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Rambow AC, Nikolai M, Jansen P, Rogmans C, Tribian N, Bauerschlag DO, Maass N, van Mackelenbergh MT. Laparoscopic surgery for endometrial cancer is oncologically safe and improves hospital stay duration: a retrospective single-center study over a 16-year period. Arch Gynecol Obstet 2024; 310:1207-1213. [PMID: 38789852 PMCID: PMC11258090 DOI: 10.1007/s00404-024-07550-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE To investigate changes in surgical procedures and patient outcomes of patients diagnosed with endometrial cancer (EC) at a German university hospital between 1998 and 2014. METHODS A monocentric, retrospective review was conducted to identify patients diagnosed and treated with EC during the aforementioned period at the Department of Gynecology and Obstetrics at the University Hospital Kiel, Germany. RESULTS 303 patients were identified. Patient demographics, risk factors, histological subtypes and stages of EC remained consistent over time. The most common surgical procedure was total abdominal hysterectomy (TAH) (81.9%). In 2011, the institution carried out its first total laparoscopic hysterectomy (TLH) for EC, resulting in a significant increase in laparoscopic surgical procedures (2011-2014: N = 70; TAH 44.2%; TLH 51.4%). Although the total number of lymph node stagings remained consistent over time, there was a significant increase in the performance of simultaneous pelvic and para-aortic lymphonodectomy (LNE) compared to pelvic LNE alone (2.6 in 2001-2005 vs. 18.0% in 2011-2014, p ≤ 0.001). The duration of hospital stays significantly decreased over time, with a mean of 20.9 days in the first and 8.5 days in the last period. When comparing surgical procedures, TLHs resulted in significantly shorter postoperative stays with an average of 6.58 vs. 13.92 days for TAH. The surgical procedure performed did not affect 5-year overall survival rates in this study (84.9% for TAH and 85.3% for TLH, p = 0.85). CONCLUSIONS Our retrospective single-center study demonstrates that laparoscopic surgery for endometrial cancer is oncologically safe and shortens hospital stays.
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Affiliation(s)
- Anna-Christina Rambow
- Department of Gynecology and Obstetrics, University Hospital Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.
| | - Moritz Nikolai
- Department of Gynecology and Obstetrics, University Hospital Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Peer Jansen
- Department of Gynecology and Obstetrics, University Hospital Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Christoph Rogmans
- Department of Gynecology and Obstetrics, University Hospital Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Nils Tribian
- Department of Gynecology and Obstetrics, University Hospital Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Dirk O Bauerschlag
- Department of Gynecology and Obstetrics, University Hospital Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Nicolai Maass
- Department of Gynecology and Obstetrics, University Hospital Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Marion T van Mackelenbergh
- Department of Gynecology and Obstetrics, University Hospital Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany
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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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Yang J, Fan X, Gao J, Li D, Xu Y, Chen G. Cost effectiveness analysis of total laparoscopic hysterectomy versus total abdominal hysterectomy for uterine fibroids in Western China: a societal perspective. BMC Health Serv Res 2022; 22:252. [PMID: 35209891 PMCID: PMC8867663 DOI: 10.1186/s12913-022-07644-9] [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: 08/06/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As a common female pelvic tumor, uterine fibroids remain the leading cause for hysterectomy in China. Hysterectomy provides a good surgical treatment of uterine fibroids, and it guarantees the removal of all uterine fibroids without lower risk of recurrence. This study compares the cost effectiveness of total laparoscopic hysterectomy (TLH) versus total abdominal hysterectomy (TAH) for women with uterine fibroids from a societal perspective. METHODS An economic analysis was conducted in 392 patients (TLH n = 75; TAH n = 317), including all relevant costs over a 12-month time horizon. Primary outcome was major surgical complications; secondary outcomes were postoperative discomfort symptoms and time of return to normal activities. Clinical, outcomes and costs data were collected from medical records, telephone survey and financial information system. Generalized linear models were used to assess costs and outcomes differences between the two groups. Incremental cost effectiveness ratio (ICER) was used to estimate the cost effectiveness. RESULTS Mean direct costs were $2,925.71 for TLH, $2,436.24 for TAH, respectively. Mean indirect costs were $1,133.22 for TLH, $1,394.85 for TAH, respectively. Incremental societal costs were $256.86 (95%CI: 249.03-264.69). Mean differences in outcome were: 4.53% (95%CI: 4.35-4.71) for major surgical complications; 6.75% (95%CI: 6.45-7.05) for postoperative discomfort symptoms; 1.27 (95%CI: 1.23-1.30) weeks for time to return to normal activities. ICER of TLH was $5,669.16 (95%CI: 5,384.76-5,955.56) per complication averted, $3,801.54 (95%CI: 3,634.81-3,968.28) per postoperative discomfort symptoms averted and $202.96 (95%CI: 194.97-210.95) per week saved to return to normal activities. CONCLUSIONS TLH is cost effective compared with TAH in preventing additional complications based on our estimated conservative threshold in China. The findings provide useful information for researchers to conduct further cost effectiveness analysis based on prospective study which can provide stronger and more evidence, in China. In addition, the data may be useful for Chinese health care policy-makers and medical insurance payers to make related health care decisions.
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Affiliation(s)
- Jinjuan Yang
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, 710061, People's Republic of China
| | - Xiaojing Fan
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China.
| | - Jianmin Gao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China.
| | - Dan Li
- School of Public Management, Northwest University School, Xi'an, 710127, People's Republic of China
| | - Yongjian Xu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, People's Republic of China
| | - Gang Chen
- Monash Business School, Monash University, Clayton, VIC, 3145, Australia
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Xu Y, Shen J, Zhang Q, He Y, Chen C, Tian Y. Oncologic safety of laparoscopic surgery for women with apparent early-stage uterine serous carcinoma: A multi-institutional retrospective cohort study. Int J Gynaecol Obstet 2021; 158:162-171. [PMID: 34561857 DOI: 10.1002/ijgo.13942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/07/2021] [Accepted: 09/23/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the long-term survival outcomes of patients with apparent early-stage uterine serous carcinoma (USC) who underwent laparoscopic staging surgery with those who underwent open surgical staging. METHODS A total of 295 patients from four Chinese teaching hospitals were included. Overall survival (OS) and disease-free survival (DFS) were estimated and compared using the Kaplan-Meier method and the log-rank test among patients after laparoscopic surgery or open surgery. The Cox proportional hazards regression model was applied to adjust for potential confounding factors. RESULTS For patients with apparent early-stage USC, laparoscopic surgery was associated with deteriorated DFS (hazard ratio [HR] 1.83, 95% confidence interval [CI] 1.15-2.93, P = 0.012), and there was no significant difference in OS between the two groups (HR 1.74, 95% CI 0.99-3.08, P = 0.056). However, after adjusting for confounding factors, the surgical approach was not an independent prognostic factor for DFS (adjusted HR 1.16, 95% CI 0.63-2.12, P = 0.636) and OS (adjusted HR 1.11, 95% CI 0.52-2.38, P = 0.794) in apparent early-stage USC. CONCLUSION For apparent early-stage USC, laparoscopic surgery is safe. This needs to be confirmed by future prospective clinical trials.
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Affiliation(s)
- Yu Xu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), Sichuan University, Chengdu, China.,West China Medical Center, Sichuan University, Chengdu, China
| | - Juan Shen
- Department of Obstetrics and Gynecology, Mianyang Central Hospital, Mianyang, China
| | - Qianwen Zhang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), Sichuan University, Chengdu, China
| | - Yuedong He
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Laboratory of Birth Defects and Related Diseases of Women and Children (Ministry of Education), Sichuan University, Chengdu, China
| | - Cheng Chen
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Yong Tian
- Department of Obstetrics and Gynecology, Enshi Clinical College of Wuhan University, Enshi, China
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Donkers H, Bekkers R, Massuger L, Galaal K. Socioeconomic deprivation and survival in endometrial cancer: The effect of BMI. Gynecol Oncol 2019; 156:178-184. [PMID: 31759773 DOI: 10.1016/j.ygyno.2019.10.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/27/2019] [Accepted: 10/28/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES METHODS: This is a retrospective study of surgically managed endometrial cancer patients in the Royal Cornwall Hospital Truro between January 2006 and August 2017. Patient characteristics, overall survival, recurrence free survival and intra- and postoperative outcomes were evaluated across socioeconomic deprivation groups in which socioeconomic deprivation was measured with the English Indices of Multiple Deprivation (IMD). RESULTS In total, we identified 831 women, of which 690 were included. The median age was 66 years with a median BMI of 31 and the majority of tumours were endometrioid tumours (80.1%). For type 1 (endometrioid) tumours, better survival was seen in the least deprived patients, however this was not significant in a multivariate analysis and only age, stage and BMI remained significant. For type 2 (all other) tumours, no association between survival and socioeconomic deprivation was found and only stage was significant. However, more affluent patients had significantly higher recurrence rates. In addition, we did not find evidence of an association between intra- or post-operative complication rates and socioeconomic deprivation. CONCLUSION Socioeconomic deprivation is associated with survival in endometrial cancer patients, however after adjusting for confounders this association does not remain. Only age, stage and BMI are independent prognostic factors for survival. In addition, there is no evidence of association between socioeconomic deprivation and peri-operative outcomes in endometrial cancer patients.
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Affiliation(s)
- H Donkers
- Royal Cornwall Hospital NHS Trust, Truro, Cornwall, United Kingdom
| | - R Bekkers
- Radboud UMC, Nijmegen, the Netherlands; Catharina Hospital, Eindhoven, the Netherlands
| | | | - K Galaal
- Royal Cornwall Hospital NHS Trust, Truro, Cornwall, United Kingdom; University of Exeter, Exeter, United Kingdom.
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Donkers H, Bekkers R, Massuger L, Galaal K. Systematic review on socioeconomic deprivation and survival in endometrial cancer. Cancer Causes Control 2019; 30:1013-1022. [DOI: 10.1007/s10552-019-01202-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/25/2019] [Indexed: 01/19/2023]
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Challenges of Robotic Gynecologic Surgery in Morbidly Obese Patients and How to Optimize Success. Curr Pain Headache Rep 2019; 23:51. [DOI: 10.1007/s11916-019-0788-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Jørgensen SL, Mogensen O, Wu C, Lund K, Iachina M, Korsholm M, Jensen PT. Nationwide Introduction of Minimally Invasive Robotic Surgery for Early-Stage Endometrial Cancer and Its Association With Severe Complications. JAMA Surg 2019; 154:530-538. [PMID: 30810740 PMCID: PMC6584253 DOI: 10.1001/jamasurg.2018.5840] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 11/23/2018] [Indexed: 01/11/2023]
Abstract
Importance Minimally invasive laparoscopic surgery (MILS) for endometrial cancer reduces surgical morbidity compared with a total abdominal hysterectomy. However, only a minority of women with early-stage endometrial cancer undergo MILS. Objective To evaluate the association between the Danish nationwide introduction of minimally invasive robotic surgery (MIRS) and severe complications in patients with early-stage endometrial cancer. Design, Setting, and Participants In this nationwide prospective cohort study of 5654 women with early-stage endometrial cancer who had undergone surgery during the period from January 1, 2005, to June 30, 2015, data from the Danish Gynecological Cancer Database were linked with national registers on socioeconomic status, deaths, hospital diagnoses, and hospital treatments. The women were divided into 2 groups; group 1 underwent surgery before the introduction of MIRS in their region, and group 2 underwent surgery after the introduction of MIRS. Women with an unknown disease stage, an unknown association with MIRS implementation, unknown histologic findings, sarcoma, or synchronous cancer were excluded, as were women who underwent vaginal or an unknown surgical type of hysterectomy. Statistical analysis was conducted from February 2, 2017, to May 4, 2018. Exposure Minimally invasive robotic surgery, MILS, or total abdominal hysterectomy. Main Outcomes and Measures Severe complications were dichotomized and encompassed death within 30 days after surgery and intraoperative and postoperative complications diagnosed within 90 days after surgery. Results A total of 3091 women (mean [SD] age, 67 [10] years) were allocated to group 1, and a total of 2563 women (mean [SD] age, 68 [10] years) were allocated to group 2. In multivariate logistic regression analyses, the odds of severe complications were significantly higher in group 1 than in group 2 (odds ratio [OR], 1.39; 95% CI, 1.11-1.74). The proportion of women undergoing MILS was 14.1% (n = 436) in group 1 and 22.2% in group 2 (n = 569). The proportion of women undergoing MIRS in group 2 was 50.0% (n = 1282). In group 2, multivariate logistic regression analyses demonstrated that a total abdominal hysterectomy was associated with increased odds of severe complications compared with MILS (OR, 2.58; 95% CI, 1.80-3.70) and MIRS (OR, 3.87; 95% CI, 2.52-5.93). No difference was found for MILS compared with MIRS (OR, 1.50; 95% CI, 0.99-2.27). Conclusions and Relevance The national introduction of MIRS changed the surgical approach for early-stage endometrial cancer from open surgery to minimally invasive surgery. This change in surgical approach was associated with a significantly reduced risk of severe complications.
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Affiliation(s)
- Siv Lykke Jørgensen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- Faculty of Health Sciences, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Ole Mogensen
- Faculty of Health Sciences, Clinical Institute, University of Southern Denmark, Odense, Denmark
- Department of Pelvic Cancer, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Chunsen Wu
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Faculty of Health Sciences, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Ken Lund
- Centre for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Maria Iachina
- Centre for Clinical Epidemiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Malene Korsholm
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- Faculty of Health Sciences, Clinical Institute, University of Southern Denmark, Odense, Denmark
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Pernille Tine Jensen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Faculty of Health Sciences, Clinical Institute, University of Southern Denmark, Odense, Denmark
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Disease-Free and Survival Outcomes for Total Laparoscopic Hysterectomy Compared With Total Abdominal Hysterectomy in Early-Stage Endometrial Carcinoma: A Meta-analysis. Int J Gynecol Cancer 2019; 28:529-538. [PMID: 29369119 DOI: 10.1097/igc.0000000000001199] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Laparoscopic hysterectomy is currently offered to a large number of patients, and assessing the noninferiority to abdominal hysterectomy with respect to clinical outcomes is key. We examine rates of recurrence, disease-free survival (DFS), and overall survival, and surgical complications of laparoscopic compared with abdominal hysterectomy for the treatment of early-stage endometrial cancer. METHODS Electronic databases were systematically searched to identify relevant studies, and patient characteristics and clinical outcomes extracted. The primary outcome was 3-year DFS, and estimates were pooled using an inverse-variance weighted meta-analysis. RESULTS Nine studies (4405 patients) were identified in which DFS was reported in 5 studies. The difference in 3-year DFS was 1.44% (95% confidence interval [CI], -0.65% to 3.53%) in favor of total abdominal hysterectomy, consistent with a noninferiority margin of 5%. Differences in DFS (hazard ratio, 1.10; 95% CI, 0.92-1.32), overall survival (hazard ratio, 1.16; 95% CI, 0.81-1.66), and local recurrence (difference, 0.42%; 95% CI, -0.41% to 1.25%) were not significant. Rates of intraoperative complications showed no difference (0.5%; 95% CI, -1.1% to 2.0%) based on 7 studies. There was a significant reduction in postoperative complications with the laparoscopic procedure (-6.83%; 95% CI, -9.19% to -4.47%). CONCLUSIONS Noninferiority of laparoscopy was demonstrated on clinical outcomes and was associated with a reduction in postoperative complications. These results support continued treatment by laparoscopic hysterectomy for early-stage endometrial cancer.
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Galaal K, Donkers H, Bryant A, Lopes AD. Laparoscopy versus laparotomy for the management of early stage endometrial cancer. Cochrane Database Syst Rev 2018; 10:CD006655. [PMID: 30379327 PMCID: PMC6517108 DOI: 10.1002/14651858.cd006655.pub3] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND This is an update of a previous Cochrane Review published in 2012, Issue 9.Surgery for endometrial cancer (hysterectomy with removal of both fallopian tubes and ovaries) is performed through laparotomy. It has been suggested that the laparoscopic approach is associated with a reduction in operative morbidity. Over the last two decades there has been a steady increase of the use of laparoscopy for endometrial cancer. This review investigated the evidence of benefits and harms of laparoscopic surgery compared with laparotomy for presumed early stage endometrial cancer. OBJECTIVES To compare overall survival (OS) and disease free survival (DFS) for laparoscopic surgery versus laparotomy in women with presumed early stage endometrial cancer. SEARCH METHODS For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 5) in the Cochrane Library, MEDLINE via Ovid (April 2012 to June 2018) and Embase via Ovid (April 2012 to June 2018). We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of included studies. The trial registers included NHMRC Clinical Trials Register, UKCCCR Register of Cancer Trials, Meta-Register and Physician Data Query Protocol. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing laparoscopy and laparotomy for early stage endometrial cancer. DATA COLLECTION AND ANALYSIS We independently abstracted data and assessed risk of bias. We used hazard ratios (HRs) for OS and recurrence free survival (RFS), risk ratios (RR) for severe adverse events and mean differences (MD) for continuous outcomes in women who received laparoscopy or laparotomy with 9% confidence intervals (CI). These were pooled in random-effects meta-analyses. MAIN RESULTS We identified one new study in this update of the review. The review contains nine RCTs comparing laparoscopy with laparotomy for the surgical management of early stage endometrial cancer.All nine studies met the inclusion criteria and assessed 4389 women at the end of the studies. Six studies assessing 3993 participants with early stage endometrial cancer found no significant difference in the risk of death between women who underwent laparoscopy and women who underwent laparotomy (HR 1.04, 95% 0.86 to 1.25; moderate-certainty evidence) and five studies assessing 3710 participants found no significant difference in the risk of recurrence between the laparoscopy and laparotomy groups (HR 1.14, 95% CI 0.90 to 1.43; moderate-certainty evidence). There was no significant difference in the rate of perioperative death; women requiring a blood transfusion; and bladder, ureteric, bowel and vascular injury. However, one meta-analysis of three studies found that women in the laparoscopy group lost significantly less blood than women in the laparotomy group (MD -106.82 mL, 95% CI -141.59 to -72.06; low-certainty evidence). A further meta-analysis of two studies, which assessed 3344 women and included one very large trial of over 2500 participants, found that there was no clinical difference in the risk of severe postoperative complications in women in the laparoscopy and laparotomy groups (RR 0.78, 95% CI 0.44 to 1.38). Most studies were at moderate risk of bias. All nine studies reported hospital stay and results showed that on average, laparoscopy was associated with a significantly shorter hospital stay. AUTHORS' CONCLUSIONS This review found low to moderate-certainty evidence to support the role of laparoscopy for the management of early endometrial cancer. For presumed early stage primary endometrioid adenocarcinoma of the endometrium, laparoscopy is associated with similar OS and DFS. Furthermore, laparoscopy is associated with reduced operative morbidity and hospital stay. There is no significant difference in severe postoperative morbidity between the two modalities.The certainty of evidence for OS and RFS was moderate and was downgraded for unclear risk of bias profiles and imprecision in effect estimates. However, most studies used adequate methods of sequence generation and concealment of allocation so studies were not prone to selection bias. Adverse event outcomes were downgraded for the same reasons and additionally for low event rates and low power thus these outcomes provided low-certainty evidence.
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Affiliation(s)
- Khadra Galaal
- Princess Alexandra Wing, Royal Cornwall HospitalGynaecological OncologyTruroUKTR1 3LJ
| | - Hannah Donkers
- Princess Alexandra Wing, Royal Cornwall HospitalGynaecological OncologyTruroUKTR1 3LJ
| | - Andrew Bryant
- Newcastle UniversityInstitute of Health & SocietyMedical School New BuildRichardson RoadNewcastle upon TyneUKNE2 4AX
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Wang YR, Lu HF, Huo HC, Qu CP, Sun GX, Shao SQ. A network meta-analysis of comparison of operative time and complications of laparoscopy, laparotomy, and laparoscopic-assisted vaginal hysterectomy for endometrial carcinoma. Medicine (Baltimore) 2018; 97:e0474. [PMID: 29703003 PMCID: PMC5944470 DOI: 10.1097/md.0000000000010474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The endometrial carcinoma (EC) is the most frequently occurring female genital cancer. The authors performed this network meta-analysis to compare operative time and the incidence of bowel injury and wound infection of 3 operative approaches (laparoscopy, laparotomy, and laparoscopic-assisted vaginal hysterectomy [LAVH]) in the treatment of EC. METHODS The Cochrane Library, PubMed, and Embase databases were searched. Randomized controlled trials (RCTs) for EC from the day of databases establishment to February 2017 were included. Direct and indirect evidences were combined to calculate the combined weighted mean difference (WMD) or odd ratio values and the surface under the cumulative ranking curve (SUCRA) value of 3 operative approaches in the treatment of EC. RESULTS A total of 9 qualified RCTs were included into the study. The results showed that laparotomy had a shorter-operative time than LAVH (WMD = -40.36, 95% confidence interval = -75.03 to -2.57). However, there was no significant difference in the incidence of bowel injury and wound infection among 3 operative approaches. Besides, the SUCRA values indicated that laparotomy had the shortest operative time but the incidence of bowel injury and wound infection was relatively higher. CONCLUSION The results from this study indicate that laparotomy had highest incidence of bowel injury and wound infection but shortest operative time among 3 operative approaches in the treatment of EC.
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Lindqvist E, Wedin M, Fredrikson M, Kjølhede P. Lymphedema after treatment for endometrial cancer − A review of prevalence and risk factors. Eur J Obstet Gynecol Reprod Biol 2017; 211:112-121. [DOI: 10.1016/j.ejogrb.2017.02.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 01/19/2017] [Accepted: 02/17/2017] [Indexed: 11/16/2022]
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Tozzi R, Gubbala K, Majd HS, Campanile RG. Interval Laparoscopic En-Bloc Resection of the Pelvis (L-EnBRP) in patients with stage IIIC-IV ovarian cancer: Description of the technique and surgical outcomes. Gynecol Oncol 2016; 142:477-83. [PMID: 27450637 DOI: 10.1016/j.ygyno.2016.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/30/2016] [Accepted: 07/03/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To describe the technique and evaluate the feasibility, efficacy and morbidity of the Laparoscopic En-Bloc Resection of the Pelvis (L-EnBRP) during Visceral-Peritoneal Debulking (VPD) at time of interval surgery. METHODS This report is part of a prospective non randomized study (service evaluation protocol) on the feasibility and safety of laparoscopy in patients with stage IIIC-IV ovarian cancer and gross residual disease following neoadjuvant chemotherapy. Primary endpoints of this part of the study were the feasibility (rate of patients in whom the surgery could be completed by laparoscopy), efficacy (rate of patients ended with a complete resection) and morbidity (number of patients that suffered complications specifically associated to the procedure) of L-EnBRP. The results were compared between patients in group 1 (L-EnBRP+L-VPD), group 2 (L-EnBRP+VPD) and group 3 (VPD). RESULTS Eighteen patients were in group 1, 8 in group 2 and 32 in group 3. Feasibility of L-EnBRP was 45% (26 patients out of 58), efficacy was 100% of the pelvic disease (94.4% overall disease) and morbidity was 5.5%. Main cause for conversion to laparotomy was high tumor load on diaphragm and/or mesentery. All but one patient had a complete resection (CR) of the disease. Group 1 patients had significantly earlier hospital discharge, lower blood loss and reduced overall morbidity than group 2 and 3. CONCLUSION L-EnBRP was feasible in almost half of the patients. In these patients a CR was achieved with a low morbidity rate. The latter was significantly decreased when compared to the patients who had a laparotomy.
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Affiliation(s)
- Roberto Tozzi
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK.
| | - Kumar Gubbala
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK
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Early endometrial carcinoma therapy in morbid obesity: A retrospective study comparing open and laparoscopic. Int J Surg 2016; 30:31-4. [PMID: 27102329 DOI: 10.1016/j.ijsu.2016.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 03/27/2016] [Accepted: 04/08/2016] [Indexed: 11/21/2022]
Abstract
OBJECT The present study sought to explore the therapeutic outcome of laparoscopic surgery for the endometrial cancer patients with morbidly obese in china. METHODS The morbidly obese patients with clinical stage I or II endometrial cancer received laparoscopic surgery (LS) at the Obstetrics and Gynecology centers of PLA general hospital between November 2012 and November 2014. The clinical outcomes of these surgeries were compared with a historical cohort of similar morbidly obese patients who had received the open surgery (OS). In the present study, the morbidly obesity was defined as the body mass index was bigger than 40 kg/m(2). The basic characteristics of the involved patients, the therapeutic effects of the surgery, as well as the incidence of perioperative complications were systematically compared between the two groups. RESULTS Totally 120 patients were included in the present study (respectively 60 patients in the LS group and the OS group). There was no statistical difference between the LS group and the OS group in terms of patient age or BMI. However, the incidence of intraoperative complication in the LS group was significantly lower than that in the OS group (5.0% vs. 16.7%; P = 0.04. Moreover, the incidence of postoperative complication in the OS group was higher than that in the LS group (20.0% vs.6.7%; P = 0.03). The length of hospital stay in the LS group was longer than that in the OS group (6 vs.11 days; P = 0.02). Furthermore, the rates of (pelvic) lymph node dissection and para-aortic node dissection in the LS group were not significantly different from the OS group. CONCLUSION LS is verified to be a safe and rational therapeutic strategy for the endometrial cancer patients with morbidly obese. The incidence of perioperative complications is significantly lower in comparison with the OS.
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Chu LH, Chang WC, Sheu BC. Comparison of the laparoscopic versus conventional open method for surgical staging of endometrial carcinoma. Taiwan J Obstet Gynecol 2016; 55:188-92. [DOI: 10.1016/j.tjog.2016.02.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2015] [Indexed: 10/21/2022] Open
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Guy MS, Sheeder J, Behbakht K, Wright JD, Guntupalli SR. Comparative outcomes in older and younger women undergoing laparotomy or robotic surgical staging for endometrial cancer. Am J Obstet Gynecol 2016; 214:350.e1-350.e10. [PMID: 26433173 DOI: 10.1016/j.ajog.2015.09.085] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 09/15/2015] [Accepted: 09/23/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Older patients are at increased risk of perioperative morbidity and mortality. There are limited data on the safety of a robotic approach in the staging for endometrial cancer. OBJECTIVE We compared outcomes in women undergoing laparotomy or robotic surgical staging for endometrial cancer. STUDY DESIGN Using the Healthcare Cost and Utilization Project National Inpatient Sample database from 2008 through 2010, we abstracted records for patients who had surgery for endometrial cancer with either a robotic approach or laparotomy. Patients were categorized by age (<65 vs ≥65 years and 5-year increments). Medical comorbidity scores were calculated using the Charlson Comorbidity Index. Outcomes included intraoperative/perioperative/medical complications, death, length of stay (LOS), and discharge disposition. Student t and χ(2) tests were used to compare groups and approach. Multiple analysis of variance models were used to compare differences between robotics and laparotomy and age groups. RESULTS We identified 16,980 patients who had surgery for endometrial cancer with either a robotic approach (age ≥65 years, n = 1228; age <65 years, n = 1574) or laparotomy (age ≥65 years, n = 5914; age <65 years, n = 8264). Older patients had a higher Charlson Comorbidity Index score at the time of surgery (2.6 vs 2.5, P < .001). In laparotomy cases, intraoperative complication rates were similar (4.1% vs 3.7%, P = .17). Older patients had higher rates of perioperative surgical (20.5% vs 15.4%, P < .001) and medical (23.3% vs 15.5%, P < .001) complications, longer LOS (5.1 vs 4.2 days, P < .001), and lower rates of discharge to home (71.2% vs 90.1%, P < .001). In robotic cases, rates of intraoperative complications were similar (5.9% vs 6.8%, P = .32). Older patients had higher rates of perioperative surgical (8.3% vs 5.2%, P = .001) and medical (12.3% vs 6.7%, P = .001) complications, longer LOS (2.00 vs 1.67 days, P < .001), and lower rates of discharge to home (88.8% vs 96.8%, P < .001). With both approaches, as age increased, perioperative surgical and medical complications also increased in a linear fashion. In a subanalysis of older patients (n = 7142), there were lower rates of perioperative surgical (8.3% vs 20.5%, P < .001) and medical (12.3% vs 23.3%, P < .001) complications, death (0.0% vs 0.8%, P < .001), shorter LOS (2.00 vs 5.13 days, P < .001) and higher rate of discharge to home (88.8% vs 71.2%, P < .001) in robotic compared to laparotomy cases. CONCLUSION Although the risks of surgery increase with age, in patients age ≥65 years, a robotic approach for endometrial cancer appears to be safe given current selection criteria utilized in the United States.
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Affiliation(s)
- Michael S Guy
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO.
| | - Jeanelle Sheeder
- Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO
| | - Kian Behbakht
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Saketh R Guntupalli
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO
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Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J, Marth C, Nout R, Querleu D, Mirza MR, Sessa C. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow-up. Int J Gynecol Cancer 2016; 26:2-30. [PMID: 26645990 PMCID: PMC4679344 DOI: 10.1097/igc.0000000000000609] [Citation(s) in RCA: 426] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The first joint European Society for Medical Oncology (ESMO), European SocieTy for Radiotherapy & Oncology (ESTRO) and European Society of Gynaecological Oncology (ESGO) consensus conference on endometrial cancer was held on 11-13 December 2014 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of endometrial cancer. Before the conference, the expert panel prepared three clinically-relevant questions about endometrial cancer relating to the following four areas: prevention and screening, surgery, adjuvant treatment and advanced and recurrent disease. All relevant scientific literature, as identified by the experts, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. Results of this consensus conference, together with a summary of evidence supporting each recommendation, are detailed in this article. All participants have approved this final article.
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Affiliation(s)
- Nicoletta Colombo
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Carien Creutzberg
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Frederic Amant
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Tjalling Bosse
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Antonio González-Martín
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Jonathan Ledermann
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Christian Marth
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Remi Nout
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Denis Querleu
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Mansoor Raza Mirza
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Cristiana Sessa
- *Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy; †Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; ‡Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium and Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam, The Netherlands; §Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; ∥Medical Oncology Department, GEICO and MD Anderson Cancer Center, Madrid, Spain; ¶Department of Oncology and Cancer Trials, UCL Cancer Institute, London, United Kingdom; #Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria; **Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands; ††Department of Surgery, Institut Bergonié, Bordeaux, France and Gynecology and Obstetrics Department, McGill University Health Centre, Montreal, Quebec, Canada; ‡‡Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; and §§Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
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Colombo N, Creutzberg C, Amant F, Bosse T, González-Martín A, Ledermann J, Marth C, Nout R, Querleu D, Mirza MR, Sessa C, Altundag O, Amant F, van Leeuwenhoek A, Banerjee S, Bosse T, Casado A, de Agustín L, Cibula D, Colombo N, Creutzberg C, del Campo JM, Emons G, Goffin F, González-Martín A, Greggi S, Haie-Meder C, Katsaros D, Kesic V, Kurzeder C, Lax S, Lécuru F, Ledermann J, Levy T, Lorusso D, Mäenpää J, Marth C, Matias-Guiu X, Morice P, Nijman H, Nout R, Powell M, Querleu D, Mirza M, Reed N, Rodolakis A, Salvesen H, Sehouli J, Sessa C, Taylor A, Westermann A, Zeimet A. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: diagnosis, treatment and follow-up. Ann Oncol 2015; 27:16-41. [PMID: 26634381 DOI: 10.1093/annonc/mdv484] [Citation(s) in RCA: 708] [Impact Index Per Article: 78.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/05/2015] [Indexed: 12/27/2022] Open
Abstract
The first joint European Society for Medical Oncology (ESMO), European SocieTy for Radiotherapy & Oncology (ESTRO) and European Society of Gynaecological Oncology (ESGO) consensus conference on endometrial cancer was held on 11-13 December 2014 in Milan, Italy, and comprised a multidisciplinary panel of 40 leading experts in the management of endometrial cancer. Before the conference, the expert panel prepared three clinically relevant questions about endometrial cancer relating to the following four areas: prevention and screening, surgery, adjuvant treatment and advanced and recurrent disease. All relevant scientific literature, as identified by the experts, was reviewed in advance. During the consensus conference, the panel developed recommendations for each specific question and a consensus was reached. Results of this consensus conference, together with a summary of evidence supporting each recommendation, are detailed in this article. All participants have approved this final article.
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Affiliation(s)
- N Colombo
- Division of Medical Gynecologic Oncology, European Institute of Oncology and University of Milan-Bicocca, Milan, Italy
| | - C Creutzberg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - F Amant
- Department of Gynecological Oncology, University Hospital Leuven, Leuven, Belgium Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek, Amsterdam
| | - T Bosse
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - A González-Martín
- Department of Medical Oncology, GEICO Cancer Center, Madrid Department of Medical Oncology, MD Anderson Cancer Center, Madrid, Spain
| | - J Ledermann
- Department of Oncology and Cancer Trials, UCL Cancer Institute, London, UK
| | - C Marth
- Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Austria
| | - R Nout
- Department of Radiotherapy, Leiden University Medical Center, Leiden, The Netherlands
| | - D Querleu
- Department of Surgery, Institut Bergonié, Bordeaux, France Department of Gynecology and Obstetrics, McGill University Health Centre, Montreal, Canada
| | - M R Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - C Sessa
- Department of Medical Oncology, Oncology Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
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ESMO–ESGO–ESTRO consensus conference on endometrial cancer: Diagnosis, treatment and follow-up. Radiother Oncol 2015; 117:559-81. [DOI: 10.1016/j.radonc.2015.11.013] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 11/18/2015] [Indexed: 12/13/2022]
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Bige Ö, Demir A, Saatli B, Koyuncuoğlu M, Saygılı U. Laparoscopy versus laparotomy for the management of endometrial carcinoma in morbidly obese patients: a prospective study. J Turk Ger Gynecol Assoc 2015; 16:164-9. [PMID: 26401110 DOI: 10.5152/jtgga.2015.15128] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/19/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare the results of total laparoscopic hysterectomy and total abdominal hysterectomy in morbidly obese women with early stage endometrial cancer. MATERIAL AND METHODS This prospective study was conducted on 140 morbidly obese women with body mass indices ≥35 kg/m(2) and presenting with clinical stage 1 endometrial cancer. The patients underwent total laparoscopic hysterectomy (n=70) or total abdominal hysterectomy (n=70), bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and peritoneal washing. Age, parity, menopausal status, weight, height, medical problems, history of previous laparotomy, surgical procedure, operative time, estimated amount of blood loss, preoperative hematocrit, postoperative hematocrit, operative complications, conversion to laparotomy, need for intraoperative or postoperative blood transfusion, intraoperative and postoperative complications, secondary surgery, tumor stage, grade, histology, number of recovered lymph nodes, and visual pain scores of the patients were recorded. RESULTS Postoperative complications were significantly higher in the laparotomy group. Hospital stay in the laparoscopy group was significantly lower than that in the laparotomy group. The visual pain scores were significantly higher in the laparotomy group on the first, second, and third postoperative days and on the day of discharge from the hospital. Resuming activity took a significantly longer time in the laparotomy group (34.70 days) than in the laparoscopic group (17.89 days). CONCLUSION With the availability of skilled endoscopic surgeons, most obese women with early stage endometrial cancer can be safely managed by performing laparoscopy with an excellent surgical outcome, shorter hospitalization, less postoperative pain, and faster resumption of full activity.
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Affiliation(s)
- Özgür Bige
- Department of Obstetrics and Gynecology, Tekirdağ Star Medica Hospital, Tekirdağ, Turkey
| | - Ahmet Demir
- Clinic of Obstetrics and Gynecology, Elazığ Training and Research Hospital, Elazığ, Turkey
| | - Bahadır Saatli
- Department of Obstetrics and Gynecology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Meral Koyuncuoğlu
- Department of Pathology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Uğur Saygılı
- Department of Obstetrics and Gynecology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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Nougaret S, Reinhold C, Alsharif SS, Addley H, Arceneau J, Molinari N, Guiu B, Sala E. Endometrial Cancer: Combined MR Volumetry and Diffusion-weighted Imaging for Assessment of Myometrial and Lymphovascular Invasion and Tumor Grade. Radiology 2015; 276:797-808. [PMID: 25928157 DOI: 10.1148/radiol.15141212] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate magnetic resonance (MR) volumetry of endometrial tumors and its association with deep myometrial invasion, tumor grade, and lymphovascular invasion and to assess the value of apparent diffusion coefficient (ADC) histographic analysis of the whole tumor volume for prediction of tumor grade and lymphovascular invasion. MATERIALS AND METHODS The institutional review board approved this retrospective study; patient consent was not required. Between May 2010 and May 2012, 70 women (mean age, 64 years; range, 24-91 years) with endometrial cancer underwent preoperative MR imaging, including axial oblique and sagittal T2-weighted, dynamic contrast material-enhanced, and diffusion-weighted imaging. Volumetry of the tumor and uterus was performed during the six sequences, with manual tracing of each section, and the tumor volume ratio (TVR) was calculated. ADC histograms were generated from pixel ADCs from the whole tumor volume. The threshold of TVR associated with myometrial invasion was assessed by using receiver operating characteristic curves. An independent sample Mann Whitney U test was used to compare differences in ADCs, skewness, and kurtosis between tumor grade and the presence of lymphovascular invasion. RESULTS No significant difference in tumor volume and TVR was found among the six MR imaging sequences (P = .95 and .86, respectively). A TVR greater than or equal to 25% allowed prediction of deep myometrial invasion with sensitivity of 100% and specificity of 93% (area under the curve, 0.96; 95% confidence interval: 0.86, 0.99) at axial oblique diffusion-weighted imaging. A TVR of greater than or equal to 25% was associated with grade 3 tumors (P = .0007) and with lymphovascular invasion (P < .0001). There was no significant difference in the ADCs between grades 1 and 2 tumors (P > .05). The minimum, 10th, 25th, 50th, 75th, and 90th percentile ADCs were significantly lower in grade 3 tumors than in grades 1 and 2 tumors (P < .02). CONCLUSION The combination of whole tumor volume and ADC can be used for prediction of tumor grade, lymphovascular invasion, and depth of myometrial invasion.
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Affiliation(s)
- Stephanie Nougaret
- From the Departments of Imaging (S.N., B.G.) and Statistics, UMR 1046 (N.M.), CHU Montpellier, St Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France; Departments of Radiology (C.R., S.S.A., H.A.) and Pathology (J.A.), McGill University Health Center, Montreal, QC, Canada; and Department of Gynecologic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (E.S.)
| | - Caroline Reinhold
- From the Departments of Imaging (S.N., B.G.) and Statistics, UMR 1046 (N.M.), CHU Montpellier, St Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France; Departments of Radiology (C.R., S.S.A., H.A.) and Pathology (J.A.), McGill University Health Center, Montreal, QC, Canada; and Department of Gynecologic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (E.S.)
| | - Shaza S Alsharif
- From the Departments of Imaging (S.N., B.G.) and Statistics, UMR 1046 (N.M.), CHU Montpellier, St Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France; Departments of Radiology (C.R., S.S.A., H.A.) and Pathology (J.A.), McGill University Health Center, Montreal, QC, Canada; and Department of Gynecologic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (E.S.)
| | - Helen Addley
- From the Departments of Imaging (S.N., B.G.) and Statistics, UMR 1046 (N.M.), CHU Montpellier, St Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France; Departments of Radiology (C.R., S.S.A., H.A.) and Pathology (J.A.), McGill University Health Center, Montreal, QC, Canada; and Department of Gynecologic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (E.S.)
| | - Jocelyne Arceneau
- From the Departments of Imaging (S.N., B.G.) and Statistics, UMR 1046 (N.M.), CHU Montpellier, St Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France; Departments of Radiology (C.R., S.S.A., H.A.) and Pathology (J.A.), McGill University Health Center, Montreal, QC, Canada; and Department of Gynecologic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (E.S.)
| | - Nicolas Molinari
- From the Departments of Imaging (S.N., B.G.) and Statistics, UMR 1046 (N.M.), CHU Montpellier, St Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France; Departments of Radiology (C.R., S.S.A., H.A.) and Pathology (J.A.), McGill University Health Center, Montreal, QC, Canada; and Department of Gynecologic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (E.S.)
| | - Boris Guiu
- From the Departments of Imaging (S.N., B.G.) and Statistics, UMR 1046 (N.M.), CHU Montpellier, St Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France; Departments of Radiology (C.R., S.S.A., H.A.) and Pathology (J.A.), McGill University Health Center, Montreal, QC, Canada; and Department of Gynecologic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (E.S.)
| | - Evis Sala
- From the Departments of Imaging (S.N., B.G.) and Statistics, UMR 1046 (N.M.), CHU Montpellier, St Eloi Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France; Departments of Radiology (C.R., S.S.A., H.A.) and Pathology (J.A.), McGill University Health Center, Montreal, QC, Canada; and Department of Gynecologic Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (E.S.)
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Karabagli P, Ugras S, Yilmaz BS, Celik C. The evaluation of reliability and contribution of frozen section pathology to staging endometrioid adenocarcinomas. Arch Gynecol Obstet 2015; 292:391-7. [PMID: 25608758 DOI: 10.1007/s00404-015-3621-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 01/12/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the reliability and accuracy of intraoperative pathological findings, compared to permanent section (PS) and to understand contributions of frozen section (FS) to final staging in patients with endometrioid carcinomas. METHODS This is a retrospective analysis of 79 patients undergoing intraoperative FS and with endometrioid adenocarcinomas. Intraoperative pathological findings were compared with final results as to grade, depth of myometrial invasion (MI), cervical involvement, lymphovascular space invasion (LVSI) and stage. We also analyzed whether staging procedures like pelvic or para-aortic lymph node metastasis, peritoneal cytology and extension beyond of uterus were related to FS findings. Staging was based on the FIGO 2009. RESULTS FS results were agreement in 89.9 % for grade, 88.6 % for depth of MI, 100 % for cervical invasion, and 92.4 % for LVSI, compared with PS. On FS, 12, 16.6 and 44.4 % of specimens in stages of IA, IB and II became upstaged in final pathology, respectively. Of 79 cases, 5 (6.3 %) were upstaged to IIIC1, and 3 (3.8 %) were upstaged to IIIC2 because of lymph node metastasis. A significant relationship was detected between lymph node metastasis, and FS grades (p = 0.001), LVSI (p = 0.000), cervical invasion (p = 0.006) and MI (p = 0.001). CONCLUSION We consider that intraoperative FS is a useful procedure to identify poor prognostic pathological factors. While grading, depth of MI, cervical stromal invasion and LVSI on FS are significant in predicting lymph node metastasis, the existence of cervical stromal invasion and LVSI should be considered more effective parameters in the identification of metastatic endometrial cancer risks.
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Affiliation(s)
- Pinar Karabagli
- Department of Pathology, Medical School of Selcuk University, Alaeddin Keykubad Campus, 42075, Selcuklu, Konya, Turkey,
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Tratamiento laparoscópico del cáncer de endometrio. Experiencia institucional. GACETA MEXICANA DE ONCOLOGÍA 2015. [DOI: 10.1016/j.gamo.2015.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Sudo S, Hattori N, Manabe O, Kato F, Mimura R, Magota K, Sugimori H, Hirata K, Sakuragi N, Tamaki N. FDG PET/CT diagnostic criteria may need adjustment based on MRI to estimate the presurgical risk of extrapelvic infiltration in patients with uterine endometrial cancer. Eur J Nucl Med Mol Imaging 2014; 42:676-84. [DOI: 10.1007/s00259-014-2964-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 11/25/2014] [Indexed: 12/21/2022]
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25
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Minimally invasive surgery for gynecological cancers: Experience of one institution. Gynecol Minim Invasive Ther 2014. [DOI: 10.1016/j.gmit.2014.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Falcone F, Balbi G, Di Martino L, Grauso F, Salzillo ME, Messalli EM. Surgical management of early endometrial cancer: an update and proposal of a therapeutic algorithm. Med Sci Monit 2014; 20:1298-313. [PMID: 25063051 PMCID: PMC4136932 DOI: 10.12659/msm.890478] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In the last few years technical improvements have produced a dramatic shift from traditional open surgery towards a minimally invasive approach for the management of early endometrial cancer. Advancement in minimally invasive surgical approaches has allowed extensive staging procedures to be performed with significantly reduced patient morbidity. Debate is ongoing regarding the choice of a minimally invasive approach that has the most effective benefit for the patients, the surgeon, and the healthcare system as a whole. Surgical treatment of women with presumed early endometrial cancer should take into account the features of endometrial disease and the general surgical risk of the patient. Women with endometrial cancer are often aged, obese, and with cardiovascular and metabolic comorbidities that increase the risk of peri-operative complications, so it is important to tailor the extent and the radicalness of surgery in order to decrease morbidity and mortality potentially derivable from unnecessary procedures. In this regard women with negative nodes derive no benefit from unnecessary lymphadenectomy, but may develop short- and long-term morbidity related to this procedure. Preoperative and intraoperative techniques could be critical tools for tailoring the extent and the radicalness of surgery in the management of women with presumed early endometrial cancer. In this review we will discuss updates in surgical management of early endometrial cancer and also the role of preoperative and intraoperative evaluation of lymph node status in influencing surgical options, with the aim of proposing a management algorithm based on the literature and our experience.
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Affiliation(s)
- Francesca Falcone
- Department of Woman, Child, and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Giancarlo Balbi
- Department of Woman, Child, and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Luca Di Martino
- Department of Woman, Child, and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Flavio Grauso
- Department of Woman, Child, and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Maria Elena Salzillo
- Department of Woman, Child, and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Enrico Michelino Messalli
- Department of Woman, Child and of General and Special Surgery, Second University of Naples, Naples, Italy
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Fischerova D, Frühauf F, Zikan M, Pinkavova I, Kocián R, Dundr P, Nemejcova K, Dusek L, Cibula D. Factors affecting sonographic preoperative local staging of endometrial cancer. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 43:575-585. [PMID: 24281994 DOI: 10.1002/uog.13248] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 10/02/2013] [Accepted: 10/25/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To identify major factors in the under- and overestimation of cervical and myometrial invasion by endometrial cancer at preoperative staging by ultrasound. METHODS This prospective study involved all patients with histologically confirmed endometrial cancer referred consecutively for surgical staging between January 2009 and December 2011. All patients underwent transvaginal ultrasound examination, obtaining metric and perfusion data, and the results were compared with final histology: myometrial invasion was defined at histology in the final pathology report as being either < or ≥ 50%, while cervical stromal invasion was reported as being either present or absent, and sonographic over-/underestimation was determined relative to these. RESULTS Enrolled prospectively into the study were 210 patients. The proportion of cases with sonographic underestimation, relative to final histology, of myometrial invasion (i.e. false-negative estimation of no or superficial invasion < 50%) and of cervical invasion (i.e. false-negative finding of absence of stromal invasion) was comparable: 8.6% (n = 18) and 10.5% (n = 22), respectively. Myometrial invasion was overestimated by ultrasound (i.e. false-positive estimation of deep invasion ≥ 50%) in 15.7% (n = 33) of cases, and cervical invasion was overestimated (i.e. false-positive finding of presence of stromal invasion) in 4.8% (n = 10) of cases. These outcomes correspond to positive and negative predictive values of 67.6% (95% CI, 57.7-76.6) and 83.3% (95% CI, 74.9-89.8), respectively, for the subjective assessment of myometrial invasion, and 60.0% (95% CI, 38.2-79.2) and 88.1% (95% CI, 82.5-92.4), respectively, for that of cervical stromal invasion. The staging error in subjective assessment was not related to body mass index (BMI), to the position of the uterus in the pelvis or to image quality. Cervical and myometrial invasion were more often underestimated in well-differentiated endometrial cancers that were smaller in size, with thick minimum tumor-free myometrium and lower perfusion, and more often overestimated in moderately and poorly differentiated cancers that were larger in size, with thin minimum tumor-free myometrium and richer perfusion. CONCLUSION The accuracy of subjective assessment of myometrial and cervical invasion by ultrasound was significantly influenced by tumor size, density of tumor vascularization, tumor vessel architecture and histological grading, while it was not significantly affected by BMI, uterine position and image quality.
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Affiliation(s)
- D Fischerova
- Gynecological Oncology Centre, Department of Obstetrics and Gynecology, First Faculty of Medicine and General University Hospital, Charles University in Prague, Prague, Czech Republic
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Rizzuto I, Odejinmi F, Al-Samarrai M. Can Body Mass Index Influence the Outcome of a Laparoscopic Hysterectomy? J Gynecol Surg 2014. [DOI: 10.1089/gyn.2012.0146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ivana Rizzuto
- Norfolk and Norwich University Hospital, Norwich, United Kingdom
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Comparison of laparoscopy and laparotomy for management of endometrial carcinoma: a prospective randomized study with 11-year experience. J Cancer Res Clin Oncol 2013; 139:1853-9. [DOI: 10.1007/s00432-013-1504-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 08/26/2013] [Indexed: 11/25/2022]
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30
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Wang HL, Ren YF, Yang J, Qin RY, Zhai KH. Total Laparoscopic Hysterectomy Versus Total Abdominal Hysterectomy for Endometrial Cancer: A Meta-analysis. Asian Pac J Cancer Prev 2013; 14:2515-9. [DOI: 10.7314/apjcp.2013.14.4.2515] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Pathiraja P, Tozzi R. Advances in gynaecological oncology surgery. Best Pract Res Clin Obstet Gynaecol 2013; 27:415-20. [PMID: 23482071 DOI: 10.1016/j.bpobgyn.2013.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 01/09/2013] [Indexed: 12/26/2022]
Abstract
Latest surgical advances in the field of gynaecological oncology, a sub-specialty of gynaecology, are reviewed in this chapter. The surgery is mainly practised in cancer centres by board-certified gynaecologists, and requires a 2-3 year period of additional training in gynaecological oncology. Surgical treatment of gynaecological malignancies has progressed in two directions: reduction of the invasiveness of the surgery and expansion of the number and type of procedures performed. Gynaecological oncology focuses on the pelvis to the upper abdomen and the thorax to target (all visible disease) the last cancer cell in women with advanced ovarian cancer. Minimal-access surgery has evolved to include any operation by laparoscopy. It uses fewer ports (single-port surgery), and robotic assistance improves the comfort of the surgeon. The concept of fertility-sparing surgery for women with cervical cancer is now supported by mature data. The indication and the aggressiveness of the exenterative surgery are also broader than originally recommended. The ideal timing of surgery is under investigation in several areas, mainly in women with ovarian and cervical cancer. The aim is to reduce morbidity and mortality of surgical procedures while maintaining the survival outcome.
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Affiliation(s)
- Pubudu Pathiraja
- Department of Gynaecologic Oncology, Oxford Cancer Centre, Oxford University Hospital - Churchill Hospital, Old Road OX3 7LJ, Oxford, UK
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Nam JH, Park JY. The Modern Surgical Strategy for Endometrial Cancer: Laparoscopic Surgery. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2013. [DOI: 10.1007/s13669-012-0031-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Peled Y, Krissi H, Sabah G, Levavi H, Eitan R. Disrupted abdominal laparotomy wounds in gynaecologic oncology patients: benefits of active surgical re-closure. J Wound Care 2013; 22:40-2. [PMID: 23299357 DOI: 10.12968/jowc.2013.22.1.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the outcome of active management of disrupted wounds through surgical approximation and re-closure. METHOD A prospective, non-comparative study, on all consecutive patients with disrupted laparotomy wounds treated at a tertiary medical centre, from November 2009 to December 2011. Data on patient demographics, diagnosis, type of abdominal incision, initial closure technique, infections and results of secondary re-closure were collected from the medical files. All patients underwent bedside closure with an en bloc mass suture mattress technique, performed by two attending gynaecologic oncologists. RESULTS Of 197 patients who underwent abdominal laparotomy during the study period, 31 (16%) had a disrupted wound. Following surgical re-closure, 26 wounds (84%) were completely healed or needed only minor additional care by follow up on day 10. Five wounds (16%) failed primary management and required re-suturing; all subsequently healed. There were no long-term complications. CONCLUSION Active surgical re-closure of disrupted abdominal laparotomy wounds is safe and effective in patients after treatment surgically for Müllerian malignancies.
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Affiliation(s)
- Y Peled
- Gynelocologic Oncology Division, The Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Galaal K, Bryant A, Fisher AD, Al-Khaduri M, Kew F, Lopes AD. Laparoscopy versus laparotomy for the management of early stage endometrial cancer. Cochrane Database Syst Rev 2012:CD006655. [PMID: 22972096 DOI: 10.1002/14651858.cd006655.pub2] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Traditionally, surgery for endometrial cancer (hysterectomy with removal of both fallopian tubes and ovaries) is performed through laparotomy. It has been suggested that the laparoscopic approach is associated with a reduction in operative morbidity. Over the last 10 to 15 years there has been a steady increase of laparoscopy for endometrial cancer. This review investigates the evidence of benefits and harms of laparoscopic surgery compared with laparotomy for presumed early stage endometrial cancer. OBJECTIVES To compare the overall survival (OS) and disease-free survival (DFS) for laparoscopic surgery versus laparotomy in women with presumed early stage endometrial cancer. SEARCH METHODS We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) Issue 3, 2012, MEDLINE, EMBASE and CINAHL up to April 2012. We also searched registers of clinical trials, abstracts of scientific meetings, and reference lists of included studies. Trial registers we searched included NHMRC Clinical Trials Register, UKCCCR Register of Cancer Trials, Meta-Register and Physician Data Query Protocol, as well as abstracts of scientific meetings. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing laparoscopy and laparotomy for early stage endometrial cancer. DATA COLLECTION AND ANALYSIS We independently abstracted data and assessed risk of bias. Hazard ratios (HRs) were used for OS and recurrence-free survival (RFS), risk ratios (RR) for severe adverse events and the mean difference (MD) method was used for continuous outcomes in women who received laparoscopy or laparotomy and these were then pooled in random-effects meta-analyses. MAIN RESULTS Eight RCTs comparing laparoscopy with laparotomy for the surgical management of early stage endometrial cancer were identified.All eight trials met the inclusion criteria, 3644 women were assessed at the end of the trials. Three trials assessing 359 participants with early stage endometrial cancer, found no statistically significant difference in the risk of death and disease or recurrence between women who underwent laparoscopy and those who underwent laparotomy (HR = 1.14, 95% confidence interval (CI): 0.62 to 2.10) and HR = 1.13, 95% CI: 0.90 to 1.42 for OS and RFS respectively). There was no statistically significant difference in the rate of peri-operative death, women requiring a blood transfusion, and bladder, ureteric, bowel and vascular injury. However, a meta-analysis of two trials found that women in the laparoscopy group lost significantly less blood than those in the laparotomy group (MD = -106.82 mL, 95% CI: -141.59 to -72.06). A further meta-analysis of two trials, which assessed 2923 women and included one very large trial of over 2500 participants, found that the rate of severe post-operative adverse events was significantly lower in the laparoscopy group compared with the laparotomy group (RR = 0.58, 95% CI: 0.37 to 0.91). The large trial did not give a breakdown of these severe post-operative adverse events into different adverse event categories. Most trials were at moderate risk of bias. Hospital stay was reported in all of the trials and results show that on average, laparoscopy was associated with a significantly shorter hospital stay. AUTHORS' CONCLUSIONS This review has found evidence to support the role of laparoscopy for the management of early endometrial cancer.For presumed early stage primary endometrioid adenocarcinoma of the endometrium, laparoscopy is associated with similar overall and disease-free survival. Laparoscopy is associated with reduced operative morbidity and hospital stay. There is no significant difference in severe post-operative morbidity between the two modalities.
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Affiliation(s)
- Khadra Galaal
- Gynaecological Oncology, Princess Alexandra Wing, Royal Cornwall Hospital, Truro, UK.
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Acholonu UC, Chang-Jackson SCR, Radjabi AR, Nezhat FR. Laparoscopy for the Management of Early-Stage Endometrial Cancer: From Experimental to Standard of Care. J Minim Invasive Gynecol 2012; 19:434-42. [DOI: 10.1016/j.jmig.2012.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 02/16/2012] [Accepted: 02/25/2012] [Indexed: 10/28/2022]
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Ghezzi F, Uccella S, Cromi A, Bogani G, Robba C, Serati M, Bolis P. Lymphoceles, lymphorrhea, and lymphedema after laparoscopic and open endometrial cancer staging. Ann Surg Oncol 2012; 19:259-267. [PMID: 21695563 DOI: 10.1245/s10434-011-1854-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Indexed: 09/19/2023]
Abstract
PURPOSE To evaluate the incidence of lymphoceles, lymphorrhea, and lymphedema after systematic pelvic lymphadenectomy in patients who underwent laparoscopic or open abdominal staging for endometrial cancer. METHODS A total of 138 consecutive women who underwent systematic laparoscopic pelvic lymphadenectomy for endometrial cancer staging were compared to 123 historical control subjects staged via an open approach. Postoperative screening for lymphadenectomy-related complications by ultrasound was consistently performed. RESULTS The incidence of perioperative complications was lower in cases than in control subjects. Overall, lymphoceles were diagnosed in 19 (15.4%) and 2 (1.4%) patients who had open and laparoscopic staging, respectively (odds ratio 12.42; 95% confidence interval 2.82-54.55; P < 0.0001). Symptomatic lymphoceles were more frequent after open staging than after laparoscopy (P = 0.028). Lymphorrhea occurred in 1 and 4 patients after laparoscopic and open surgery (P = 0.19). No difference in the incidence of lymphedema was observed. CONCLUSIONS Our findings suggest that laparoscopic endometrial cancer staging is associated with a lower occurrence of both asymptomatic and symptomatic lymphoceles compared to open surgery.
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Affiliation(s)
- Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
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Marnitz S, Köhler C. Current therapy of patients with endometrial carcinoma. A critical review. Strahlenther Onkol 2011; 188:12-20. [PMID: 22189438 DOI: 10.1007/s00066-011-0004-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 09/28/2011] [Indexed: 10/14/2022]
Abstract
Magnetic resonance imaging (MRI), 18-FDG positron emission tomography ((18)FDG PET-CT), and computed tomography (CT) have demonstrated disappointing detectability of lymph node metastases in endometrial cancer. The treatment of choice in patients with endometrial cancer is hysterectomy and bilateral salpingoophorectomy. Above all, obese patients with comorbidity have benefited the most from laparoscopically assisted approaches. For inoperable patients in FIGO stage I/II, radiation remains an alternative to hysterectomy. The role of pelvic and paraaortic lymphadenectomy is the most controversial issue in endometrial carcinoma treatment. The current spectrum of treatment ranges from no lymphadenectomy, exclusive pelvic or additional inframesentric paraaortic sampling, or complete pelvic to infrarenal paraaortic lymphadenectomy. The sentinel concept in patients with endometrial carcinoma is far from being introduced into routine clinical practice. Without a lymphadenectomy, decision making for adjuvant therapy remains a challenge, because no information is available from lymph node status and the reliability of pathologic grading is poor. For patients after hysterectomy with a low risk of local relapse (stage I/II without additional risk factors), vaginal brachytherapy is sufficient to prevent vaginal relapses. Adjuvant external beam irradiation (EBRT) in stage I/II demonstrated improved local control which impacted overall survival only in patients with high-risk features (higher age, grading myometrial infiltration). Stage IIIC patients seem to benefit from EBRT with regard to overall survival. In patients at high risk of progression (grade 3, MI > 50%, FIGO IIIC, unfavorable histology), multimodal treatment should be considered. The optimal substances and sequences are under investigation.
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Affiliation(s)
- S Marnitz
- Department of Radiooncology, Charité University Medicine, Charité - Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
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Zhang H, Cui J, Jia L, Hong S, Kong B, Li D. Comparison of laparoscopy and laparotomy for endometrial cancer. Int J Gynaecol Obstet 2011; 116:185-91. [DOI: 10.1016/j.ijgo.2011.10.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 10/11/2011] [Accepted: 11/22/2011] [Indexed: 11/25/2022]
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Abstract
Over the past 10 years, multiple studies have shown that minimally invasive surgical approaches for the treatment of endometrial cancer reduce blood loss, length of hospital stay, and the incidence and severity of surgical complications compared with laparotomy. In addition, minimally invasive approaches result in better cosmesis and short-term patient quality of life. Although data from prospective studies have yet to mature, laparoscopic and open surgeries seem to be equivalent oncologically. In this article, we will review the current literature on traditional laparoscopy, robotically assisted laparoscopy, and single-port laparoscopy as surgical approaches for the treatment of endometrial cancer.
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Helm CW, Arumugam C, Gordinier ME, Metzinger DS, Pan J, Rai SN. Laparoscopic surgery for endometrial cancer: increasing body mass index does not impact postoperative complications. J Gynecol Oncol 2011; 22:168-76. [PMID: 21998759 PMCID: PMC3188715 DOI: 10.3802/jgo.2011.22.3.168] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 04/07/2011] [Accepted: 05/01/2011] [Indexed: 11/30/2022] Open
Abstract
Objective To determine the effect of body mass index on postoperative complications and the performance of lymph node dissection in women undergoing laparoscopy or laparotomy for endometrial cancer. Methods Retrospective chart review of all patients undergoing surgery for endometrial cancer between 8/2004 and 12/2008. Complications graded and analyzed using Common Toxicity Criteria for Adverse Events ver. 4.03 classification. Results 168 women underwent surgery: laparoscopy n=65, laparotomy n=103. Overall median body mass index 36.2 (range, 18.1 to 72.7) with similar distributions for age, body mass index and performance of lymph node dissection between groups. Following laparoscopy vs. laparotomy the percent rate of overall complications 53.8:73.8 (p=0.01), grade ≥3 complications 9.2:34.0 (p<0.01), ≥3 wound complications 3.1:22.3 (p<0.01) and ≥3 wound infection 3.1:20.4 (p=0.01) were significantly lower after laparoscopy. In a logistic model there was no effect of body mass index (≥36 and<36) on complications after laparoscopy in contrast to laparotomy. Para-aortic lymph node dissection was performed by laparoscopy 19/65 (29%): by laparotomy 34/103 (33%) p=0.61 and pelvic lymph node dissection by laparoscopy 21/65 (32.3%): by laparotomy 46/103 (44.7%) p=0.11. Logistic regression analysis revealed that for patients undergoing laparoscopy for stage I disease there was an inverse relationship between the performance of both para-aortic lymph node dissection and pelvic lymph node dissection and increasing body mass index (p=0.03 and p<0.01 respectively) in contrast to the laparotomy group where there was a trend only (p=0.09 and 0.05). Conclusion For patients undergoing laparoscopy, increasing body mass index did not impact postoperative complications but did influence the decision to perform lymph node dissection.
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Affiliation(s)
- C William Helm
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, St. Louis University School of Medicine, St. Louis, MO, USA
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Bharwani N, Miquel ME, Sahdev A, Narayanan P, Malietzis G, Reznek RH, Rockall AG. Diffusion-weighted imaging in the assessment of tumour grade in endometrial cancer. Br J Radiol 2011; 84:997-1004. [PMID: 21896664 DOI: 10.1259/bjr/14980811] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Endometrial cancer is the most common gynaecological malignancy in developed countries. Histological grade and subtype are important prognostic factors obtained by pipelle biopsy. However, pipelle biopsy "samples" tissue and a high-grade component that requires more aggressive treatment may be missed. The purpose of the study was to assess the use of diffusion-weighted MRI (DW-MRI) in the assessment of tumour grade in endometrial lesions. METHOD 42 endometrial lesions including 23 endometrial cancers and 19 benign lesions were evaluated with DW-MRI (1.5T with multiple b-values between 0 and 750 s mm(-2)). Visual evaluation and the calculation of mean and minimum apparent diffusion coefficient (ADC) value were performed and correlated with histology. RESULTS The mean and minimum ADC values for each histological grade were 1.02 ± 0.29×10(-3) mm(2) s(-1) and 0.74 ± 0.24×10(-3) mm(2) s(-1) (grade 1), 0.88 ± 0.39×10(-3) mm(2) s(-1) and 0.64 ± 0.36×10(-3) mm(2) s(-1) (grade 2), and 0.94 ± 0.32×10(-3) mm(2) s(-1) and 0.72 ± 0.36×10(-3) mm(2) s(-1) (grade 3), respectively. There was no statistically significant difference between tumour grades. However, the mean ADC value for endometrial carcinoma was 0.97 ± 0.31, which was significantly lower (p<0.0001) than that of benign endometrial pathology (1.50 ± 0.14). Applying a cut-off mean ADC value of less than 1.28 × 10(-3) mm(2) s(-1)we obtained a sensitivity, specificity, positive predictive value and negative predictive value for malignancy of 87%, 100%, 100% and 85.7%, respectively. CONCLUSION Tumour mean and minimum ADC values are not useful in differentiating histological tumour grade in endometrial carcinoma. However, mean ADC measurement can provide useful information in differentiating benign from malignant endometrial lesions. This information could be clinically relevant in those patients where pre-operative endometrial sampling is not possible.
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Affiliation(s)
- N Bharwani
- Department of Imaging, Barts and The London NHS Trust, London, UK.
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Laparoscopic hysterectomy is preferred over laparotomy in early endometrial cancer patients, however not cost effective in the very obese. Eur J Cancer 2011; 47:2158-65. [DOI: 10.1016/j.ejca.2011.04.035] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Revised: 04/13/2011] [Accepted: 04/27/2011] [Indexed: 11/17/2022]
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Rabischong B, Larraín D, Canis M, Le Bouëdec G, Pomel C, Jardon K, Kwiatkowski F, Bourdel N, Achard JL, Dauplat J, Mage G. Long-Term Follow-Up After Laparoscopic Management of Endometrial Cancer in the Obese: A Fifteen-Year Cohort Study. J Minim Invasive Gynecol 2011; 18:589-96. [DOI: 10.1016/j.jmig.2011.05.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 05/17/2011] [Accepted: 05/26/2011] [Indexed: 10/18/2022]
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Barnett JC, Havrilesky LJ, Bondurant AE, Fleming ND, Lee PS, Secord AA, Berchuck A, Valea FA. Adverse events associated with laparoscopy vs laparotomy in the treatment of endometrial cancer. Am J Obstet Gynecol 2011; 205:143.e1-6. [PMID: 21514921 DOI: 10.1016/j.ajog.2011.03.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 02/21/2011] [Accepted: 03/08/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of the study was to compare adverse event rates between laparoscopic vs open surgery for endometrial cancer. STUDY DESIGN This was a retrospective cohort study comparing 107 women who underwent laparoscopy with 269 age- and body mass index-matched women who underwent laparotomy for treatment of endometrial cancer. RESULTS Adverse event rates were similar between cohorts (37% laparoscopy vs 43% laparotomy, P=.248). Laparotomies had higher rates of cellulitis (16% vs 7%, P=.018) and open wound infection (9% vs 2%, P=.02), whereas laparoscopy had higher rates of sensory peripheral nerve deficit (5% vs 0%, P=.008) and lymphedema (7% vs 1%, P=.003). Laparoscopy was associated with longer mean operating room times but with shorter hospital stays and lower mean blood loss. CONCLUSION Laparoscopy was associated with decreased rates of surgical site infections but had an increased risk of peripheral sensory nerve deficits and lymphedema when compared with laparotomy.
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Affiliation(s)
- Jason C Barnett
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA
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Total laparoendoscopic single-site surgery (LESS) hysterectomy in low-risk early endometrial cancer: a pilot study. Surg Endosc 2011; 26:41-6. [PMID: 21789644 DOI: 10.1007/s00464-011-1825-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 06/13/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND In the last few years, technical advances have produced a dramatic shift from traditional open surgery toward a minimally invasive approach, even in oncological procedures. We present our initial experience with laparoendoscopic single-site surgery (LESS) in the surgical treatment of early-stage endometrial cancer patients. METHODS Between July 2009 and May 2010, 20 consecutive low-risk early endometrial cancer patients were enrolled in this single institution prospective cohort trial. RESULTS The median age of the patients was 57 years (range = 42-68) and median body mass index was 24 kg/m(2) (range = 21-30). Median operative time was 105 min (range = 85-155) and median estimated blood loss was 20 ml (range = 10-180). The larger skin and fascial incision required for the single-port approach was 2.5 cm (median = 2.2 cm; range = 2.0-2.5). No laparoscopic/laparotomic conversion was registered, and no insertion of additional ports was necessary. Median ileus was 16 h (range = 12-20) and median time to discharge was 1 day (range = 1-2). All patients were completely satisfied with the cosmetic results and postoperative pain control. CONCLUSIONS Laparoendoscopic single-site surgery could represent a surgical option for extra-fascial hysterectomy in early-stage endometrial cancer patients, with the potential to further decrease invasiveness of the conventional laparoscopic approach.
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The role of lymphadenectomy in surgical staging of endometrial cancer. Int J Surg Oncol 2011; 2011:814649. [PMID: 22312525 PMCID: PMC3263657 DOI: 10.1155/2011/814649] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 04/26/2011] [Accepted: 04/30/2011] [Indexed: 11/28/2022] Open
Abstract
Surgical staging, including lymph node sampling, for endometrial cancer was adopted by the
International Federation of Gynecology and Obstetrics (FIGO) in 1988 based on reports demonstrating
diagnostic and therapeutic advantages. This review focuses on the incidence of lymph node metastasis,
risk factors for lymph node involvement, the effect of lymph node metastasis on prognosis, the
therapeutic effect and diagnostic usefulness of lymphadenectomy, risks of lymph node dissection, and
future directions in surgical staging of endometrial cancer. Surgical staging identifies most patients with
extrauterine disease as well as uterine risk factors for recurrence, thereby allowing for a more informed
approach to postoperative adjuvant therapy. Lymphadenectomy as a part of surgical staging is not
required in patients assessed intraoperatively to be at low risk for lymph node metastasis (<2 cm grade
1 tumors with superficial myometrial invasion), however, a systematic lymph node dissection should be
performed in most other patients with endometrial cancer. In the future, molecular markers may be
useful to predict preoperatively tumor aggressiveness and lymph node metastasis. It is hoped that an
approach of surgical staging with selective lymph node dissection will improve survival and spare
patients additional surgical complications or unnecessary postoperative exposure to radiation and/or
chemotherapy.
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Marcickiewicz J, Sundfeldt K. Accuracy of intraoperative gross visual assessment of myometrial invasion in endometrial cancer. Acta Obstet Gynecol Scand 2011; 90:846-51. [PMID: 21534933 DOI: 10.1111/j.1600-0412.2011.01166.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the accuracy of gross visual assessment of myometrial invasion in endometrial carcinoma. DESIGN Prospective, descriptive study. SETTING University hospital. POPULATION Two hundred and fourteen consecutive patients operated between 2005 and 2008. All patients were preoperatively diagnosed with endometrial carcinoma or complex atypical hyperplasia considered by the pathologist to be at the border of highly differentiated endometrial cancer. METHODS Intraoperative gross visual assessment of myometrial tumor invasion (<50 or ≥50%), cervical tumor engagement and tumor diameter in millimeters were noted for all patients. MAIN OUTCOME MEASURES The collected data were compared with final histopathology. RESULTS Intraoperative gross visual assessment of myometrial tumour invasion correlated well with final histology, with an accuracy of 87%. Agreement between gross visual assessment and final histology was reached in 91% of grade 1 tumors. Additionally, we found that 98.5% of tumors with a diameter <20mm had <50% myometrial invasion, regardless of grade. CONCLUSIONS Intraoperative gross visual assessment of myometrial tumor invasion and tumor size measurements are simple, fast and inexpensive methods that may provide important information for the surgeon to decide upon the extent of staging when other more accurate methods are not at hand.
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Affiliation(s)
- Janusz Marcickiewicz
- Institute for Clinical Sciences, Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Sweden.
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Is early stage endometrial cancer safely treated by laparoscopy? Complications of a multicenter study and review of recent literature. Surg Oncol 2011; 20:80-7. [DOI: 10.1016/j.suronc.2009.11.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 10/18/2009] [Accepted: 11/15/2009] [Indexed: 11/21/2022]
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Ball A, Bentley JR, O’Connell C, Kieser KE. Choosing the Right Patient: Planning for Laparotomy or Laparoscopy in the Patient With Endometrial Cancer. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2011; 33:468-474. [DOI: 10.1016/s1701-2163(16)34880-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Oehler MK. Robotic surgery in gynaecology and gynaecological oncology: Program initiation and operative outcomes at the Royal Adelaide Hospital. Aust N Z J Obstet Gynaecol 2011; 51:119-24. [PMID: 21466512 DOI: 10.1111/j.1479-828x.2011.01293.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Martin K Oehler
- Department of Gynaecological Oncology, Royal Adelaide Hospital, South Australia, Australia.
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