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Yamauchi K, Sekiyama K, Otsuki M, Nakamura S, Kawai E, Kojima M, Kozono Y, Okuda A, Yoshioka Y, Higuchi T. Multidirectional Traction Method Using SURGICEL NU-KNIT and Surgical Suture in Robot-assisted Laparoscopic Surgery for Endometrial Cancer. J Minim Invasive Gynecol 2024; 31:12-13. [PMID: 37875212 DOI: 10.1016/j.jmig.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/22/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE To describe a novel approach to robot-assisted laparoscopic total hysterectomy (RH) for endometrial cancer that minimizes cancer sell spillage and develops a stable surgical field. DESIGN Demonstration of the multidirectional traction method with narrated video footage. SETTING Many reports have indicated that RH for endometrial cancer has the same or superior short-term results compared with conventional laparoscopic hysterectomy (LH), and the long-term prognosis is the same [1,2]. However, there are no randomized controlled trials of RH versus LH, and some previous reports [3] have suggested that RH has a worse prognosis than LH, so the long-term prognosis should be considered with caution. Factors that may affect the long-term prognosis include the use of uterine manipulators [4] and compression of the uterine body with robotic forceps without tactile sensation [3]. However, to the best of our knowledge, no surgical technique capable of avoiding these factors has been established yet. Herein, we report a multidirectional traction method using SURGICEL NU-KNIT (Ethicon; Johnson & Johnson Medical Ltd., Tokyo, Japan), a local hemostatic agent, and surgical sutures. INTERVENTION Cut 2-0 Prolene (Ethicon; Johnson & Johnson Medical Ltd., Tokyo, Japan) with straight needles (ST-70) thread to 35 cm, stick a 1 × 2 cm piece of SURGICEL NU-KNIT, and make knots Fig. 1. This implement is used to puncture the incisional margins of the peritoneum and then the abdominal wall to bring the thread to the surface of the body, where it is grasped with forceps and fixed. By repeating this operation, multidirectional traction can be obtained Fig. 2. A manipulating suture is also attached to the uterus to minimize the compression of the uterine body with robotic forceps. CONCLUSION The multidirectional traction method allows for reproducible stable surgical field development and minimizes cancer cell spillage by reducing uterine grasping by robotic forceps without the use of uterine manipulators.
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Affiliation(s)
- Kota Yamauchi
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka, Japan.
| | - Kentaro Sekiyama
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Miki Otsuki
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Shihori Nakamura
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Eri Kawai
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Machiko Kojima
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Yuki Kozono
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Akiko Okuda
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Yumiko Yoshioka
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka, Japan
| | - Toshihiro Higuchi
- Department of Obstetrics and Gynecology, Medical Research Institute KITANO HOSPITAL, PIIF Tazuke-Kofukai, Osaka, Japan
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Seon KE, Lee YJ, Lee JY, Nam EJ, Kim S, Kim YT, Kim SW. Initial experience with the da Vinci SP robot-assisted surgical staging of endometrial cancer: a retrospective comparison with conventional laparotomy. J Robot Surg 2023; 17:2889-2898. [PMID: 37816993 DOI: 10.1007/s11701-023-01730-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/24/2023] [Indexed: 10/12/2023]
Abstract
To compare the perioperative outcomes of surgical staging performed using conventional laparotomy (LT) or the da Vinci SP robotic system (SP) in patients with endometrial cancer. We retrospectively analyzed 180 patients with stage I-III endometrial cancer who underwent surgical staging using LT (n = 126) or SP (n = 54) at the Yonsei Cancer Center between November 2018 and December 2022. Propensity score matching (PSM) was performed to mitigate potential confounding biases. Fifty-one pairs of patients were matched by PSM. SP required longer total operation time than LT (221 vs. 142 min in SP vs. LT, respectively, p < 0.001). However, estimated blood loss and postoperative hemoglobin change were lower in SP than in LT (30 vs. 100 mL, p < 0.001; 0.6 vs. 1.6 g/dL, p < 0.001 for SP vs. LT respectively). Furthermore, postoperative minor complications (13.7% in SP vs. 33.3% in LT, p = 0.02), perioperative transfusion rate (0% in SP vs. 11.8% in LT, p = 0.03), and postoperative hospital stay (2 days for SP vs. 8 days for LT, p < 0.001) were lower in SP than in LT. Although the patient-controlled analgesia administration rate was lower in SP (13.8% in SP vs. 100% in LT, p < 0.001), the median postoperative pain score at 6, 12, and 24 h after surgery was lower in SP than in LT (2 vs. 3, p = 0.002; 2 vs. 3, p = 0.005; 2 vs. 3, p = 0.001 for SP vs. LT, respectively). Although SP required longer total operation time, it demonstrated several advantages over LT in endometrial cancer staging.
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Affiliation(s)
- Ki Eun Seon
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Yong Jae Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Jung-Yun Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Eun Ji Nam
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Sunghoon Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Young Tae Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Sang Wun Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea.
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Lim YH, Dagher C, Abu-Rustum NR, Mueller JJ, Sonoda Y, Zivanovic O, Broach V, Leitao MM. Oncologic outcomes of robot-assisted laparoscopy versus conventional laparoscopy for the treatment of apparent early-stage endometrioid adenocarcinoma of the uterus. Gynecol Oncol 2023; 179:152-157. [PMID: 37980770 PMCID: PMC10872455 DOI: 10.1016/j.ygyno.2023.11.009] [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: 08/16/2023] [Revised: 10/30/2023] [Accepted: 11/08/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE To compare long-term oncologic outcomes in patients with clinically uterine-confined endometrioid endometrial cancer who underwent surgical staging with robot-assisted (RA) versus conventional laparoscopy. METHODS We performed a retrospective chart review of patients with newly diagnosed, uterine-confined endometrioid endometrial cancer who were treated and had primary surgery at our institution between 1/1/2009-1/1/2018. Clinicopathologic, surgical, and survival data were collected. Appropriate statistical methods were applied. RESULTS Of 1728 patients identified, 1389 (80.4%) underwent RA and 339 (19.6%) conventional laparoscopy. At diagnosis, median age was 60 years (range, 24-92) and median BMI was 30.2 kg/m2 (range, 15.1-71.5). In the RA group, patients had longer operative time (170 vs 152 min, P < .001), lower conversion rate to laparotomy (0.6% vs 4.7%, P < .001), and a higher proportion had a BMI > 40 kg/m2 (17.2% vs 11.5%, P = .01) and same-day discharge (19.2% vs 5.3%, P < .001). Overall, 93% (RA) and 90% (conventional) of patients underwent lymph node assessment (P = .1). Comparing the RA versus conventional groups, final surgical stage on pathology (P = .6), median follow-up (55.7 vs 52.9 months, P = .4), and rates of perioperative complications (9.9% vs 7.7%, P = .6), recurrence (9.5% vs 7.4%, P = .3), 5-year PFS (88.5% vs 91.0%, P = .3), and 5-year OS (92.5% vs 92.4%, P = .7) were not significantly different. No significant increase in risk of recurrence (HR = 1.2, 95% CI: 0.8-1.9, P = .3) or poorer OS outcomes (HR = 0.9, 95% CI: 0.6-1.4, P = .7) were observed in the RA group. CONCLUSION In uterine-confined endometrioid endometrial cancers, surgical staging using RA laparoscopy was not associated with adverse survival outcomes compared to conventional laparoscopy.
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Affiliation(s)
- Yu Hui Lim
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christian Dagher
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Jennifer J Mueller
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Vance Broach
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA
| | - Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of OB/GYN, Weill Cornell Medical College, New York, NY, USA.
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Cho SH, Lee JY, Nam EJ, Kim S, Kim YT, Kim SW. Comparison of Single-Port Laparoscopy with Other Surgical Approaches in Endometrial Cancer Surgical Staging: Propensity-Score-Matched Analysis. Cancers (Basel) 2023; 15:5322. [PMID: 38001582 PMCID: PMC10670050 DOI: 10.3390/cancers15225322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
This single-institution, retrospective study aimed to compare the surgical outcomes of single-port, multi-port, and robot-assisted laparoscopy, as well as laparotomy, in patients with endometrial cancer who underwent surgical staging between January 2006 and December 2017. This study evaluated various parameters, including disease-free survival (DFS), overall survival (OS), recurrence rate (RR), recurrence site, and intra- and postoperative complications. Propensity score matching was performed to account for baseline characteristics, and a total of 881 patients were included in the analysis. The 3-year DFS of single-port laparoscopy was similar to that of the other groups, but laparotomy exhibited a lower 3-year DFS compared to multi-port (p = 0.001) and robot-assisted (p = 0.031) laparoscopy. Single-port laparoscopy resulted in a significantly higher 3-year OS than laparotomy (p = 0.013). After propensity score matching, the four groups demonstrated similar survival outcomes (3-year DFS: p = 0.533; 3-year OS: p = 0.328) and recurrence rates (10.3%, 12.1%, 10.3%, and 15.9% in the single-port, multi-port, and robot-assisted laparoscopy and laparotomy groups, respectively, p = 0.552). Recurrence most commonly occurred in distant organs. The single-port laparoscopy group had the longest operative time (205.1 ± 76.9 min) but the least blood loss (69.5 ± 90.8 mL) and the shortest postoperative hospital stay (5.2 ± 2.3 days). In contrast, the laparotomy group had the shortest operative time (163.4 ± 51.0 min) but the highest blood loss (368.3 ± 326.4 mL) and the longest postoperative hospital stay (10.3 ± 4.6 days). The transfusion rate was 0% in the single-port laparoscopy group and 3.7% in the laparotomy group. Notably, the laparotomy group had the highest wound complication rate (p = 0.001), whereas no wound hernias were observed in the three minimally invasive approaches. In conclusion, the survival outcomes were comparable between the methods, with the benefit of lower blood loss and shorter hospital stay observed in the single-port laparoscopy group. This study suggests that single-port laparoscopy is a feasible approach for endometrial cancer surgical staging.
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Affiliation(s)
- Sang Hyun Cho
- Department of Obstetrics and Gynecology, Graduate School, Yonsei University College of Medicine, Seoul 03722, Republic of Korea;
- Department of Obstetrics and Gynecology, St. Vincent’s Hospital, The Catholic University of Korea, Suwon 16247, Republic of Korea
| | - Jung-Yun Lee
- Department of Obstetrics and Gynecology, Women’s Cancer Center, Yonsei Cancer Center, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.-Y.L.); (E.J.N.); (S.K.); (Y.T.K.)
| | - Eun Ji Nam
- Department of Obstetrics and Gynecology, Women’s Cancer Center, Yonsei Cancer Center, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.-Y.L.); (E.J.N.); (S.K.); (Y.T.K.)
| | - Sunghoon Kim
- Department of Obstetrics and Gynecology, Women’s Cancer Center, Yonsei Cancer Center, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.-Y.L.); (E.J.N.); (S.K.); (Y.T.K.)
| | - Young Tae Kim
- Department of Obstetrics and Gynecology, Women’s Cancer Center, Yonsei Cancer Center, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.-Y.L.); (E.J.N.); (S.K.); (Y.T.K.)
| | - Sang Wun Kim
- Department of Obstetrics and Gynecology, Women’s Cancer Center, Yonsei Cancer Center, Institute of Women’s Life Medical Science, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (J.-Y.L.); (E.J.N.); (S.K.); (Y.T.K.)
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Wang W, Gao Y, Qin J, Yin R. Application of the da Vinci robot in gynecologic malignancies: A bibliometric analysis (2005 - 2023). Asian J Surg 2023; 46:4918-4919. [PMID: 37330299 DOI: 10.1016/j.asjsur.2023.05.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023] Open
Affiliation(s)
- Wenxiang Wang
- Department of Obstetrics and Gynecology, West China Second Hospital of Sichuan University, Sichuan, Chengdu, 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan, Chengdu, 610041, China; Department of Obstetrics and Gynecology, Xinxiang Central Hospital, The Fourth Clinical College of Xinxiang Medical College, Xinxiang, 453000, Henan, China
| | - Yuxia Gao
- Department of Obstetrics and Gynecology, Xinxiang Central Hospital, The Fourth Clinical College of Xinxiang Medical College, Xinxiang, 453000, Henan, China
| | - Jinxia Qin
- Department of Obstetrics and Gynecology, Xinxiang Central Hospital, The Fourth Clinical College of Xinxiang Medical College, Xinxiang, 453000, Henan, China
| | - Rutie Yin
- Department of Obstetrics and Gynecology, West China Second Hospital of Sichuan University, Sichuan, Chengdu, 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan, Chengdu, 610041, China.
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Eoh KJ, Kim TJ, Park JY, Kim HS, Paek J, Kim YT. Robot-assisted versus conventional laparoscopic surgery for endometrial cancer: long-term comparison of outcomes. Front Oncol 2023; 13:1219371. [PMID: 37781200 PMCID: PMC10540847 DOI: 10.3389/fonc.2023.1219371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/17/2023] [Indexed: 10/03/2023] Open
Abstract
Objective There is a lack of multi-institutional large-volume and long-term follow-up data on comparisons between robot-assisted surgery and conventional laparoscopic surgery. This study compared the surgical and long-term survival outcomes between patients who underwent robot-assisted or conventional laparoscopic surgery for endometrial cancer. Methods We retrospectively reviewed the data of patients from five large academic institutions who underwent either robot-assisted or conventional laparoscopic surgery for the treatment of endometrial cancer between 2012 and 2017, ensuring at least 5 years of potential follow-up. Intra- and postoperative outcomes, long-term disease-free survival, and overall survival were compared. Results The study cohort included 1,003 unselected patients: 551 and 452 patients received conventional laparoscopic and robot-assisted surgery, respectively. The median follow-up duration was 57 months. Postoperative complications were significantly less likely to occur in the robot-assisted surgery group compared to the laparoscopic surgery group (7.74% vs. 13.79%, P = 0.002), primarily limited to minor complications. There were no significant differences in survival: 5-year disease-free survival was 91.2% versus 90.0% (P = 0.628) and overall survival was 97.9% versus 96.8% (P = 0.285) in the robot-assisted and laparoscopic surgery cohorts, respectively. Cox proportional hazard regression models demonstrated that the mode of surgery was not associated with disease-free survival (hazard ratio, 0.897; confidence interval, 0.563-1.429) or overall survival (hazard ratio, 0.791; confidence interval, 0.330-1.895) after adjusting for confounding factors. Conclusion Robot-assisted surgery for endometrial cancer demonstrates comparable long-term survival outcomes and a reduced incidence of postoperative minor complications when compared to conventional laparoscopic surgery.
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Affiliation(s)
- Kyung Jin Eoh
- Department of Obstetrics and Gynecology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Tae-Joong Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Seoul, Republic of Korea
| | - Jeong-Yeol Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jiheum Paek
- Departments of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Young Tae Kim
- Department of Obstetrics and Gynecology, Institute of Women’s Medical Life Science, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Sallée C, Lacorre A, Despoux F, Mbou VB, Margueritte F, Gauthier T. Use of uterine manipulator and uterine perforation in minimally invasive endometrial cancer surgery. J Gynecol Obstet Hum Reprod 2023; 52:102621. [PMID: 37301478 DOI: 10.1016/j.jogoh.2023.102621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Safety of the uterine manipulator (UM) within endometrial cancer (EC) surgery is being questioned. Its use might be one of the issues for potential tumor dissemination during the procedure, especially in the case of uterine perforation (UP). No prospective data on this surgical complication, nor on the oncological consequences exist. The aim of this study was to assess the rate of UP while using UM when performing surgery for EC and the impact of UP on the choice of adjuvant treatment. METHODS We conducted a prospective single-center cohort study from November 2018 to February 2022, considering all EC cases surgically treated by a minimally invasive approach with the help of a UM. Demographic, preoperative, postoperative and adjuvant treatment corresponding to the included patients were collected and comparatively analyzed according to the absence or presence of a UP. RESULTS Of the 82 patients included in the study, 9 UPs (11%) occurred during surgery. There was no significant difference in demographics and disease characteristics at diagnosis that may have induced UP. The type of UM used or the approach (laparoscopic vs. robotic) did not influence the occurrence of UP (p = 0.44). No positive peritoneal cytology was found post hysterectomy. There was a statistically significantly higher rate of lymph-vascular space invasion within the perforation group, 67% vs. 25% in the no perforation group, p = 0.02. Two out of nine (22%) adjuvant therapies were changed because of UP. The median follow-up time for patients was 7.6 months (range 0.5-33.1 months). No recurrence was found in the UP group. CONCLUSION Our study found a uterine perforation rate of 11%. This information needs to be further integrated to consider the usefulness of MU for EC surgery.
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Affiliation(s)
- C Sallée
- Department of Gynecology and Obstetrics, CHU Limoges, 8 Avenue Dominique Larrey, Cedex, Limoges 87042, France.
| | - A Lacorre
- Department of Gynecology and Obstetrics, CHU Limoges, 8 Avenue Dominique Larrey, Cedex, Limoges 87042, France
| | - F Despoux
- Department of Gynecology and Obstetrics, CHU Limoges, 8 Avenue Dominique Larrey, Cedex, Limoges 87042, France
| | - V B Mbou
- Department of Anatomopathology, CHU Limoges, 8 avenue Dominique Larrey, Cedex, Limoges 87042, France
| | - F Margueritte
- Department of Gynecology and Obstetrics, CHI Poissy, 10 rue du Champ Gaillard, Poissy 78300, France
| | - T Gauthier
- Department of Gynecology and Obstetrics, CHU Limoges, 8 Avenue Dominique Larrey, Cedex, Limoges 87042, France
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Capasso I, Garzon S, Kumar S, Weaver AL, Mc Gree M, De Vitis LA, Uccella S, Petersen I, Glaser G, Langstraat C, Scambia G, Fanfani F, Mariani A. Prognostic factors in patients with endometrial cancer with isolated lymphatic recurrence. Int J Gynecol Cancer 2023; 33:1169-1178. [PMID: 37321674 DOI: 10.1136/ijgc-2023-004435] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE To analyze the clinicopathological features and outcomes in patients with endometrial cancer with isolated lymphatic recurrence after lymphadenectomy, stratified by different isolated lymphatic recurrence sites and treatment approaches. METHODS We retrospectively reviewed all surgically treated patients with endometrial cancer, identifying those with recurrence. We defined primary isolated lymphatic recurrence as the first and unique evidence of recurrence in lymph node-bearing areas, without concomitant vaginal, hematogenous, or peritoneal recurrence. Isolated lymphatic recurrences were classified as pelvic, para-aortic, distant, or multiple sites. Our primary outcome was cause-specific survival after diagnosis of the recurrence. RESULTS Among 4216 patients with surgically staged endometrial cancer, we identified 66 (1.6%) women with isolated lymphatic recurrence. The overall median cause-specific survival for patients with isolated lymphatic recurrence was 24 months. Although cause-specific survival was not significantly different between the four isolated lymphatic recurrence groups (p=0.21), 7 of 15 (47%) patients with isolated lymphatic recurrence in the para-aortic area were long-term survivors. At multivariate Cox regression, the absence of lymphovascular space invasion and grade 1 histology in the primary tumor were significantly associated with improved cause-specific survival. In addition, patients with isolated lymphatic recurrence who underwent surgery for recurrence (with/without other associated therapies) had improved cause-specific survival compared with patients who did not undergo surgery, also after adjusting for age. CONCLUSIONS Low-grade histology and absence of lymphovascular space invasion in the primary tumor were predictors of improved prognosis in patients with endometrial cancer with isolated lymphatic recurrence. In addition, in this retrospective cohort, patients with isolated lymphatic recurrence who were selected for eradicative surgical treatment had improved cause-specific survival.
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Affiliation(s)
- Ilaria Capasso
- Department of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Women, Children and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Sanjeev Kumar
- Department of Gynecologic Oncology, Baptist Memorial Hospital for Women, Memphis, Tennessee, USA
| | - Amy L Weaver
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Michaela Mc Gree
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Stefano Uccella
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, Verona, Italy
| | - Ivy Petersen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gretchen Glaser
- Department of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Carrie Langstraat
- Department of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Giovanni Scambia
- Department of Women, Children and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
| | - Francesco Fanfani
- Department of Women, Children and Public Health Sciences, Gynecologic Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
| | - Andrea Mariani
- Department of Gynecologic Oncology, Mayo Clinic, Rochester, Minnesota, USA
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Seon KE, Lee YJ, Lee JY, Nam EJ, Kim S, Kim YT, Kim SW. Comparing surgical outcomes of da Vinci SP and da Vinci Xi for endometrial cancer surgical staging in a propensity score-matched study. Sci Rep 2023; 13:11752. [PMID: 37474581 PMCID: PMC10359395 DOI: 10.1038/s41598-023-37659-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/25/2023] [Indexed: 07/22/2023] Open
Abstract
The number of studies comparing robotic systems in endometrial cancer staging is limited. This retrospective study analyzed the medical records of 42 consecutive endometrial cancer patients, who underwent robotic staging using the da Vinci SP (SP) system, and 126 propensity score-matched patients who underwent staging using the da Vinci Xi (Xi) system. Median console and total operation times were longer in the SP group than those in the Xi group (125 vs. 77 min, p < 0.001; 225 vs. 154.5 min, p < 0.001, respectively). Notably, the median console time of the first 10 cases using SP was 184 min; it subsequently decreased to 99.5 min in the fourth 10 cases. SP had lesser postoperative hemoglobin (Hb) change (0.6 ± 0.7 g/dL vs. 1.8 ± 0.9 g/dL in Xi, p < 0.001) and lower median pain score at 6 h after surgery (2 vs. 3 in Xi, p = 0.046). Moreover, median postoperative hospital stay was shorter in the SP group (2 days) than that in the Xi group (6 days) (p < 0.001). Although SP was correlated with lower postoperative Hb change, shorter postoperative hospital stay, and lower pain score than those in Xi, it required longer operation times. Further prospective randomized studies are needed to validate the benefits of SP compared to other robotic platforms.
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Affiliation(s)
- Ki Eun Seon
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Yong Jae Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Jung-Yun Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Eun Ji Nam
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Sunghoon Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Young Tae Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea
| | - Sang Wun Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 03722, Korea.
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10
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Fu H, Zhang J, Zhao S, He N. Survival outcomes of robotic-assisted laparoscopy versus conventional laparoscopy and laparotomy for endometrial cancer: A systematic review and meta-analysis. Gynecol Oncol 2023; 174:55-67. [PMID: 37149906 DOI: 10.1016/j.ygyno.2023.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 04/11/2023] [Accepted: 04/28/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Robotic-assisted laparoscopy (RALS) has gained widespread acceptance in the field of gynecological oncology. However, whether the prognosis of endometrial cancer after RALS is superior to conventional laparoscopy (CLS) and laparotomy (LT) remains inconclusive. Therefore, the aim of this meta-analysis was to compare the long-term survival outcomes of RALS with CLS and LT for endometrial cancer. METHODS A systematic literature search was conducted on electronic databases (PubMed, Cochrane, EMBASE and Web of Science) until May 24, 2022, followed by a manual search. Based on inclusion and exclusion criteria, publications investigating long-term survival outcomes after RALS vs CLS or LT in endometrial cancer patients were collected. The primary outcomes included overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS) and disease-free survival (DFS). Fixed effects models or random effects models were employed to calculate the pooled hazard ratios (HRs) and 95% confidence intervals (CIs) as appropriate. Heterogeneity and publication bias were also assessed. RESULTS RALS and CLS had no difference in OS (HR = 0.962, 95% CI: 0.922-1.004), RFS (HR = 1.096, 95% CI: 0.947-1.296), and DSS (HR = 1.489, 95% CI: 0.713-3.107) for endometrial cancer; however, RALS was significantly associated with favorable OS (HR = 0.682, 95% CI: 0.576-0.807), RFS (HR = 0.793, 95% CI: 0.653-0.964), and DSS (HR = 0.441, 95% CI: 0.298-0.652) when compared with LT. In the subgroup analysis of effect measures and follow-up length, RALS showed comparable or superior RFS/OS to CLS and LT. In early-stage endometrial cancer patients, RALS had similar OS but worse RFS than CLS. CONCLUSIONS RALS is safe in the management of endometrial cancer, with long-term oncological outcomes equivalent to CLS and superior to LT.
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Affiliation(s)
- Hanlin Fu
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiahui Zhang
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shiyi Zhao
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Nannan He
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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11
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Perrone E, Capasso I, De Felice F, Giannarelli D, Dinoi G, Petrecca A, Palmieri L, Foresta A, Nero C, Arciuolo D, Lorusso D, Zannoni GF, Scambia G, Fanfani F. Back to the future: The impact of oestrogen receptor profile in the era of molecular endometrial cancer classification. Eur J Cancer 2023; 186:98-112. [PMID: 37062213 DOI: 10.1016/j.ejca.2023.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE The aim of this study is to evaluate the impact of the oestrogen receptor (ER) profile on oncologic outcomes in the new endometrial cancer (EC) risk classification. METHODS Immunohistochemistry (IHC) analyses were performed in a retrospectively reviewed large series of ECs to assess the presence/absence of oestrogen receptors (ER0\1+ or ER2+\3+) and other molecular factors (i.e. p53 mutation, p53mut; and mismatch repair mutational status, MMRd (mismatch repair deficient) versus MMRp (mismatch repair proficient)), histopathologic and clinical outcomes. ER status was correlated with molecular, histologic, clinical and prognostic data. RESULTS 891 EC patients were included in the study (211 ER0\1+ and 680 ER2+\3+). The ER0\1+ phenotype was associated with an unfavourable clinicopathological profile (i.e. grading, histotype, lymphovascular space invasion (LVSI), stages, etc.). Simple regression showed that risk class, p53mut, and ER0/1+ impacted on both disease-free survival (DFS) and overall survival (OS) (p < 0.05). In the ER0/1+ population, p53mut no longer influenced DFS and OS (p > 0.05). In multiple regression, age, high and advanced/metastatic risk classes influenced survival outcomes (p < 0.05), but lost significance in the ER0/1+ population (p > 0.05). ER-positivity retained a remarkable prognostic impact even after stratification of the population according to the European Society of Gynaecological Oncology, the European Society for Radiotherapy and Oncology, and the European Society of Pathology (ESGO/ESTRO/ESP) 2021 risk classes and molecular classification. ER0/1+ intermediate, high-intermediate, high and advanced risk versus ER2+/3+ intermediate, high-intermediate, high and advanced risk classes showed statistically different OS and DFS (p< 0.001). ER0/1+ status was associated with a worse prognosis when associated with MMRp, MMRd and p53mut compared to the same molecular classes associated with ER2+/3 (p < 0.001). CONCLUSIONS We demonstrated that ER status has a significant impact on oncologic outcomes, regardless of risk class and p53/MMR status. Based on our results, we recommend the inclusion of ER assessment in featured EC risk classification system.
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Affiliation(s)
- Emanuele Perrone
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy
| | - Ilaria Capasso
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Diana Giannarelli
- Facility of Epidemiology and Biostatistics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Roma, Italy
| | - Giorgia Dinoi
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy
| | - Alessandro Petrecca
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Luca Palmieri
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Aniello Foresta
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Camilla Nero
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy
| | - Damiano Arciuolo
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Gyneco-pathology and Breast Pathology Unit, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Domenica Lorusso
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy.
| | - Gian Franco Zannoni
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, Gyneco-pathology and Breast Pathology Unit, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Fanfani
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
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12
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Clinical Relevance of Uterine Manipulation on Oncologic Outcome in Robot-Assisted versus Open Surgery in the Management of Endometrial Cancer. J Clin Med 2023; 12:jcm12051950. [PMID: 36902743 PMCID: PMC10004409 DOI: 10.3390/jcm12051950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/10/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023] Open
Abstract
In this study, we investigated the impact of uterine manipulation on endometrial cancer survival outcomes. We analyzed patients with endometrial cancer who underwent robot-assisted staging and open staging surgery between 2010 and 2020. Either uterine manipulators or vaginal tubes were utilized in robot-assisted staging. Propensity score matching was performed to correct baseline characteristics. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier curve analysis. In total, 574 patients, including those undergoing robot-assisted staging with a uterine manipulator (n = 213) or vaginal tube (n = 147) and staging laparotomy (n = 214), were analyzed. Propensity score matching was performed for age, histology, and stage as covariates. Before matching, Kaplan-Meier curve analysis showed that PFS and OS were significantly different among the three groups (p < 0.001 and p = 0.009, respectively). In the propensity-matched cohorts of 147 women, the previously suggested differences in PFS and OS were not observed in patients undergoing robot-assisted staging with a uterine manipulator or vaginal tube or open surgery. In conclusion, robotic surgery using a uterine manipulator or vaginal tube did not compromise survival outcomes in endometrial cancer management.
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13
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Perrone E, De Felice F, Capasso I, Distefano E, Lorusso D, Nero C, Arciuolo D, Zannoni GF, Scambia G, Fanfani F. The immunohistochemical molecular risk classification in endometrial cancer: A pragmatic and high-reproducibility method. Gynecol Oncol 2022; 165:585-593. [PMID: 35341588 DOI: 10.1016/j.ygyno.2022.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/27/2022] [Accepted: 03/13/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The aim of this study is to assess the clinical reproducibility and the potential oncological validity of the molecular information provided by the immunohistochemistry (IHC) to properly stratify the endometrial cancer patients. METHODS Retrospective IHC analyses were conducted in a large series of 778 pre-operative uterine-confined ECs, studying the presence/absence of MLH1, MSH2, MSH6 and PMS2 to define the mismatch repair (MMR) stable or instable phenotype; the presence of p53 mutations and other molecular features. The molecular profile was correlated with histological, clinical and prognostic data. RESULTS Based on IHC assessment, we defined 3 EC populations: stable MMR patients (MMRs), instable patients (MMRi) and p53 mutated patients (p53+). Our result demonstrated that the IHC stratification statistically correlated with the most relevant pathologic-clinical features: FIGO stage (p < 0.001), grading (p < 0.001), histotype (p < 0.001), presence of LVSI (p < 0.001), myometrial invasion and tumor dimension (p = 0.003 for both). These 3 IHC populations statistically reflected the EC risk class ESGO-ESMO-ESP classification 2021 (p < 0.001). These results were also confirmed in the Kaplan-Meier curves in terms of overall survival (OS) and disease-free survival (DFS) (p < 0.0001). The multivariate analyses demonstrated that absence of estrogen receptor (ER) impacted the OS (p = 0.011) and, the Age > 60 years and the ER-status the DFS (p = 0.041 and p = 0.004). CONCLUSION In this large series, we demonstrated that the pragmatic and systematic use of IHC may have an important role to properly stratify, in terms of histological features and clinical outcomes, the EC patients.
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Affiliation(s)
- Emanuele Perrone
- Agostino Gemelli IRCCS University Hospital Foundation, Department of Women, Children and Public Health Sciences, Gynecologic Oncology Unit, Rome, Italy
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | | | | | - Domenica Lorusso
- Agostino Gemelli IRCCS University Hospital Foundation, Department of Women, Children and Public Health Sciences, Gynecologic Oncology Unit, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy.
| | - Camilla Nero
- Agostino Gemelli IRCCS University Hospital Foundation, Department of Women, Children and Public Health Sciences, Gynecologic Oncology Unit, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Damiano Arciuolo
- Agostino Gemelli IRCCS University Hospital Foundation, Department of Women, Children and Public Health Sciences, Gyneco-Pathology and Breast Pathology Unit, Rome, Italy
| | - Gian Franco Zannoni
- Catholic University of the Sacred Heart, Rome, Italy; Agostino Gemelli IRCCS University Hospital Foundation, Department of Women, Children and Public Health Sciences, Gyneco-Pathology and Breast Pathology Unit, Rome, Italy
| | - Giovanni Scambia
- Agostino Gemelli IRCCS University Hospital Foundation, Department of Women, Children and Public Health Sciences, Gynecologic Oncology Unit, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Fanfani
- Agostino Gemelli IRCCS University Hospital Foundation, Department of Women, Children and Public Health Sciences, Gynecologic Oncology Unit, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
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14
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Argenta PA, Mattson J, Rivard CL, Luther E, Schefter A, Vogel RI. Robot-assisted versus laparoscopic minimally invasive surgery for the treatment of stage I endometrial cancer. Gynecol Oncol 2022; 165:347-352. [PMID: 35314086 PMCID: PMC9299557 DOI: 10.1016/j.ygyno.2022.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Recent reports in both cervical and endometrial cancer suggest that minimally invasive surgery (MIS) had an unanticipated negative impact on long-term clinical outcomes, including recurrence and death. Given increasing use of robotic surgery since the LAP2 trial, we sought to compare the intermediate and long-term outcomes between those who underwent robotic surgery or laparoscopy for Stage I endometrial cancer. METHODS We performed a retrospective review of patients from a single, large, academic, urban practice who underwent either laparoscopic or robot-assisted MIS (RA-MIS) for the treatment of endometrial carcinoma between 2006 and 2016, ensuring at least 5 years of potential follow-up. To adjust for differences in confounding variables between groups, propensity score-based inverse probability of treatment weighting (IPTW) was performed. Overall and recurrence-free survival were compared using Cox proportional hazards regression models adjusting for confounding weights. RESULTS 1027 patients were included; 461 received laparoscopy and 566 received RA-MIS. RA-MIS use increased steadily during the study window, which resulted in longer mean surveillance in laparoscopy group (median 8.7 years versus 6.3 years, p < 0.001). RA-MIS was associated poorer recurrence-free (HR: 1.41, 95% CI: 1.12, 1.77) and overall survival (HR: 1.39, 95% CI: 1.06, 1.83). Disease-specific survival was also poorer in the RA-MIS group (HR: 3.51, 95% CI: 2.19, 5.63). Among those who recurred, median time to first recurrence was shorter in the RA-MIS group than the laparoscopy group (16.3 vs. 28.7 months, p = 0.07). CONCLUSION RA-MIS was associated with poorer long-term patient outcomes. Our data in this lower-risk population indicate relevant clinical endpoints may be occurring during intermediate and long-term follow-up windows. These findings support a prospective evaluation of the long-term outcomes of RA-MIS.
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15
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Bogani G, Scambia G, Cimmino C, Fanfani F, Costantini B, Loverro M, Ferrandina G, Landoni F, Bazzurini L, Grassi T, Vitobello D, Siesto G, Perrone AM, Zanagnolo V, De Iaco P, Multinu F, Ghezzi F, Casarin J, Berretta R, Capozzi VA, Zupi E, Centini G, Pellegrino A, Corso S, Stevenazzi G, Montoli S, Boschi AC, Comerci G, Greco P, Martinello R, Sopracordevole F, Giorda G, Simoncini T, Caretto M, Sartori E, Ferrari F, Cianci A, Sarpietro G, Matarazzo MG, Zullo F, Bifulco G, Morelli M, Ferrero A, Biglia N, Barra F, Ferrero S, Leone Roberti Maggiore U, Cianci S, Chiantera V, Ercoli A, Sozzi G, Martoccia A, Schettini S, Orlando T, Cannone FG, Ettore G, Puppo A, Borghese M, Martinelli C, Muzii L, Di Donato V, Driul L, Restaino S, Bergamini A, Candotti G, Bocciolone L, Plotti F, Angioli R, Mantovani G, Ceccaroni M, Cassani C, Dominoni M, Giambanco L, Amodeo S, Leo L, Thomasset R, Raimondo D, Seracchioli R, Malzoni M, Gorlero F, Di Luca M, Busato E, Kilzie S, Dell'Acqua A, Scarfone G, Vercellini P, Petrillo M, Dessole S, Capobianco G, Ciavattini A, Delli Carpini G, Giannella L, Mereu L, Tateo S, Sorbi F, Fambrini M, Cicogna S, Romano F, Ricci G, Trojano G, Consonni R, Cantaluppi S, Lippolis A, Tinelli R, D'Ippolito G, Aguzzoli L, Mandato VD, Palomba S, Calandra D, Rosati M, Gallo C, Surico D, Remorgida V, Ruscitto F, Beretta P, Benedetti Panici P, Raspagliesi F. Characteristics and patterns of care of endometrial cancer before and during COVID-19 pandemic. J Gynecol Oncol 2021; 33:e10. [PMID: 34910391 PMCID: PMC8728669 DOI: 10.3802/jgo.2022.33.e10] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/03/2021] [Accepted: 10/28/2021] [Indexed: 11/30/2022] Open
Abstract
Objective Coronavirus disease 2019 (COVID-19) outbreak has correlated with the disruption of screening activities and diagnostic assessments. Endometrial cancer (EC) is one of the most common gynecological malignancies and it is often detected at an early stage, because it frequently produces symptoms. Here, we aim to investigate the impact of COVID-19 outbreak on patterns of presentation and treatment of EC patients. Methods This is a retrospective study involving 54 centers in Italy. We evaluated patterns of presentation and treatment of EC patients before (period 1: March 1, 2019 to February 29, 2020) and during (period 2: April 1, 2020 to March 31, 2021) the COVID-19 outbreak. Results Medical records of 5,164 EC patients have been retrieved: 2,718 and 2,446 women treated in period 1 and period 2, respectively. Surgery was the mainstay of treatment in both periods (p=0.356). Nodal assessment was omitted in 689 (27.3%) and 484 (21.2%) patients treated in period 1 and 2, respectively (p<0.001). While, the prevalence of patients undergoing sentinel node mapping (with or without backup lymphadenectomy) has increased during the COVID-19 pandemic (46.7% in period 1 vs. 52.8% in period 2; p<0.001). Overall, 1,280 (50.4%) and 1,021 (44.7%) patients had no adjuvant therapy in period 1 and 2, respectively (p<0.001). Adjuvant therapy use has increased during COVID-19 pandemic (p<0.001). Conclusion Our data suggest that the COVID-19 pandemic had a significant impact on the characteristics and patterns of care of EC patients. These findings highlight the need to implement healthcare services during the pandemic. The prevalence of patients with early-stage endometrial cancer (EC) has been lower during coronavirus disease 2019 (COVID-19) pandemic than before its onset. Further evidence is needed to assess the impact of COVID-19 pandemic on survival outcomes of EC patients.
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Affiliation(s)
- Giorgio Bogani
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
| | - Giovanni Scambia
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Chiara Cimmino
- Department of Obstetrics and Gynaecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy.
| | - Francesco Fanfani
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Barbara Costantini
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Matteo Loverro
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gabriella Ferrandina
- Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Fabio Landoni
- Department of Obstetrics and Gynaecology, San Gerardo Hospital, Monza, Italy
| | - Luca Bazzurini
- Department of Obstetrics and Gynaecology, San Gerardo Hospital, Monza, Italy
| | - Tommaso Grassi
- Department of Obstetrics and Gynaecology, San Gerardo Hospital, Monza, Italy
| | - Domenico Vitobello
- Unit of Gynecology, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Gabriele Siesto
- Unit of Gynecology, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | | | - Vanna Zanagnolo
- Department of Gynecologic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Francesco Multinu
- Department of Gynecologic Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynaecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy
| | - Jvan Casarin
- Department of Obstetrics and Gynaecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy
| | - Roberto Berretta
- Department of Obstetrics and Gynaecology, University of Parma, Parma, Italy
| | - Vito A Capozzi
- Department of Obstetrics and Gynaecology, University of Parma, Parma, Italy
| | - Errico Zupi
- Department of Obstetrics and Gynaecology, University of Siena, Siena, Italy
| | - Gabriele Centini
- Department of Obstetrics and Gynaecology, University of Siena, Siena, Italy
| | - Antonio Pellegrino
- Department of Obstetrics and Gynaecology, ASST Lecco - Ospedale Alessandro Manzoni, Lecco, Italy
| | - Silvia Corso
- Department of Obstetrics and Gynaecology, ASST Lecco - Ospedale Alessandro Manzoni, Lecco, Italy
| | - Guido Stevenazzi
- Department of Obstetrics and Gynaecology, ASST OVEST MI, Legnano (Milan) Hospital, Legnano, Italy
| | - Serena Montoli
- Department of Obstetrics and Gynaecology, ASST OVEST MI, Legnano (Milan) Hospital, Legnano, Italy
| | - Anna Chiara Boschi
- Department of Obstetrics and Gynaecology, AUSL Romagna, Ospedale "Santa Maria delle Croci", Ravenna, Italy
| | - Giuseppe Comerci
- Department of Obstetrics and Gynaecology, AUSL Romagna, Ospedale "Santa Maria delle Croci", Ravenna, Italy
| | - Pantaleo Greco
- Clinica Ostetrica e Ginecologica - Dipartimento Scienze Mediche - Università di Ferrara, Ferarra, Italy
| | - Ruby Martinello
- Clinica Ostetrica e Ginecologica - Dipartimento Scienze Mediche - Università di Ferrara, Ferarra, Italy
| | - Francesco Sopracordevole
- Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - Giorgio Giorda
- Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marta Caretto
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Enrico Sartori
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Federico Ferrari
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonio Cianci
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, University of Catania, Catania, Italy
| | - Giuseppe Sarpietro
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, University of Catania, Catania, Italy
| | - Maria Grazia Matarazzo
- Department of General Surgery and Medical Surgical Specialties, Gynecological Clinic, University of Catania, Catania, Italy
| | - Fulvio Zullo
- Department of Obstetrics and Gynaecology, Azienda Ospedaliera Universitaria - Federico II, Naples, Italy
| | - Giuseppe Bifulco
- Department of Obstetrics and Gynaecology, Azienda Ospedaliera Universitaria - Federico II, Naples, Italy
| | - Michele Morelli
- Department of Obstetrics and Gynaecology, AO "S.S. Annunziata", Cosenza, Italy
| | - Annamaria Ferrero
- Academic Department of Obstetrics and Gynecology, Mauriziano Hospital, Torino, Italy
| | - Nicoletta Biglia
- Academic Department of Obstetrics and Gynecology, Mauriziano Hospital, Torino, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Stefano Cianci
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - Alfredo Ercoli
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Giulio Sozzi
- Department of Gynecologic Oncology, University of Palermo, Palermo, Italy
| | - Angela Martoccia
- Department of Obstetrics and Gynaecology, AOR San Carlo, Potenza, Italy
| | - Sergio Schettini
- Department of Obstetrics and Gynaecology, AOR San Carlo, Potenza, Italy
| | - Teresa Orlando
- Department of Obstetrics and Gynaecology, AOR San Carlo, Potenza, Italy
| | - Francesco G Cannone
- Department of Obstetrics and Gynaecology, ARNAS Garibaldi Catania, Catania, Italy
| | - Giuseppe Ettore
- Department of Obstetrics and Gynaecology, ARNAS Garibaldi Catania, Catania, Italy
| | - Andrea Puppo
- Department of Obstetrics and Gynaecology, ASO Santa Croce e Carle, Cuneo, Italy
| | - Martina Borghese
- Department of Obstetrics and Gynaecology, ASO Santa Croce e Carle, Cuneo, Italy
| | - Canio Martinelli
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Lorenza Driul
- Department of Maternal and Child Health, University-Hospital of Udine, Udine, Italy
| | - Stefano Restaino
- Department of Maternal and Child Health, University-Hospital of Udine, Udine, Italy
| | - Alice Bergamini
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giorgio Candotti
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Luca Bocciolone
- Department of Obstetrics and Gynaecology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Francesco Plotti
- Department of Obstetrics and Gynecology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Roberto Angioli
- Department of Obstetrics and Gynecology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Giulia Mantovani
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital Negrar, Verona, Italy
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecology Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital Negrar, Verona, Italy
| | - Chiara Cassani
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Mattia Dominoni
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Laura Giambanco
- Department of Obstetrics and Gynecology, S. Antonio Abate Hospital, Trapani, Italy and Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Silvia Amodeo
- Department of Obstetrics and Gynecology, S. Antonio Abate Hospital, Trapani, Italy and Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Livio Leo
- Departments of Gynecology & Obstetrics, Hopital Beauregard, AUSL Valleè d'Aoste, Aosta, Italy
| | - Raphael Thomasset
- Departments of Gynecology & Obstetrics, Hopital Beauregard, AUSL Valleè d'Aoste, Aosta, Italy
| | - Diego Raimondo
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Univeristaria di Bologna. S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Renato Seracchioli
- Division of Gynaecology and Human Reproduction Physiopathology, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Univeristaria di Bologna. S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Mario Malzoni
- Endoscopica Malzoni, Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
| | - Franco Gorlero
- Department of Obstetrics and Gynaecology, Ente Ospedaliero Ospedali Galliera, Genova, Italy
| | - Martina Di Luca
- Department of Obstetrics and Gynaecology, Ente Ospedaliero Ospedali Galliera, Genova, Italy
| | - Enrico Busato
- Department of Obstetrics and Gynaecology, Ospedale di Treviso, Treviso, Italy
| | - Sami Kilzie
- Department of Obstetrics and Gynaecology, Ospedale di Treviso, Treviso, Italy
| | - Andrea Dell'Acqua
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Scarfone
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Vercellini
- Gynaecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Petrillo
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Salvatore Dessole
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Giampiero Capobianco
- Gynecologic and Obstetric Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Andrea Ciavattini
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Giovanni Delli Carpini
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Luca Giannella
- Gynecologic Section, Department of Odontostomatologic and Specialized Clinical Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Liliana Mereu
- Gynecological Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | - Saverio Tateo
- Gynecological Oncology Unit, Santa Chiara Hospital, Trento, Italy
| | - Flavia Sorbi
- Gynecology Unit, Careggi University Hospital, Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Massimiliano Fambrini
- Gynecology Unit, Careggi University Hospital, Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Stefania Cicogna
- Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Federico Romano
- Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy
| | - Giuseppe Ricci
- Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo', Trieste, Italy.,Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Giuseppe Trojano
- Department of Obstetrics and Gynaecology, Madonna delle Grazie Hospital ASM, Matera, Italy
| | | | | | - Antonio Lippolis
- Unit of Obstetrics and Gynaecology, Valle D'Itra Hospital, Martina Franca, Taranto, Italy
| | - Raffaele Tinelli
- Unit of Obstetrics and Gynaecology, Valle D'Itra Hospital, Martina Franca, Taranto, Italy
| | - Giovanni D'Ippolito
- Unit of Obstetrics and Gynecology, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Lorenzo Aguzzoli
- Unit of Obstetrics and Gynecology, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Vincenzo D Mandato
- Unit of Obstetrics and Gynecology, Azienda Unità Sanitaria Locale - IRCCS, Reggio Emilia, Italy
| | - Stefano Palomba
- Unit of Obstetrics and Gynecology, GOM of Reggio Calabria & Magna Grcia University of Catanzaro, Catanzaro, Italy
| | - Davide Calandra
- Unit of Obstetrics and Gynecology, University G. D'Annunzio of Chieti, Pescara, Italy
| | - Maurizio Rosati
- Unit of Obstetrics and Gynecology, University G. D'Annunzio of Chieti, Pescara, Italy.,Unit of Obstetrics and Gynecology, Santo Spirito Hospital, Pescara, Italy
| | - Cinzia Gallo
- Unit of Obstetrics and Gynecology, Università "Magna Graecia" di Catanzaro - AO "Pugliese - Ciaccio" Catanzaro, Italy
| | - Daniela Surico
- Unit of Obstetrics and Gynecology, University of Eastern Piedmont, Novara, Italy
| | - Valentino Remorgida
- Unit of Obstetrics and Gynecology, University of Eastern Piedmont, Novara, Italy
| | - Francesco Ruscitto
- Gynecology Unit, Ospedale Valduce, Como - ASST Lariana, S. Anna, Como, Italy
| | - Paolo Beretta
- Gynecology Unit, Ospedale Valduce, Como - ASST Lariana, S. Anna, Como, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Francesco Raspagliesi
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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16
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Gueli Alletti S, Perrone E, Fedele C, Cianci S, Pasciuto T, Chiantera V, Uccella S, Ercoli A, Vizzielli G, Fagotti A, Gallotta V, Cosentino F, Costantini B, Restaino S, Monterossi G, Rosati A, Turco LC, Capozzi VA, Fanfani F, Scambia G. A Multicentric Randomized Trial to Evaluate the ROle of Uterine MANipulator on Laparoscopic/Robotic HYsterectomy for the Treatment of Early-Stage Endometrial Cancer: The ROMANHY Trial. Front Oncol 2021; 11:720894. [PMID: 34568050 PMCID: PMC8461311 DOI: 10.3389/fonc.2021.720894] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/09/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This prospective randomized trial aimed to assess the impact of the uterine manipulator in terms of lymph vascular space invasion (LVSI) in patients undergoing minimally invasive staging for early-stage endometrial cancer. METHODS In this multicentric randomized trial, enrolled patients were randomly allocated in two groups according to the no use (arm A) or the use (arm B) of the uterine manipulator. Inclusion criteria were G1-G2 early-stage endometrial cancer at preoperative evaluation. The variables collected included baseline demographic characteristics, perioperative data, final pathology report, adjuvant treatment, and follow-up. RESULTS In the study, 154 patients (76 in arm A and 78 in arm B) were finally included. No significant differences were recorded regarding the baseline characteristics. A statistically significant difference was found in operative time for the laparoscopic staging (p=0.005), while no differences were reported for the robotic procedures (p=0.419). The estimated blood loss was significantly lower in arm A (p=0.030). No statistically significant differences were recorded between the two study groups in terms of peritoneal cytology, LVSI (p=0.501), and pattern of LVSI (p=0.790). No differences were detected in terms of overall survival and disease-free survival (p=0.996 and p=0.480, respectively). Similarly, no differences were recorded in the number of recurrences, 6 (7.9%) in arm A and 4 (5.2%) in arm B (p=0.486). The use of the uterine manipulator had no impact on DFS both at univariable and multivariable analyses. CONCLUSIONS The intrauterine manipulator does not affect the LVSI in early-stage endometrial cancer patients undergoing laparoscopic/robotic staging. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov, identifier (NCT: 02762214).
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Affiliation(s)
- Salvatore Gueli Alletti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Obstetrics and Gynecology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Emanuele Perrone
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Camilla Fedele
- Institute of Obstetrics and Gynecology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Cianci
- Department of Human Pathology of Adult and Childhood “G. Barresi,” Unit of Gynecology and Obstetrics, University of Messina, Messina, Italy
| | - Tina Pasciuto
- STAR Center (Statistics Technology Archiving Research), Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
| | - Vito Chiantera
- Department of Gynecologic Oncology, ARNAS Civico Di Cristina Benfratelli, Università di Palermo, Palermo, Italy
| | - Stefano Uccella
- Department of Obstetrics and Gynecology, AOUI Verona, Università di Verona, Verona, Italy
| | - Alfredo Ercoli
- Division of Obstetrics and Gynecology, Università degli studi di Messina, Policlinico G. Martino, Messina, Italy
| | - Giuseppe Vizzielli
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Obstetrics and Gynecology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Obstetrics and Gynecology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio Gallotta
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Obstetrics and Gynecology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Cosentino
- Division of Gynecologic Oncology, Gemelli-Molise, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Barbara Costantini
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Obstetrics and Gynecology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Restaino
- Department of Maternal and Child Health, University-Hospital of Udine, Udine, Italy
| | - Giorgia Monterossi
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Andrea Rosati
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Luigi Carlo Turco
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Vito Andrea Capozzi
- Department of Gynecology and Obstetrics of Parma, University of Parma, Parma, Italy
| | - Francesco Fanfani
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Obstetrics and Gynecology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Obstetrics and Gynecology, Universita’ Cattolica del Sacro Cuore, Rome, Italy
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