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Natarajan P, Delanerolle G, Dobson L, Xu C, Zeng Y, Yu X, Marston K, Phan T, Choi F, Barzilova V, Powell SG, Wyatt J, Taylor S, Shi JQ, Hapangama DK. Surgical Treatment for Endometrial Cancer, Hysterectomy Performed via Minimally Invasive Routes Compared with Open Surgery: A Systematic Review and Network Meta-Analysis. Cancers (Basel) 2024; 16:1860. [PMID: 38791939 PMCID: PMC11119247 DOI: 10.3390/cancers16101860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/06/2024] [Accepted: 04/27/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Total hysterectomy with bilateral salpingo-oophorectomy via minimally invasive surgery (MIS) has emerged as the standard of care for early-stage endometrial cancer (EC). Prior systematic reviews and meta-analyses have focused on outcomes reported solely from randomised controlled trials (RCTs), overlooking valuable data from non-randomised studies. This inaugural systematic review and network meta-analysis comprehensively compares clinical and oncological outcomes between MIS and open surgery for early-stage EC, incorporating evidence from randomised and non-randomised studies. Methods: This study was prospectively registered on PROSPERO (CRD42020186959). All original research of any experimental design reporting clinical and oncological outcomes of surgical treatment for endometrial cancer was included. Study selection was restricted to English-language peer-reviewed journal articles published 1 January 1995-31 December 2021. A Bayesian network meta-analysis was conducted. Results: A total of 99 studies were included in the network meta-analysis, comprising 181,716 women and 14 outcomes. Compared with open surgery, laparoscopic and robotic-assisted surgery demonstrated reduced blood loss and length of hospital stay but increased operating time. Compared with laparoscopic surgery, robotic-assisted surgery was associated with a significant reduction in ileus (OR = 0.40, 95% CrI: 0.17-0.87) and total intra-operative complications (OR = 0.38, 95% CrI: 0.17-0.75) as well as a higher disease-free survival (OR = 2.45, 95% CrI: 1.04-6.34). Conclusions: For treating early endometrial cancer, minimal-access surgery via robotic-assisted or laparoscopic techniques appears safer and more efficacious than open surgery. Robotic-assisted surgery is associated with fewer complications and favourable oncological outcomes.
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Affiliation(s)
- Purushothaman Natarajan
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
- Liverpool Women’s Hospital NHS Foundation Trust, Liverpool L8 7SS, UK
| | - Gayathri Delanerolle
- Institute of Applied Health Research, College of Medicine, University of Birmingham, Vincent Drive, Edgbaston B15 2TT, UK
| | - Lucy Dobson
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
- Liverpool Women’s Hospital NHS Foundation Trust, Liverpool L8 7SS, UK
| | - Cong Xu
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen 518055, China
| | - Yutian Zeng
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen 518055, China
| | - Xuan Yu
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen 518055, China
| | - Kathleen Marston
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
| | - Thuan Phan
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
| | - Fiona Choi
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
- Liverpool Women’s Hospital NHS Foundation Trust, Liverpool L8 7SS, UK
| | - Vanya Barzilova
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
| | - Simon G. Powell
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
| | - James Wyatt
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
| | - Sian Taylor
- Liverpool Women’s Hospital NHS Foundation Trust, Liverpool L8 7SS, UK
| | - Jian Qing Shi
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen 518055, China
- National Center for Applied Mathematics Shenzhen, Shenzhen 518038, China
| | - Dharani K. Hapangama
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
- Liverpool Women’s Hospital NHS Foundation Trust, Liverpool L8 7SS, UK
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Hayashi S, Kojima J, Sasaki T, Yamamoto A, Kato K, Nishi H. Robot-assisted Surgery with Para-aortic Lymphadenectomy for Endometrial Cancer: A Preliminary Report. Gynecol Minim Invasive Ther 2024; 13:95-100. [PMID: 38911311 PMCID: PMC11192276 DOI: 10.4103/gmit.gmit_29_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: 02/28/2023] [Revised: 06/03/2023] [Accepted: 06/09/2023] [Indexed: 06/25/2024] Open
Abstract
Objectives There are few reported cases of robot-assisted surgery for endometrial cancer with para-aortic lymphadenectomy (PAL) in Japan. Therefore, this study aimed to examine the clinical outcomes of robot-assisted surgery with PAL for endometrial cancer. Materials and Methods This retrospective cohort study was analyzed 13 endometrial cancer patients who underwent robotic surgery with PAL between January 2011 and October 2018 at our hospital. We examined their perioperative complications and oncological outcomes. Results The median follow-up period, median overall survival, and disease-free interval were 80 months, 79 months (61-120), and 79 months (5-120), respectively. There were two (15.3%) cases of perioperative complications of Clavien-Dindo Class II or higher and three (23.0%) cases of recurrence. Conclusion Our results showed that the surgical and oncological outcomes of robot-assisted surgery for endometrial cancer with PAL were comparable with those of other developed countries.
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Affiliation(s)
- Shigehiro Hayashi
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo
| | - Junya Kojima
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo
| | - Toru Sasaki
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo
| | - Akiko Yamamoto
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo
| | - Kazuyoshi Kato
- Department of Obstetrics and Gynecology, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hirotaka Nishi
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo
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Hayashi S, Yamanaka Z, Kojima J, Ono M, Sasaki T, Yamamoto A, Ono M, Futagami M, Nishi H. Retrospective comparative study of robot-assisted surgery, laparoscopic surgery, and laparotomy for endometrial cancer in patients with a low risk of recurrence. J Obstet Gynaecol Res 2024; 50:103-112. [PMID: 37848280 DOI: 10.1111/jog.15816] [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: 03/23/2023] [Accepted: 10/08/2023] [Indexed: 10/19/2023]
Abstract
AIM Minimally invasive surgeries for endometrial cancer are increasing worldwide. In Japan, some articles have examined surgical outcomes, but only a few have addressed oncological outcomes. This study aims to compare robot surgery, laparoscopic surgery, and laparotomy in terms of surgical and oncological outcomes within a low-risk group for endometrial cancer recurrence. METHODS This study included patients with endometrial cancer deemed to be at low risk of recurrence and who underwent surgery between January 2011 and December 2020. We studied 99 patients who underwent robot surgery, 85 patients who underwent laparotomy, and 77 patients who underwent laparoscopic surgery. Surgical and oncological outcomes were compared retrospectively for these groups of patients. RESULTS The median follow-up period was 47, 61, and 60 months in the laparotomy, laparoscopy, and robotic groups, respectively. The three groups had similar perioperative and pathological data. No significant differences in overall survival and disease-free survival were observed among the groups. Univariate and multivariate analyses conducted on the overall study population for disease-free survival and overall survival showed that the surgical approach did not have any influence. Minimally invasive surgery groups had longer operating times compared to the laparotomy group, but they had significantly less blood loss. The number of resected pelvic lymph nodes was similar, and the complication rate was not significant. CONCLUSIONS Robot-assisted surgery and laparoscopic surgery were found to be less invasive and showed similar oncologic outcomes compared to laparotomy surgery for endometrial cancer in patients with a low risk of recurrence.
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Affiliation(s)
- Shigehiro Hayashi
- Department of Obstetrics & Gynecology, Tokyo Medical University, Tokyo, Japan
| | - Zenta Yamanaka
- Department of Obstetrics & Gynecology, Tokyo Medical University, Tokyo, Japan
| | - Junya Kojima
- Department of Obstetrics & Gynecology, Tokyo Medical University, Tokyo, Japan
| | - Masataka Ono
- Department of Obstetrics & Gynecology, Tokyo Medical University, Tokyo, Japan
| | - Toru Sasaki
- Department of Obstetrics & Gynecology, Tokyo Medical University, Tokyo, Japan
| | - Akiko Yamamoto
- Department of Obstetrics & Gynecology, Tokyo Medical University, Tokyo, Japan
| | - Masanori Ono
- Department of Obstetrics & Gynecology, Tokyo Medical University, Tokyo, Japan
| | - Masayuki Futagami
- Department of Obstetrics & Gynecology, Tokyo Medical University, Tokyo, Japan
| | - Hirotaka Nishi
- Department of Obstetrics & Gynecology, Tokyo Medical University, Tokyo, Japan
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Lu TF, Lu CH, Sun L, Liu CK, Shih YH, Hwang SF, Hsu ST. Long-term outcome of minimally invasive staging surgery for clinical stage I endometrial cancer: A single institute experience in Taiwan. J Chin Med Assoc 2024; 87:79-87. [PMID: 37792993 DOI: 10.1097/jcma.0000000000001006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Endometrial cancer is the most common gynecological cancer in developed countries. With recent advances in equipment and knowledge, minimally invasive surgery (MIS) is widely accepted for the treatment of endometrial cancer. This study had the largest number of cases to date in Taiwan, comparing outcomes between MIS and laparotomy staging surgery using real-world data with long-term follow-up. METHODS We retrospectively reviewed patients with clinical stage 1 endometrial cancer from 2009 to 2020 in our institute. All patients underwent comprehensive surgical staging procedures by MIS or laparotomy. The safety, morbidity, progression-free survival (PFS), and overall survival (OS) rates of the two groups were compared. Clinical and pathologic factors were compared with Chi-square and Fisher Exact test. PFS and OS were estimated by the Kaplan-Meier method. Differences between survival curves were analyzed using the log-rank test. A p value of <0.05 was considered statistically significant. Using Cox proportional hazards models, all factors found to be significantly associated with risk of recurrence on univariate analyses were then assessed together through multivariable models, resulting in a final oncologic outcome between MIS and laparotomy. RESULTS A total of 665 cases (412 cases in MIS group and 253 cases in laparotomy group) were enrolled for data analysis. Median operation time was shorter in MIS group (244 and 265 minutes, p < 0.001). Median blood loss was also less (75 and 430 mL, p < 0.001). Median postoperative hospitalization duration was longer in the laparotomy group (2 and 7 days, p = 0.001). After adjusting presurgery risk factors, the PFS and OS were no significant difference in MIS and laparotomy groups. CONCLUSION Using real-world data with long-term follow-up, we could confirm excellent PFS and OS in selective patients with clinical stage 1 endometrial carcinoma who received MIS, and the surgical time, hospital day, and blood loss were also less.
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Affiliation(s)
- Ting-Fang Lu
- Department of Obstetrics and Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Chien-Hsing Lu
- Department of Obstetrics and Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Biomedical Sciences, Ph.D. Program in Translational Medicine, and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan, ROC
| | - Lou Sun
- Department of Obstetrics and Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Chi-Ku Liu
- Department of Obstetrics and Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Yu-Hsiang Shih
- Department of Obstetrics and Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Sheau-Feng Hwang
- Department of Obstetrics and Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
| | - Shih-Tien Hsu
- Department of Obstetrics and Gynecology and Women's Health, Taichung Veterans General Hospital, Taichung, Taiwan, ROC
- Center for General Education, Ling Tung University, Taichung, Taiwan, ROC
- School of Medicine, China Medical University, Taichung, Taiwan, ROC
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Durdağ GD, Alemdaroğlu S, Baran ŞY, Şimşek SY, Yetkinel S, Çelik H. Safety of laparoscopic surgery in the management of endometrioid endometrial cancer. Indian J Cancer 2023; 60:366-372. [PMID: 36861713 DOI: 10.4103/ijc.ijc_206_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Laparoscopic surgery has increasingly been preferred in recent years. However, data regarding the safety of laparoscopy in endometrial cancer are not sufficient. The aim of this study was to compare perioperative and oncologic outcomes of laparoscopic and laparotomic staging surgery in patients with endometrioid endometrial cancer and to evaluate the safety and efficacy of laparoscopic surgery in this population. Methods Data of 278 patients, who underwent surgical staging for endometrioid endometrial cancer at the gynecologic oncology department of a university hospital between 2012 and 2019, were analyzed retrospectively. Demographic, histopathologic, perioperative, and oncologic characteristics were compared between laparoscopy and laparotomy groups. A subgroup of patients with a body mass index (BMI) >30 was further evaluated. Results Demographic and histopathologic characteristics were similar between the two groups, while laparoscopic surgery was seen to be significantly superior in terms of perioperative outcomes. The number of removed and metastatic lymph nodes was significantly higher in the laparotomy group; however, this difference did not affect the oncologic outcomes, including recurrence and survival rates, and the two groups had similar results in this aspect. The outcomes of the subgroup with BMI >30 were also in accordance with the whole population. Intraoperative complications in laparoscopy were managed successfully. Conclusions Laparoscopic surgery appears to be advantageous over laparotomy, and depending on the surgical experience, it may be performed safely for surgical staging of endometrioid endometrial cancer.
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Affiliation(s)
- Gülşen Doğan Durdağ
- Department of Gynecology and Obstetrics, Baskent University Faculty of Medicine, Adana Application and Research Hospital, Adana, Turkey
| | - Songül Alemdaroğlu
- Department of Gynecology and Obstetrics, Baskent University Faculty of Medicine, Adana Application and Research Hospital, Adana, Turkey
| | - Şafak Yilmaz Baran
- Department of Gynecology and Obstetrics, Baskent University Faculty of Medicine, Adana Application and Research Hospital, Adana, Turkey
| | - Seda Yüksel Şimşek
- Department of Gynecology and Obstetrics, Baskent University Faculty of Medicine, Adana Application and Research Hospital, Adana, Turkey
| | - Selçuk Yetkinel
- Department of Gynecology and Obstetrics, Baskent University Faculty of Medicine, Adana Application and Research Hospital, Adana, Turkey
| | - Hüsnü Çelik
- Department of Gynecology and Obstetrics, Baskent University Faculty of Medicine, Adana Application and Research Hospital, Adana, Turkey
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Hwang JH, Kim BW. The incidence of postoperative symptomatic lymphocele after pelvic lymphadenectomy between abdominal and laparoscopic approach: a systemic review and meta-analysis. Surg Endosc 2022; 36:7114-7125. [PMID: 35467142 DOI: 10.1007/s00464-022-09227-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 03/29/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the risks of symptomatic lymphocele after pelvic lymphadenectomy between the laparoscopic and abdominal approach in uterine cervical and endometrial cancer. METHODS We searched Ovid Medline, Ovid EMBASE, and the Cochrane library through April 2020. We selected the comparative studies contained information on symptomatic lymphoceles in postoperative complications. All articles searched were independently reviewed and selected by two researchers. A meta-analysis was performed using the Stata MP version 16.0 software package. RESULTS A total of 33 eligible clinical trials were ultimately enrolled in this meta-analysis. When all studies were pooled, the odds ratios (OR) of the laparoscopic approach for the risk of symptomatic lymphoceles compared to the abdominal approach was 0.58 [95% confidence interval (CI): 0.42-0.81, p = 0.022, I-squared = 0.0%]. The risk of postoperative symptomatic lymphoceles in the laparoscopic group tended to decrease over time in the cumulative meta-analysis. In the subgroup analysis, there was no evidence for an association between cancer type, quality of the study methodology, hysterectomy type, and postoperative symptomatic lymphoceles. However, in a recently published article, being overweight (body mass index ≥ 25) and studies conducted in oriental area were associated with a lower incidence of postoperative symptomatic lymphoceles. CONCLUSION Laparoscopic lymphadenectomy was associated with a significantly lower risk of postoperative symptomatic lymphoceles than abdominal lymphadenectomy (PROSPERO registration number: CRD 42,020,187,165).
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Affiliation(s)
- Jong Ha Hwang
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Seo-Gu Incheon Metropolitan City, Simgokro 100 Gil 25, Incheon, 22711, South Korea.
| | - Bo Wook Kim
- Department of Obstetrics and Gynecology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Seo-Gu Incheon Metropolitan City, Simgokro 100 Gil 25, Incheon, 22711, South Korea
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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: 0] [Impact Index Per Article: 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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Chikazawa K, Netsu S, Imai K, Kimura A, Kuwata T, Konno R. Volume index is a risk factor for recurrence even in patients with clinical stage IA endometrial cancer undergoing either laparotomy or laparoscopy: A retrospective study. Gynecol Minim Invasive Ther 2022; 11:94-99. [PMID: 35746912 PMCID: PMC9212171 DOI: 10.4103/gmit.gmit_12_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/19/2021] [Accepted: 03/25/2021] [Indexed: 11/06/2022] Open
Abstract
Objectives: The objective of the study was to investigate the long-term outcomes, in particular, recurrence risk, especially tumor volume, for Stage IA endometrial cancer and to identify the risk factors for recurrence. Materials and Methods: This single-center retrospective study analyzed women who underwent primary surgical treatment for the International Federation of Gynecology and Obstetrics Stage IA (Grade 1 or 2) endometrioid carcinoma at our institute between January 2010 and July 2018. Patients' demographic characteristics, including age, operative time, number of lymph nodes, final stage, volume index as tumor volume, and final histological type, were reviewed. A total of 168 patients were enrolled, with 95 and 73 patients in the laparotomy and laparoscopy groups, respectively. The Cox proportional hazards model was used to adjust for prognostic factors in the analysis including upstaged patients, tumor histology, lymphovascular invasion, and volume index. Results: There was no difference in the recurrence rate between laparoscopic and open surgeries for Stage IA endometrial cancer. The operative time was longer, and the amount of blood loss was lesser in the laparoscopy group than in the laparotomy group. For all patients undergoing either laparoscopy or open surgery, upstaged ≥IB, nonendometrioid Grade 1 or 2, lymphovascular invasion, and volume index ≥36 were significant independent recurrence risk factors. Conclusion: Laparoscopic surgery for Stage IA endometrial cancer is technically and oncologically safe. Patients with a high-volume index have a higher recurrence risk. Furthermore, the volume index can be a recurrence predictor in low-risk endometrial cancer patients.
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Duraisamy KY, Ezhilmani M, Balasubramaniam D, Periyasamy K. A Prospective Analysis of Laparoscopic Management of Endometrial Cancer in a Tertiary Care Centre. J Obstet Gynaecol India 2021; 71:621-628. [PMID: 34898901 DOI: 10.1007/s13224-020-01405-6] [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: 07/27/2020] [Accepted: 11/20/2020] [Indexed: 10/21/2022] Open
Abstract
Background Laparoscopic management of endometrial cancer is beneficial in view of decreased operative morbidity and post-operative recovery. In the case of early gynaecological malignancies, it is a safe and feasible mode of surgery. Methods A prospective study was conducted in our tertiary centre in the period January 2017-December 2019. The study included 51 patients diagnosed with endometrial carcinoma. Demographic details and operative findings have been recorded. Results The mean age was 55.47 years; 64.7% were post-menopausal. 86.2% had stage IA disease. All patients underwent laparoscopic staging. The mean operative time was 115 min, estimated blood loss was 82.5 ml, pelvic nodal yield was 13.53, and para-aortic nodes were 20.78. There were no conversions to laparotomy or any intra-operative complications, and none of the patients had recurrence. During post-operative follow-up, 2 patients had lymphocyst, 1 had chylous ascites and 1 had port site hernia. Average hospital stay was 3 days. Conclusion In our study, we found that laparoscopic management of endometrial cancer is less morbid and has better post-operative recovery.
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Affiliation(s)
- Kavitha Yogini Duraisamy
- Department of Endogynecology, Gem Hospital and Research Centre, 45A, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu 641045 India
| | - Malathi Ezhilmani
- Department of Endogynecology, Gem Hospital and Research Centre, 45A, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu 641045 India
| | - Devi Balasubramaniam
- Department of Endogynecology, Gem Hospital and Research Centre, 45A, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu 641045 India
| | - Kodeeswari Periyasamy
- Department of Endogynecology, Gem Hospital and Research Centre, 45A, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu 641045 India
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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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11
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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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12
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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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13
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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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14
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Eoh KJ, Lee DW, Lee JH, Nam EJ, Kim SW, Kim YT. Comparative Survival Outcome of Robot-Assisted Staging Surgery Using Three Robotic Arms versus Open Surgery for Endometrial Cancer. Yonsei Med J 2021; 62:68-74. [PMID: 33381936 PMCID: PMC7820443 DOI: 10.3349/ymj.2021.62.1.68] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/02/2020] [Accepted: 11/11/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE There is lack of data on direct comparison of survival outcomes between open surgery and robot-assisted staging surgery (RSS) using three robotic arms for endometrial cancer. The purpose of this study was to compare the overall survival (OS) and disease-free survival (DFS) between open surgery and RSS using three robotic arms for endometrial cancer. MATERIALS AND METHODS Consecutive women with endometrial cancer who underwent surgery between May 2006 and May 2018 were identified. Robotic procedures were performed using the da Vinci robotic system, and the robotic approach consisted of three robotic arms including a camera arm. Propensity score matching, as well as univariate and multivariate Cox regression of OS and DFS were performed according to clinicopathologic data and surgical method. RESULTS The study cohort included 423 unselected patients with endometrial cancer, of whom 218 underwent open surgery and 205 underwent RSS using three robotic arms. Propensity score-matched cohorts of 146 women in each surgical group showed no significant differences in survival: 5-year OS of 91% vs. 92% and DFS of 86% vs. 89% in the open and robotic cohorts, respectively (hazard ratio, 1.02; 95% confidence interval, 0.82-1.67). In the univariate analysis with OS as the endpoint, surgical method, age, stage, type II histology, grade, and lymph node metastasis were independently associated with survival. Surgical stage, grade, and type II histology were found to be significant independent predictors for OS in the multivariate analysis. CONCLUSION RSS using three robotic arms and laparotomy for endometrial carcinoma had comparable survival outcomes.
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Affiliation(s)
- Kyung Jin Eoh
- Department of Obstetrics and Gynecology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
- Department of Obstetrics and Gynecology, Institute of Women's Medical Life Science, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Woo Lee
- Department of Obstetrics and Gynecology, Bucheon St. Mary's Hospital, the Catholic University College of Medicine, Bucheon, Korea
| | - Ji Hyun Lee
- Department of Obstetrics and Gynecology, Institute of Women's Medical Life Science, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ji Nam
- Department of Obstetrics and Gynecology, Institute of Women's Medical Life Science, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Wun Kim
- Department of Obstetrics and Gynecology, Institute of Women's Medical Life Science, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Tae Kim
- Department of Obstetrics and Gynecology, Institute of Women's Medical Life Science, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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15
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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: 854] [Impact Index Per Article: 213.5] [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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16
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Eoh KJ, Nam EJ, Kim SW, Shin M, Kim SJH, Kim JA, Kim YT. Nationwide Comparison of Surgical and Oncologic Outcomes in Endometrial Cancer Patients Undergoing Robotic, Laparoscopic, and Open Surgery: A Population-Based Cohort Study. Cancer Res Treat 2020; 53:549-557. [PMID: 33091967 PMCID: PMC8053860 DOI: 10.4143/crt.2020.802] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/20/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose Population-based comparisons between minimally invasive surgery (MIS) (robotic surgery [RS] and laparoscopic surgery [LS]) and open surgery (OS) for managing endometrial cancer are lacking. This study aimed to compare surgical and oncologic outcomes between endometrial cancer patients who underwent surgical staging via MIS or OS. Materials and Methods A population-based retrospective cohort study was performed using claims data from the Korean National Health Insurance database from January 2012 to December 2016. All patients who underwent hysterectomy under diagnosis of endometrial cancer were identified. Patients were classified into RS, LS, and OS groups. Operative and oncologic outcomes were compared among the three groups after adjustments for age group, risk group (adjuvant therapy status), modified Charlson comorbidity index, income level, insurance type, and index year using propensity scores obtained via the inverse probability of treatment weighted method. Results After adjustment, 5,065 patients (RS, n=315; LS, n=3,248; OS, n=1,503) were analyzed. Patient demographics were comparable. Hospital stay, postoperative complications, and cost were more favorable in the RS and LS groups than in the OS group (all p < 0.001). Five-year overall survival was significantly longer in the RS and LS groups than in the OS group (94.8%, 91.9%, and 86.9%, respectively; p < 0.001). Moreover, the survival benefit of RS was shown in the subgroup analysis of low-risk endometrial cancer patients. Conclusion Our study provides further evidence for the RS being a safe surgical alternative to the LS and OS, especially in low-risk endometrial cancer patients, offering surgical and oncologic outcomes equivalent to other surgical approaches.
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Affiliation(s)
- Kyung-Jin Eoh
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Yongin Severance Hospital, Yongin, Korea
| | - Eun-Ji Nam
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Women's Cancer Center, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Wun Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Women's Cancer Center, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Minkyung Shin
- Health Economics and Outcomes Research - APAC, Intuitive Surgical, Sunnyvale, CA, USA
| | | | | | - Yong-Tae Kim
- Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Women's Cancer Center, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Doğan Durdağ G, Alemdaroğlu S, Yılmaz Baran Ş, Alkaş Yağınç D, Yüksel Şimşek S, Çelik H. Laparoscopic para-aortic lymphadenectomy: Technique and surgical outcomes. J Gynecol Obstet Hum Reprod 2020; 50:101917. [PMID: 32961327 DOI: 10.1016/j.jogoh.2020.101917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 09/16/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Pelvic and para-aortic lymph node dissection is an important part of staging surgery. Aim of this study is to evaluate perioperative outcomes of patients, who underwent laparoscopic para-aortic lymphadenectomy for gynecological cancer in a single center over a period of 7 years, based on body mass index (BMI), and to present the surgical technique in steps. METHODS Data of patients who underwent para-aortic lymphadenectomy at gynecological oncology department of a tertiary center in between March 2013 and July 2020 were analyzed retrospectively. Patients were evaluated in two groups according to their BMI (< 30 kg/m2 as non-obese and ≥ 30 kg/m2 as obese groups). Surgical technique is described in steps. Perioperative outcomes of the two groups were evaluated. RESULTS A total of 230 patients were included in the study. BMI was ≥30 at 58.46 % of the patients. Peri-operative features were not significantly affected by the patient's BMI with the presented surgical technique, however, collected para-aortic lymph node numbers were higher in the group with BMI < 30, though sufficient number of lymph nodes were achieved in both groups. CONCLUSION Although some technical difficulties may be encountered, laparoscopic para-aortic lymphadenectomy is feasable in gynecologic oncological surgery independent of BMI. However, surgical experience is important.
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Affiliation(s)
- Gülşen Doğan Durdağ
- Başkent University Faculty of Medicine, Adana Application and Research Hospital, Department of Gynecology and Obstetrics, Adana, Turkey.
| | - Songül Alemdaroğlu
- Başkent University Faculty of Medicine, Adana Application and Research Hospital, Department of Gynecology and Obstetrics, Adana, Turkey
| | - Şafak Yılmaz Baran
- Başkent University Faculty of Medicine, Adana Application and Research Hospital, Department of Gynecology and Obstetrics, Adana, Turkey
| | - Didem Alkaş Yağınç
- Başkent University Faculty of Medicine, Adana Application and Research Hospital, Department of Gynecology and Obstetrics, Adana, Turkey
| | - Seda Yüksel Şimşek
- Başkent University Faculty of Medicine, Adana Application and Research Hospital, Department of Gynecology and Obstetrics, Adana, Turkey
| | - Hüsnü Çelik
- Başkent University Faculty of Medicine, Adana Application and Research Hospital, Department of Gynecology and Obstetrics, Adana, Turkey
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Deura I, Shimada M, Azuma Y, Komatsu H, Nagira K, Sawada M, Harada T. Comparison of laparoscopic surgery and conventional laparotomy for surgical staging of patients with presumed low-risk endometrial cancer: The current state of Japan. Taiwan J Obstet Gynecol 2019; 58:99-104. [DOI: 10.1016/j.tjog.2018.11.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2018] [Indexed: 12/17/2022] Open
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Ruan XC, Wong WL, Yeong HQ, Lim YKT. Comparison of outcomes following laparoscopic and open hysterectomy with pelvic lymphadenectomy for early stage endometrial carcinoma. Singapore Med J 2018; 59:366-369. [PMID: 30109355 DOI: 10.11622/smedj.2018088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Endometrial carcinoma is the most common gynaecological malignancy. Studies have shown that laparoscopic total hysterectomy, bilateral salpingo-oophorectomy and pelvic lymph node dissection was advantageous compared to laparotomy in reducing length of stay and intraoperative blood loss. However, these studies had a predominantly Caucasian population. A comparison study was conducted among the Singapore population to investigate the differences in oncological and surgical outcomes between these two methods. METHODS A retrospective, single-centre cohort study was conducted. Records of hospitalised patients with Stage 1 endometrioid carcinoma from 2008 to 2014 were extracted for review. Demographic data and study-specific parameters, including operative time, length of hospitalisation, intraoperative and postoperative complications, pain scores, final staging and recurrence rates, were compared between the two groups. RESULTS 475 endometrioid carcinoma patients were admitted for surgical staging, among whom 374 fulfilled our inclusion criteria. Out of these patients, 229 underwent laparotomy and 145 underwent laparoscopy. The race, parity and body mass index of both groups were comparable. Patients who underwent laparoscopic surgery reported reduced pain score within two hours postoperatively (p = 0.007) and at Postoperative Days 1, 2 and 3 (p < 0.001). Laparoscopic surgery also illustrated better outcomes such as reduced length of stay (p < 0.001) and reduced intraoperative blood loss (p < 0.001). The operative time, recurrence rate and disease-free intervals were comparable between both groups. CONCLUSION Laparoscopy offered similar oncological outcomes with superior surgical outcomes compared to laparotomy. It provides a suitable alternative in the surgical staging of endometrioid carcinoma.
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Affiliation(s)
| | - Wai Loong Wong
- Department of Gynaecological Oncology, KK Women's and Children's Hospital, Singapore
| | | | - Yong Kuei Timothy Lim
- Department of Gynaecological Oncology, KK Women's and Children's Hospital, Singapore
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Agarwal R, Rajanbabu A, Goel G, Unnikrishnan UG. A Comparison of the Clinical Outcomes in Uterine Cancer Surgery After the Introduction of Robotic-Assisted Surgery. J Obstet Gynaecol India 2018; 69:284-291. [PMID: 31178646 DOI: 10.1007/s13224-018-1170-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 08/12/2018] [Indexed: 01/07/2023] Open
Abstract
Objective To compare the rates of intraoperative and postoperative complications of open and robotic-assisted surgery in the treatment of endometrial cancer. Methods This retrospective study was performed at a single academic institution from January 2014 to February 2017 in the Department of Gynecology Oncology at Amrita Institute of Medical Science, Kerala, India. The study included patients with clinically early stage uterine malignancy undergoing open or robotic-assisted surgery. Data collected included clinicopathological factors, intraoperative data, length of hospital stay and intraoperative and postoperative (early and late and severity according to Clavien-Dindo classification). Morbidity was compared between two groups. Results The study included 128 patients, of whom 61 underwent open surgery and 67 underwent robotic-assisted surgery. Mean operative time (P = 0.112), mean estimated blood loss (P < 0.001), number of patients requiring blood transfusion (P < 0.001) and mean length of hospital stay (P < 0.001) were significantly lower in robotic group. None of the patients in robotic group experienced intraoperative hemorrhage (P = 0.010). The early postoperative complications, SSI (P < 0.001), infection (P = 0.002), and urinary complications (P = 0.030) and late postoperative complications lymphoedema (P = 0.002), vault-related complications (1.5% robotic vs. 6.6% open) and incisional hernia (none in robotic vs. 4.9% in open) were significantly lower in robotic group. Grade-II complications (Clavien-Dindo classification) were significantly lower in robotic group (P < 0.001). Conclusion Robotic-assisted surgical staging for uterine cancer is feasible and safe in terms of short-term outcomes and results in fewer complications and shorter hospital stay.
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Affiliation(s)
- Reshu Agarwal
- 1Department of Gynecologic Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala 682041 India
| | - Anupama Rajanbabu
- 1Department of Gynecologic Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala 682041 India
| | - Gaurav Goel
- 1Department of Gynecologic Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala 682041 India
| | - U G Unnikrishnan
- 2Department of Biostatistics, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala India
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Minimally invasive abdominal cerclage compared to laparotomy: a comparison of surgical and obstetric outcomes. J Robot Surg 2017; 12:295-301. [DOI: 10.1007/s11701-017-0726-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
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Hong MK, Chu TY, Ding DC. How the silent mentor program improves our surgical level and safety and nourishes our spiritual life. Gynecol Minim Invasive Ther 2017; 6:99-102. [PMID: 30254889 PMCID: PMC6135181 DOI: 10.1016/j.gmit.2016.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 12/12/2016] [Accepted: 12/19/2016] [Indexed: 11/20/2022] Open
Abstract
We briefly share our experience of using the silent mentor program in the Medical Simulation Center (MSC) of Tzu Chi University (TCU), Hualien, Taiwan, to improve our minimally invasive surgical level and patient's safety. The silent mentor program, established in 2000 by the Department of Anatomy of TCU, is a pioneering clinical skill training program based on unembalmed bodies. This program provides three valuable advantages for surgery. The first is the comprehensive understanding of the deep or rarely observed but crucial structures of the human body, which is normally difficult to achieve in living humans. The second is gaining the first experience of a novel procedure or surgery on silent mentors rather than on living humans, which is essential for young surgeons to begin their careers. The third is evaluating the safety and feasibility of a novel surgical method. In addition to surgical techniques, the most valuable point of the program is the humane ceremonies conducted for silent mentors to nourish our soul. After the workshop, all the incision wounds on every silent mentor were carefully checked and sutured in the same manner as in closing surgical wounds in a patient. Subsequently, encoffining, cremation, and thanksgiving ceremonies were solemnly held, in the hope that the medical students or trainees would imperceptibly understand their responsibility to society and the silent mentor's expectations. The Asia-Pacific Association for Gynecologic Endoscopy and Minimally Invasive Therapy, or the Taiwan Association for Minimally Gynecology Therapy, or both can consider initiating a regular silent mentor program in the MSC of TCU. It is not only intended to improve the skills of surgeons but also to allow them to participate in the interactive ceremony and thus refresh their humanitarian knowledge.
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Affiliation(s)
- Mun-Kun Hong
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, ROC
- Institute of Medical Science, Tzu Chi University, Hualien, Taiwan, ROC
| | - Tang-Yuan Chu
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, ROC
- Institute of Medical Science, Tzu Chi University, Hualien, Taiwan, ROC
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, ROC
- Institute of Medical Science, Tzu Chi University, Hualien, Taiwan, ROC
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Tanaka T, Terai Y, Maeda K, Ashihara K, Kogata Y, Maruoka H, Terada S, Yamada T, Ohmichi M. Intraperitoneal cytology after laparoscopic hysterectomy in patients with endometrial cancer: A retrospective observational study. Medicine (Baltimore) 2017; 96:e7502. [PMID: 28682921 PMCID: PMC5502194 DOI: 10.1097/md.0000000000007502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to evaluate the dissemination of cancer cells at laparoscopic hysterectomy according to the intraperitoneal cytology.Patients with endometrial cancer underwent total laparoscopic modified radical hysterectomy. Peritoneal wash cytology was performed on entering the peritoneal cavity before surgical preparation and just after hysterectomy.Seventy-eight patients underwent laparoscopic hysterectomy for endometrial cancer. Among the 15 patients who had positive intraperitoneal cytology on entering the peritoneal cavity, 10 converted to negative intraperitoneal cytology after hysterectomy. In contrast, among the 63 patients who had negative intraperitoneal cytology on entering the peritoneal cavity, 2 converted to positive intraperitoneal cytology after hysterectomy.While surgery can reduce the number of cancer cells in the peritoneal cavity, leakage can occur, as seen in some cases of hysterectomy. Careful washing must be performed after hysterectomy.
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Affiliation(s)
| | | | | | | | | | | | | | - Takashi Yamada
- Department of Pathology, Osaka Medical College, Takatsuki, Osaka, Japan
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Tanaka T, Terai Y, Hayashi S, Aoki D, Miki M, Kobayashi E, Kimura T, Baba T, Matsumura N, Ohmichi M. Comparison Between Laparoscopy and Laparotomy in Systematic Para-Aortic Lymphadenectomy for Patients with Endometrial Cancer: A Retrospective Multicenter Study. J Gynecol Surg 2017; 33:105-110. [PMID: 28611530 PMCID: PMC5466012 DOI: 10.1089/gyn.2016.0101] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: Laparoscopic surgery has been developed worldwide due to its minimal invasion as well as noninferiority, compared with laparotomy. However, whether or not laparoscopic systematic para-aortic lymphadenectomy for endometrial cancer is feasible and has advantages of various clinical factors, such as a short hospital stay, less blood loss, and faster recovery, compared with open surgery has not yet been clarified. The aim of this study was to compare a laparoscopic procedure with laparotomy for para-aortic lymphadenectomy for patients with endometrial cancer. Study Design: This was a retrospective multicenter study of laparoscopic systematic para-aortic lymphadenectomy for endometrial cancer in five institutions. Materials and Methods: The current authors conducted a retrospective multicenter study of laparoscopic systematic para-aortic lymphadenectomy for endometrial cancer. The study involved patients from five institutions in Japan between January 2008 and March 2016. Clinical data were compared with those of a laparotomic procedure performed around the same period. Results: A total of 54 patients in the laparoscopic group and 99 patients in the laparotomic group were analyzed. In the laparoscopic group, 21 patients had stage IA disease, 19 had stage IB disease, 5 had stage II disease, and 9 had stage III disease. In the laparotomic group, 35 patients had stage IA disease, 19 had stage IB disease, 9 had stage II disease, and 36 had stage III disease. There were no significant differences in characteristics between the groups, including age, body mass index, and histologic type. The mean operative time in the laparoscopic group was 483 ± 102 minutes, while that in the laparotomic group was 481 ± 106 minutes (p = 0.9). The laparoscopic group had less intraoperative blood loss (143 ± 253 versus 988 ± 694 mL; p < 0.01) and shorter hospital stays (8.4 ± 5.7 versus 16.1 ± 8.0 days; p < 0.01). The rates of intraoperative complications were not significantly different between the groups. No cases of ileus occurred in the laparoscopic group. Procedures for 2 of the 54 patients in the laparoscopic group were converted to laparotomy. The number of dissected pelvic lymph nodes (31.8 ± 10.1 versus 39.9 ± 15.9, p < 0.01) and para-aortic lymph nodes (26.2 ± 10.9 versus 31.1 ± 13.2; p = 0.02) were lower in the laparoscopic group than in the laparotomic group. The postoperative minimum level of hemoglobin was higher in the laparoscopic group than in the laparotomic group (10.4 ± 1.1 g/dL versus 9.9 ± 1.4 g/dL; p = 0.02). In contrast, the postoperative maximum level of C-reactive protein was lower in the laparoscopic group than in the laparotomic group (6.3 ± 3.8 mg/dL versus 10.2 ± 4.9 mg/dL; p < 0.01). The recurrence rate was not significantly different between the groups in the above time period (7.4% versus 14.3%; p = 0.2). Conclusions: Laparoscopic systematic para-aortic lymphadenectomy is feasible and can be substituted for laparotomic procedures for patients with early stage endometrial cancer. ( J GYNECOL SURG 33:105)
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Affiliation(s)
- Tomohito Tanaka
- Department of Obstetrics and Gynecology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Yoshito Terai
- Department of Obstetrics and Gynecology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Shigenori Hayashi
- Keio University School of Medicine, Tokyo, Japan.,Tokyo Medical Center, Meguro-ku, Tokyo, Japan
| | - Daisuke Aoki
- Keio University School of Medicine, Tokyo, Japan
| | | | - Eiji Kobayashi
- Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tadashi Kimura
- Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tsukasa Baba
- Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | | | - Masahide Ohmichi
- Department of Obstetrics and Gynecology, Osaka Medical College, Takatsuki, Osaka, Japan
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Uterine sarcoma Part II-Uterine endometrial stromal sarcoma: The TAG systematic review. Taiwan J Obstet Gynecol 2017; 55:472-9. [PMID: 27590366 DOI: 10.1016/j.tjog.2016.04.034] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2016] [Indexed: 12/16/2022] Open
Abstract
Endometrial stromal tumors are rare uterine tumors (<1%). Four main categories include endometrial stromal nodule, low-grade endometrial stromal sarcoma (LG-ESS), high-grade endometrial stromal sarcoma (HG-ESS), and uterine undifferentiated sarcoma (UUS). This review is a series of articles discussing the uterine sarcomas. LG-ESS, a hormone-dependent tumor harboring chromosomal rearrangement, is an indolent tumor with a favorable prognosis, but characterized by late recurrences even in patients with Stage I disease, suggesting the requirement of a long-term follow-up. Patients with HG-ESS, based on the identification of YWHAE-NUTM2A/B (YWHAE-FAM22A/B) gene fusion, typically present with advanced stage diseases and frequently have recurrences, usually within a few years after initial surgery. UUS is, a high-grade sarcoma, extremely rare, lacking a specific line of differentiation, which is a diagnosis of exclusion (the wastebasket category, which fails to fulfill the morphological and immunohistochemical criteria of translocation-positive ESS). Surgery is the main strategy in the management of uterine sarcoma. Due to rarity, complex biological characteristics, and unknown etiology and risk factors of uterine sarcomas, the role of adjuvant therapy is not clear. Only LG-ESS might respond to progestins or aromatase inhibitors.
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Uterine sarcoma Part I—Uterine leiomyosarcoma: The Topic Advisory Group systematic review. Taiwan J Obstet Gynecol 2016; 55:463-71. [DOI: 10.1016/j.tjog.2016.04.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2016] [Indexed: 12/21/2022] Open
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Wang PH, Horng HC, Chen CP. Is it safe to use minimally invasive surgery in the management of endometrial cancer? Taiwan J Obstet Gynecol 2016; 55:155-6. [DOI: 10.1016/j.tjog.2016.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2016] [Indexed: 10/21/2022] Open
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