons, non-endometrioid histological subtypes should not be considered a contraindication for minimally invasive surgery.
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Affiliation(s)
- Jung Hwan Ahn
- Department of Obstetrics and Gynecology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Dong Choon Park
- Department of Obstetrics and Gynecology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joo Hee Yoon
- Department of Obstetrics and Gynecology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Jong Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jimin Cha
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Geun Yoo
- Department of Obstetrics and Gynecology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hae Nam Lee
- Department of Obstetrics and Gynecology, Buchen St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Il Kim
- Department of Obstetrics and Gynecology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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17
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Concin N, Matias-Guiu X, Vergote I, Cibula D, Mirza MR, Marnitz S, Ledermann J, Bosse T, Chargari C, Fagotti A, Fotopoulou C, Martin AG, Lax S, Lorusso D, Marth C, Morice P, Nout RA, O'Donnell D, Querleu D, Raspollini MR, Sehouli J, Sturdza A, Taylor A, Westermann A, Wimberger P, Colombo N, Planchamp F, Creutzberg CL. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Radiother Oncol 2021; 154:327-353. [PMID: 33712263 DOI: 10.1016/j.radonc.2020.11.018] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A European consensus conference on endometrial carcinoma was held in 2014 to produce multidisciplinary evidence-based guidelines on selected questions. Given the large body of literature on the management of endometrial carcinoma published since 2014, the European Society of Gynaecological Oncology (ESGO), the European SocieTy for Radiotherapy & Oncology (ESTRO) and the European Society of Pathology (ESP) jointly decided to update these evidence-based guidelines and to cover new topics in order to improve the quality of care for women with endometrial carcinoma across Europe and worldwide. ESGO/ESTRO/ESP nominated an international multidisciplinary development group consisting of practicing clinicians and researchers who have demonstrated leadership and expertise in the care and research of endometrial carcinoma (27 experts across Europe). To ensure that the guidelines are evidence-based, the literature published since 2014, identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 191 independent international practitioners in cancer care delivery and patient representatives. The guidelines comprehensively cover endometrial carcinoma staging, definition of prognostic risk groups integrating molecular markers, pre- and intra-operative work-up, fertility preservation, management for early, advanced, metastatic, and recurrent disease and palliative treatment. Principles of radiotherapy and pathological evaluation are also defined.
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Affiliation(s)
- Nicole Concin
- Department of Gynecology and Obstetrics, Innsbruck Medical University, Austria; Evangelische Kliniken Essen-Mitte, Germany.
| | - Xavier Matias-Guiu
- Department of Pathology, Hospital Universitari Arnau de Vilanova, University of Lleida, CIBERONC, Irblleida, Spain; Department of Pathology, Hospital Universitari de Bellvitge, University of Barcelona, Idibell, Spain
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, Gynecologic Oncology, Leuven Cancer Institute, Catholic University Leuven, Belgium
| | - David Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Czech Republic
| | - Mansoor Raza Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Simone Marnitz
- Department of Radiation Oncology, Medical Faculty of the University of Cologne, Germany
| | | | - Tjalling Bosse
- Department of Pathology, Leids Universitair Medisch Centrum, Leiden, Netherlands
| | - Cyrus Chargari
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Christina Fotopoulou
- Department of Gynaecologic Oncology, Imperial College London Faculty of Medicine, UK
| | | | - Sigurd Lax
- Department of Pathology, Hospital Graz II, Austria; School of Medicine, Johannes Kepler University Linz, Austria
| | - Domenica Lorusso
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Christian Marth
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Austria
| | - Philippe Morice
- Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | - Remi A Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | - Denis Querleu
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy; Department of Obstetrics and Gynecologic Oncology, University Hospital, Strasbourg, France
| | - Maria Rosaria Raspollini
- Histopathology and Molecular Diagnostics, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Germany
| | - Alina Sturdza
- Department of Radiation Oncology, Comprehensive Cancer Center, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria
| | | | - Anneke Westermann
- Department of Medical Oncology, Amsterdam University Medical Centres, Noord-Holland, Netherlands
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, TU Dresden Medizinische Fakultat Carl Gustav Carus, Germany
| | - Nicoletta Colombo
- Gynecologic Oncology Program, European Institute of Oncology, IRCCS, Milan and University of Milan-Bicocca, Italy
| | | | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden Netherlands
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18
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Concin N, Creutzberg CL, Vergote I, Cibula D, Mirza MR, Marnitz S, Ledermann JA, Bosse T, Chargari C, Fagotti A, Fotopoulou C, González-Martín A, Lax SF, Lorusso D, Marth C, Morice P, Nout RA, O'Donnell DE, Querleu D, Raspollini MR, Sehouli J, Sturdza AE, Taylor A, Westermann AM, Wimberger P, Colombo N, Planchamp F, Matias-Guiu X. ESGO/ESTRO/ESP Guidelines for the management of patients with endometrial carcinoma. Virchows Arch 2021; 478:153-190. [PMID: 33604759 DOI: 10.1007/s00428-020-03007-z] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A European consensus conference on endometrial carcinoma was held in 2014 to produce multidisciplinary evidence-based guidelines on selected questions. Given the large body of literature on the management of endometrial carcinoma published since 2014, the European Society of Gynaecological Oncology (ESGO), the European SocieTy for Radiotherapy & Oncology (ESTRO) and the European Society of Pathology (ESP) jointly decided to update these evidence-based guidelines and to cover new topics in order to improve the quality of care for women with endometrial carcinoma across Europe and worldwide. ESGO/ESTRO/ESP nominated an international multidisciplinary development group consisting of practicing clinicians and researchers who have demonstrated leadership and expertise in the care and research of endometrial carcinoma (27 experts across Europe). To ensure that the guidelines are evidence-based, the literature published since 2014, identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the development group. The guidelines are thus based on the best available evidence and expert agreement. Prior to publication, the guidelines were reviewed by 191 independent international practitioners in cancer care delivery and patient representatives. The guidelines comprehensively cover endometrial carcinoma staging, definition of prognostic risk groups integrating molecular markers, pre- and intra-operative work-up, fertility preservation, management for early, advanced, metastatic, and recurrent disease and palliative treatment. Principles of radiotherapy and pathological evaluation are also defined.
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Affiliation(s)
- Nicole Concin
- Department of Gynecology and Obstetrics, Innsbruck Medical University, Innsbruck, Austria. .,Evangelische Kliniken Essen-Mitte, Essen, Germany.
| | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, Gynecologic Oncology, Leuven Cancer Institute, Catholic University Leuven, Leuven, Belgium
| | - David Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
| | - Mansoor Raza Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Simone Marnitz
- Department of Radiation Oncology, Medical Faculty of the University of Cologne, Cologne, Germany
| | | | - Tjalling Bosse
- Department of Pathology, Leids Universitair Medisch Centrum, Leiden, The Netherlands
| | - Cyrus Chargari
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy
| | - Christina Fotopoulou
- Department of Gynaecologic Oncology, Imperial College London Faculty of Medicine, London, UK
| | | | - Sigurd F Lax
- Department of Pathology, Hospital Graz II, Graz, Austria.,School of Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Domenica Lorusso
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy
| | - Christian Marth
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
| | - Philippe Morice
- Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | - Remi A Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Denis Querleu
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Roma, Italy.,Department of Obstetrics and Gynecologic Oncology, University Hospital, Strasbourg, France
| | - Maria Rosaria Raspollini
- Histopathology and Molecular Diagnostics, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Alina E Sturdza
- Department of Radiation Oncology, Comprehensive Cancer Center, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | | | - Anneke M Westermann
- Department of Medical Oncology, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, TU Dresden Medizinische Fakultat Carl Gustav Carus, Dresden, Germany
| | - Nicoletta Colombo
- Gynecologic Oncology Program, European Institute of Oncology, IRCCS, Milan and University of Milan-Bicocca, Milan, Italy
| | | | - Xavier Matias-Guiu
- Department of Pathology, Hospital Universitari Arnau de Vilanova, University of Lleida, CIBERONC, Irblleida, Spain.,Department of Pathology, Hospital Universitari de Bellvitge, University of Barcelona, Idibell, Spain
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19
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Kim SI, Park DC, Lee SJ, Yoo JG, Song MJ, Kim CJ, Lee HN, Yoon JH. Minimally invasive surgery for patients with advanced stage endometrial cancer. Int J Med Sci 2021; 18:1153-1158. [PMID: 33526975 PMCID: PMC7847628 DOI: 10.7150/ijms.52293] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 12/19/2020] [Indexed: 11/06/2022] Open
Abstract
Objective: Compare the oncologic outcomes of patients with advanced stage endometrial cancer who were staged by minimally invasive surgery with the outcomes of patients who underwent open surgery. Methods: Data from 138 patients with advanced stage endometrial cancer who were treated between January 2009 and January 2019 were reviewed. The patients' data were retrieved from five institutions. The patients were divided into two groups: those who underwent open surgery and those who underwent minimally invasive surgery. Tumor characteristics, recurrence rate, disease-free survival, and overall survival were compared according to surgical approach. Results: Among the 138 patients included in this study, 72 underwent open surgery (52.2%) and 66 underwent MIS (47.8%). In patients with advanced-stage endometrial cancer, the recurrence rate was significantly higher among those who underwent open surgery (43.1% vs. 25.8%, p = 0.033). Patients with advanced-stage endometrial cancer who underwent open surgery had a significantly lower disease-free survival (p = 0.029) than those who underwent minimally invasive surgery, however, the overall survival (p = 0.051) was similar between the two groups. Conclusion: Minimally invasive surgery showed better survival outcomes when compared to open surgery in advanced-stage EC patients irrespective of the histologic type.
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Affiliation(s)
- Sang Il Kim
- Department of Obstetrics and Gynecology, St. Vincent's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Choon Park
- Department of Obstetrics and Gynecology, St. Vincent's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Jong Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Geun Yoo
- Department of Obstetrics and Gynecology, Daejeon St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Jong Song
- Department of Obstetrics and Gynecology, Yeouido St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Joo Kim
- Department of Obstetrics and Gynecology, Uijeongbu St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hae Nam Lee
- Department of Obstetrics and Gynecology, Buchen St. Mary's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joo Hee Yoon
- Department of Obstetrics and Gynecology, St. Vincent's hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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20
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Perrone E, Capasso I, Pasciuto T, Gioè A, Gueli Alletti S, Restaino S, Scambia G, Fanfani F. Laparoscopic vs. robotic-assisted laparoscopy in endometrial cancer staging: large retrospective single-institution study. J Gynecol Oncol 2021; 32:e45. [PMID: 33825360 PMCID: PMC8039171 DOI: 10.3802/jgo.2021.32.e45] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/09/2021] [Accepted: 01/29/2021] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of this study is to analyze and draw the potential differences between the robotic-assisted surgery (RS) and the laparoscopy (LPS) in endometrial cancer staging. Methods In this single-institution retrospective study we enrolled 1,221 consecutive clinical stage I–III endometrial cancer patients undergone minimally invasive surgical staging. We compared patients treated by LPS and by RS, on the basis of perioperative and oncological outcomes (disease-free survival [DFS] and overall survival [OS]). A sub-analysis of the high-risk endometrial cancer population was performed in the 2 cohorts. Results The 2 cohorts (766 treated by LPS and 455 by RS) were homogeneous in terms of perioperative and pathological data. We recorded differences in number of relapse/progression (11.7% in LPS vs. 7% in RS, p=0.008) and in number of deaths (9.8% in LPS vs. 4.8% in RS, p=0.002). Whereas, univariate and multivariate analyses according to DFS and OS confirmed that the surgical approach did not influence the DFS or the OS. In the multivariable analysis the association of the age and grading was significant for DFS and OS. In the sub-analysis of the 426 high risk EC patients (280 in LPS and 146 in RS) the univariate and the multivariate confirmed the influence of the age in DFS and OS, independently of the minimally invasive approach. Conclusions In our large retrospective analysis, we confirmed that the RS and LPS have similar efficacy and safety for endometrial cancer staging also for the high-risk endometrial cancer patients.
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Affiliation(s)
- Emanuele Perrone
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy
| | - Ilaria Capasso
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Tina Pasciuto
- Statistics Technology Archiving Research (STAR) Center, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
| | - Alessandro Gioè
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Salvatore Gueli Alletti
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy
| | - Stefano Restaino
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Fanfani
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy.
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21
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Han Z, Zheng Z, Tao K, Yu Y, Wu J, Tian X. The effect of surgical approach on the outcomes and prognosis of high-risk histologic endometrioid carcinomas. Gland Surg 2021; 10:355-363. [PMID: 33633992 DOI: 10.21037/gs-20-887] [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] [Indexed: 11/06/2022]
Abstract
Background High-risk histologic endometrioid carcinomas include poorly differentiated endometrial carcinoma (PDEC), uterine clear cell carcinoma (UCCC), uterine carcinosarcoma (UCS), and uterine papillary serous carcinomas (UPCS). The purpose of this study was to investigate and compare the effect of open surgery and minimally invasive surgery on the prognosis of patients with high-risk endometrial cancer tissue types. Methods A retrospective analysis was conducted to investigate 57 UCS or UPCS, 53 UCCC, and 110 PDEC patients receiving initial treatment at the Department of Gynecology in Shaanxi Provincial Tumor hospital and the Affiliated Hospital of Medical College of Xi'an Jiaotong University between February 2010 and January 2015. Prognostic factors were determined using univariate/multivariate analysis, and survival rates were assessed using the Kaplan-Meier method. The Cox regression model was adopted to assess the independent prognostic factors. Results Two hundred and twenty patients who met the criteria were included in this study. At the end of follow-up period, 94 patients were still alive. Univariate analysis found that the survival time of the patients was related to staging, adjuvant therapy, and surgical approach. Multivariate analysis revealed that surgical approach, staging, pathology, and adjuvant therapy were independent prognostic factors. Conclusions Minimally invasive surgery has a shorter survival time compared to open surgery in women with PDEC, UCCC, UCS, and UPCS. Multivariate analysis confirmed that staging, pathological type, surgical approach, and postoperative adjuvant therapy are independent risk factors for prognosis and affect the survival of women with PDEC, UCCC, UCS, and UPCS.
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Affiliation(s)
- Zhihong Han
- Department of Gynecologic Oncology, Shaanxi Provincial Tumor Hospital, Xi'an, China
| | - Zhong Zheng
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Kai Tao
- Department of Gynecologic Oncology, Shaanxi Provincial Tumor Hospital, Xi'an, China
| | - Yanping Yu
- Department of Gynecologic Oncology, Shaanxi Provincial Tumor Hospital, Xi'an, China
| | - Jinping Wu
- Department of Gynecology and Obstetrics, 521 Hospital of Norinco Group Xi'an, Xi'an, China
| | - Xiaofei Tian
- Department of Gynecologic Oncology, Shaanxi Provincial Tumor Hospital, Xi'an, China
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22
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Concin N, Matias-Guiu X, Vergote I, Cibula D, Mirza MR, Marnitz S, Ledermann J, Bosse T, Chargari C, Fagotti A, Fotopoulou C, Gonzalez Martin A, Lax S, Lorusso D, Marth C, Morice P, Nout RA, O'Donnell D, Querleu D, Raspollini MR, Sehouli J, Sturdza A, Taylor A, Westermann A, Wimberger P, Colombo N, Planchamp F, Creutzberg CL. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer 2020; 31:12-39. [PMID: 33397713 DOI: 10.1136/ijgc-2020-002230] [Citation(s) in RCA: 878] [Impact Index Per Article: 219.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 11/16/2020] [Indexed: 12/13/2022] Open
Abstract
A European consensus conference on endometrial carcinoma was held in 2014 to produce multi-disciplinary evidence-based guidelines on selected questions. Given the large body of literature on the management of endometrial carcinoma published since 2014, the European Society of Gynaecological Oncology (ESGO), the European SocieTy for Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP) jointly decided to update these evidence-based guidelines and to cover new topics in order to improve the quality of care for women with endometrial carcinoma across Europe and worldwide.
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Affiliation(s)
- Nicole Concin
- Department of Gynecology and Obstetrics, Innsbruck Medical University, Innsbruck, Austria .,Evangelische Kliniken Essen-Mitte, Essen, Germany
| | - Xavier Matias-Guiu
- Department of Pathology, Hospital Universitari Arnau de Vilanova, University of Lleida, CIBERONC, Irblleida, Spain.,Department of Pathology, Hospital Universitari de Bellvitge, University of Barcelona, Idibell, Spain
| | - Ignace Vergote
- Department of Gynecology and Obstetrics, Gynecologic Oncology, Leuven Cancer Institute, Catholic University Leuven, Leuven, Belgium
| | - David Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
| | - Mansoor Raza Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Simone Marnitz
- Department of Radiation Oncology, Medical Faculty of the University of Cologne, Cologne, Germany
| | | | - Tjalling Bosse
- Department of Pathology, Leids Universitair Medisch Centrum, Leiden, Netherlands
| | - Cyrus Chargari
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Christina Fotopoulou
- Department of Gynaecologic Oncology, Imperial College London Faculty of Medicine, London, UK
| | | | - Sigurd Lax
- Department of Pathology, Hospital Graz II, Graz, Austria.,School of Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Domenica Lorusso
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Christian Marth
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
| | - Philippe Morice
- Department of Surgery, Institut Gustave Roussy, Villejuif, France
| | - Remi A Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | - Denis Querleu
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.,Department of Obstetrics and Gynecologic Oncology, University Hospital, Strasbourg, France
| | - Maria Rosaria Raspollini
- Histopathology and Molecular Diagnostics, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Alina Sturdza
- Department of Radiation Oncology, Comprehensive Cancer Center, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | | | - Anneke Westermann
- Department of Medical Oncology, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, Netherlands
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, TU Dresden Medizinische Fakultat Carl Gustav Carus, Dresden, Germany
| | - Nicoletta Colombo
- Gynecologic Oncology Program, European Institute of Oncology, IRCCS, Milan and University of Milan-Bicocca, Milan, Italy
| | | | - Carien L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands
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23
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Tanaka T, Ueda S, Miyamoto S, Terada S, Konishi H, Kogata Y, Fujiwara S, Tanaka Y, Taniguchi K, Komura K, Ohmichi M. Oncologic outcomes for patients with endometrial cancer who received minimally invasive surgery: a retrospective observational study. Int J Clin Oncol 2020; 25:1985-1994. [PMID: 32648131 DOI: 10.1007/s10147-020-01744-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/01/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laparoscopic hysterectomy has been performed for patients with endometrial cancer as minimally invasive surgery; however, the long-term outcomes of high-risk disease compared to open surgery remain unclear. METHODS Eight hundred and eighty-three patients with endometrial cancer who underwent laparoscopic or abdominal hysterectomy were categorized into three groups. Low-risk disease was defined as stage IA disease with endometrioid carcinoma of grade 1 or 2. Uterine-confined disease was defined as stage IA disease with high-grade tumors or stage IB and II disease. Advanced disease was defined as stage III or IV disease. The progression-free survival (PFS) and overall survival (OS) rates were compared between laparoscopic and laparotomic hysterectomy. RESULTS Among 478 patients with low-risk disease, including 226 with laparoscopy and 252 with laparotomy, the prognosis was not significantly different between the groups (3-year PFS rate, 97.4% vs. 97.1%, p = 0.8; 3-year OS rate, 98.6% vs. 98.3%, p = 0.9). Among the 229 patients with uterine-confined disease, including 51 with laparoscopy and 178 with laparotomy, the prognosis was not significantly different between the groups (3-year PFS rate, 90.5% vs. 85.5%, p = 0.7; 3-year OS rate, 91.3% vs. 92.5%, p = 0.8). Among the 176 patients with advanced disease, including 24 with laparoscopy and 152 with laparotomy, laparoscopic hysterectomy had a higher PFS rate and OS rate than laparotomic hysterectomy (3-year PFS rate, 74.5% vs. 51.5%, p = 0.01; 3-year OS rate, 92.3% vs. 75.1%, p = 0.03). CONCLUSIONS Laparoscopic procedures are not associated with a poorer outcome than laparotomy in patients with advanced endometrial cancer or uterine-confined endometrial cancer.
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Affiliation(s)
- Tomohito Tanaka
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
- Translational Research Program, Osaka Medical College, Takatsuki, Japan.
| | - Shoko Ueda
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Shunsuke Miyamoto
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Shinichi Terada
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Hiromi Konishi
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Yuhei Kogata
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Satoe Fujiwara
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Yoshimichi Tanaka
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Kohei Taniguchi
- Translational Research Program, Osaka Medical College, Takatsuki, Japan
| | - Kazumasa Komura
- Translational Research Program, Osaka Medical College, Takatsuki, Japan
| | - Masahide Ohmichi
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
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24
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Kakkos A, Ver Eecke C, Ongaro S, Traen K, Peeters F, Van Trappen P, Laenen A, Despierre E, Van Nieuwenhuysen E, Vergote I, Goffin F. Robot-assisted surgery for women with endometrial cancer: Surgical and oncologic outcomes within a Belgium gynaecological oncology group cohort. Eur J Surg Oncol 2020; 47:1117-1123. [PMID: 33268212 DOI: 10.1016/j.ejso.2020.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate surgical and oncologic outcomes of patients treated by robot-assisted surgery for endometrial cancer within the Belgium Gynaecological Oncology Group (BGOG). STUDY DESIGN We performed a retrospective analysis of women with clinically Stage I endometrial cancer who underwent surgical treatment from 2007 to 2018 in five institutions of the BGOG group. RESULTS A total of 598 consecutive women were identified. The rate of conversion to laparotomy was low (0.8%). The mean postoperative Complication Common Comprehensive Index (CCI) score was 3.4. The rate of perioperative complications did not differ between age groups, however the disease-free survival was significantly lower in patients over 75 years compared to patients under 65 years of age (p=0.008). Per-operative complications, conversion to laparotomy rate, post-operative hospital stay, CCI score and disease-free survival were not impacted by increasing BMI. CONCLUSION Robot-assisted surgery for the surgical treatment of patients suffering from early-stage endometrial cancer is associated with favourable surgical and oncologic outcomes, particularly for unfavourable groups such as elderly and obese women, thus permitting a low morbidity minimally-invasive surgical approach for the majority of patients in expert centres.
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Affiliation(s)
- A Kakkos
- Department of Obstetrics and Gynaecology, Centre Hospitalier Universitaire de Liège, Site Notre Dame des Bruyères et Centre Hospitalier Régional, Liège, Belgium.
| | - C Ver Eecke
- Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, Leuven Cancer Institute, Catholic University of Leuven, Leuven, Belgium
| | - S Ongaro
- Department of Obstetrics and Gynaecology, Centre Hospitalier Universitaire de Liège, Site Notre Dame des Bruyères et Centre Hospitalier Régional, Liège, Belgium
| | - K Traen
- Department of Obstetrics and Gynaecology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - F Peeters
- Department of Obstetrics and Gynaecology, General Hospital Klina, Brasschaat, Belgium
| | - Ph Van Trappen
- Department of Obstetrics and Gynaecology, General Hospital Sint-Jan, Bruges, Belgium
| | - A Laenen
- Department of Biostatistics and Methodology, Catholic University of Leuven, Leuven, Belgium
| | - E Despierre
- Department of Obstetrics and Gynaecology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - E Van Nieuwenhuysen
- Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, Leuven Cancer Institute, Catholic University of Leuven, Leuven, Belgium
| | - I Vergote
- Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, Leuven Cancer Institute, Catholic University of Leuven, Leuven, Belgium
| | - F Goffin
- Department of Obstetrics and Gynaecology, Centre Hospitalier Universitaire de Liège, Site Notre Dame des Bruyères et Centre Hospitalier Régional, Liège, Belgium
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Corrado G, Ciccarone F, Cosentino F, Legge F, Rosati A, Arcieri M, Turco LC, Certelli C, Federico A, Vizza E, Fanfani F, Scambia G, Ferrandina G. Role of minimally invasive surgery versus open approach in patients with early-stage uterine carcinosarcomas: a retrospective multicentric study. J Cancer Res Clin Oncol 2020; 147:845-852. [PMID: 32880752 PMCID: PMC7873090 DOI: 10.1007/s00432-020-03372-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 08/19/2020] [Indexed: 12/13/2022]
Abstract
Objective The aim of this retrospective study was to compare surgical and survival outcome in only patients with early-stage UCSs managed by laparotomic surgery (LPT) versus minimally invasive surgery (MIS). Methods Data were retrospectively collected in four Italian different institutions. Inclusion criteria were UCS diagnosis confirmed by the definitive histological examination, and stage I or II according to the FIGO staging system. Results Between August 2000 and March 2019, the data relative to 170 patients bearing UCSs were collected: of these, 95 were defined as early-stage disease (stage I–II) based on the histological report at the primary surgery, and thus were included in this study. Forty-four patients were managed by LPT, and 51 patients were managed by MIS. The operative time was lower in the MIS group versus the LPT group (p value 0.021); the median estimated blood loss was less in the MIS group compared to the median of LPT group (p value < 0.0001). The length of hospital stay days was shorter in the MIS patients (p value < 0.0001). Overall, there were eight (8.4%) post-operative complications; of these, seven were recorded in the LPT group versus one in the MIS group (p value 0.023). There was no difference in the disease-free survival (DFS) and overall survival (OS) between the two groups. Conclusion There was no difference of oncologic outcome between the two approaches, in face of a more favourable peri-operative and post-operative profile in the MIS group.
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Affiliation(s)
- Giacomo Corrado
- Department of Woman, Child Health and Public Health, Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.
| | - Francesca Ciccarone
- Department of Woman, Child Health and Public Health, Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Francesco Cosentino
- Department of Gynecologic Oncology, Gemelli Molise Spa, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Francesco Legge
- Gynecologic Oncology Unit, "F. Miulli" General Regional Hospital, Acquaviva Delle Fonti, Bari, Italy
| | - Andrea Rosati
- Department of Woman, Child Health and Public Health, Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Martina Arcieri
- Department of Woman, Child Health and Public Health, Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Luigi Carlo Turco
- Department of Gynecologic Oncology, Gemelli Molise Spa, Università Cattolica del Sacro Cuore, Campobasso, Italy.,Department Gynecology and Breast Care Unit, Mater Olbia Spa, Olbia, Italy
| | - Camilla Certelli
- Department of Experimental Clinical Oncology, Gynecologic Oncology Unit, "Regina Elena" National Cancer Institute, IRCCS, Rome, Italy
| | - Alex Federico
- Department of Woman, Child Health and Public Health, Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Enrico Vizza
- Department of Experimental Clinical Oncology, Gynecologic Oncology Unit, "Regina Elena" National Cancer Institute, IRCCS, Rome, Italy
| | - Francesco Fanfani
- Department of Woman, Child Health and Public Health, Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Istituto di Ostetricia e Ginecologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Department of Woman, Child Health and Public Health, Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Istituto di Ostetricia e Ginecologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gabriella Ferrandina
- Department of Woman, Child Health and Public Health, Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.,Istituto di Ostetricia e Ginecologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Nasioudis D, Heyward QD, Haggerty AF, Giuntoli Ii RL, Burger RA, Morgan MA, Ko EM, Latif NA. Surgical and oncologic outcomes of minimally invasive surgery for stage I high-grade endometrial cancer. Surg Oncol 2020; 34:7-12. [PMID: 32103792 DOI: 10.1016/j.suronc.2020.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 10/31/2019] [Accepted: 02/14/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the prevalence and outcomes of minimally invasive surgery for stage I high grade endometrial cancer. We hypothesized that route of surgery is not associated with survival. MATERIALS Patients diagnosed between 2010 and 2014, with stage I grade 3 endometrioid, serous, clear cell and carcinosarcoma endometrial carcinoma, who underwent hysterectomy with lymphadenectomy were drawn from the National Cancer Database. Patients converted to open surgery were excluded. Overall survival was assessed with Kaplan-Meier curves and compared with the log-rank test. A Cox model was constructed to control for confounders. RESULTS A total of 12852 patients were identified. The rate of minimally invasive surgery was 62.2%. An increase in the use between 2010 and 2014 was noted (p < 0.001). Open surgery was associated with longer hospital stay (median 3 vs 1 day, p < 0.001), higher 30-day unplanned re-admission rate (4.5% vs 2.4%, p < 0.001) and 30-day mortality (0.6% vs 0.3%, p = 0.008). There was no difference in overall survival between patients who had open or minimally invasive surgery, p = 0.22; 3-yr overall survival rates were 83.7% and 84.4% respectively. After controlling for patient age, tumor histology, substage, type of insurance, type of reporting facility, receipt of radiation therapy and chemotherapy, extent of lymphadenectomy, the presence of comorbidities and personal history of another tumor, minimally invasive surgery was not associated with a worse survival (hazard ratio: 1.06, 95% confidence interval: 0.97, 1.15). CONCLUSIONS Minimally invasive surgery for patients with stage I high grade endometrial cancer, was associated with superior short-term outcomes with no difference in overall survival noted.
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Affiliation(s)
- Dimitrios Nasioudis
- Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA.
| | - Quetrell D Heyward
- Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Ashley F Haggerty
- Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Robert L Giuntoli Ii
- Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Robert A Burger
- Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Mark A Morgan
- Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Emily M Ko
- Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Nawar A Latif
- Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA
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27
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Scaletta G, Dinoi G, Capozzi V, Cianci S, Pelligra S, Ergasti R, Fagotti A, Scambia G, Fanfani F. Comparison of minimally invasive surgery with laparotomic approach in the treatment of high risk endometrial cancer: A systematic review. Eur J Surg Oncol 2020; 46:782-788. [DOI: 10.1016/j.ejso.2019.11.519] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/24/2019] [Accepted: 11/30/2019] [Indexed: 02/04/2023] Open
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Uterine Papillary Serous Carcinoma Arising in a Polyp: A Multicenter Retrospective Analysis on 75 Patients. Am J Clin Oncol 2020; 42:472-480. [PMID: 30973371 DOI: 10.1097/coc.0000000000000541] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives of this study were to evaluate whether the international recommendations on the management of uterine papillary serous carcinoma arising in a polyp are uniformly followed in Italian Oncologic Centers and whether the strategy adopted is effective. MATERIALS AND METHODS Patients with uterine papillary serous carcinoma arising in a polyp and who had undergone a hysterectomy were identified in the 2003-2013 database of 7 Italian Gynecologic Oncology Centers. Clinical and pathologic characteristics and outcomes were compared between staging procedure types. Survival curves of the women were plotted using the Kaplan-Meier method and analyzed using Cox regression hazard model and the log-rank test. Associations between clinical parameters and the incidence of recurrence were assessed by generalized linear models and the Fisher test. RESULTS A total of 75 patients met the inclusion criteria. Recurrence-free survival was affected positively by type of surgical staging and negatively by preoperative diagnosis of hypertension. The association between surgical staging and recurrence-free survival resulted significant at univariate survival analysis (P=0.048 and 0.045) and maintained a trend of significance (P=0.070) in multivariate analysis, whereas hypertension was demonstrated to be the principal influencing factor. CONCLUSIONS The international recommendations on the management of uterine papillary serous carcinoma are not uniformly followed in daily practice, although the extension of the surgery seems to be associated with lower recurrence rates also when uterine papillary serous carcinoma is confined to a polyp or endometrial surface.
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Papadia A, Garbade A, Gasparri ML, Wang J, Radan AP, Mueller MD. Minimally invasive surgery does not impair overall survival in stage IIIC endometrial cancer patients. Arch Gynecol Obstet 2019; 301:585-590. [PMID: 31781888 DOI: 10.1007/s00404-019-05393-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 11/19/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE We aimed to evaluate weather survival is impaired in stage IIIC endometrial cancer patients treated with minimally invasive surgery as compared to laparotomy. METHODS We analyzed surgical data and oncologic outcome of histologically proven stage IIIC endometrial cancer patients who were treated at our institution via laparotomy or via laparoscopic surgery. All the patients underwent a systematic pelvic and para-aortic lymphadenectomy and a complete tumor resection. Perioperative morbidity and overall survival of the patients subjected to the two surgical approaches were compared. RESULTS Sixty-six patients with stage IIIC endometrial cancer were identified. Of these, 15 patients were operated via laparotomy and 51 via laparoscopy. The two groups were similar with regards to median age at diagnosis, BMI, histotype, number of affected lymph nodes, and median maximal diameter of the affected lymph nodes. Patients undergoing laparoscopic surgery had fewer perioperative complications, a smaller estimated blood loss, and were subjected less frequently to transfusions. Overall survival at 60 months of follow-up did not differ between the two groups. At uni- and multivariate analysis, surgical approach did not affect survival. Only age was a variable associated with overall survival. CONCLUSIONS Minimally invasive surgery has better perioperative outcomes and does not impair survival in stage IIIC endometrial cancer patients. Age at diagnosis is the only factor independently affecting survival.
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Affiliation(s)
- Andrea Papadia
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Friedbühlstrasse 19, 3010, Bern, Switzerland.
| | - Alicia Garbade
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Friedbühlstrasse 19, 3010, Bern, Switzerland
| | - Maria Luisa Gasparri
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Friedbühlstrasse 19, 3010, Bern, Switzerland
- Department of Gynecology and Obstetrics, "Sapienza" University of Rome, Rome, Italy
| | - Junjie Wang
- Department of Gynaecological Oncology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Anda Petronela Radan
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Friedbühlstrasse 19, 3010, Bern, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Friedbühlstrasse 19, 3010, Bern, Switzerland
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Mortality Rates in Laparoscopic and Robotic Gynecologic Oncology Surgery: A Systemic Review and Meta-analysis. J Minim Invasive Gynecol 2019; 26:1253-1267.e4. [DOI: 10.1016/j.jmig.2019.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 11/18/2022]
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Zhang K, Li H, Yan Y, Zang Y, Li K, Wang Y, Xue F. Identification of key genes and pathways between type I and type II endometrial cancer using bioinformatics analysis. Oncol Lett 2019; 18:2464-2476. [PMID: 31452737 PMCID: PMC6676660 DOI: 10.3892/ol.2019.10550] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 05/17/2019] [Indexed: 12/24/2022] Open
Abstract
Endometrial carcinoma (EC) is a common malignant neoplasm of the female reproductive tract. The malignant degree of type II EC is much greater than that of type I EC, usually presenting with a high recurrence rate and a poor prognosis. Therefore, the present study aimed to examine the principal genes associated with the degree of differentiation in type I and type II EC and reveal their potential mechanisms. Differentially expressed genes (DEGs) were selected from the gene expression profiles derived from The Cancer Genome Atlas. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were conducted. In the present study, the KEGG pathway enrichment analysis revealed that 5,962 upregulated DEGs were significantly enriched in the ‘p53 signaling pathway’ and involved in ‘lysine degradation’. In addition, 3,709 downregulated DEGs were enriched in ‘pathways in cancer’, as well as ‘tight junction regulation’, the ‘cell cycle’ and the ‘Wnt signaling pathway’. The 13 top hub genes MAPK1, PHLPP1, ESR1, MDM2, CDKN2A, CDKN1A, AURKA, BCL2L1, POLQ, PIK3R3, RHOQ, EIF4E and LATS2 were identified via the protein-protein interaction network. Furthermore, the OncoPrint algorithm from cBioPortal declared that 25% of EC cases carried genetic alterations. The altered DEGs (MAPK1, MDM2, AURKA, EIF4E and LATS2) may be involved in tumor differentiation and may be valuable diagnostic biomarkers. In conclusion, a number of principal genes were identified in the present study that may be determinants of poorly differentiated type II EC carcinogenesis, which may contribute to future research into potential molecular mechanisms. In addition, these genes may help identify candidate biomarkers and novel therapeutic targets for type II EC.
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Affiliation(s)
- Kai Zhang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Huiyang Li
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Ye Yan
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Yuqin Zang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Ke Li
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Yingmei Wang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Fengxia Xue
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
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