Comparative Study of Laparoscopic versus Conventional Open Surgical Staging Procedure for Endometrial Cancer: Our Institutional Experience

Unravelling the mystique of recurrence: A comparative analysis of surgical approaches for early-stage endometrial cancer

AIM

This study aims to compare long-term survival differences and recurrence patterns between robotic and open surgery for early-stage endometrial cancer (EC).

METHODS

This study was conducted retrospectively from 1st January 2015 to 30th June 2021 on all patients with stage I or stage II EC (FIGO 2023 Staging), irrespective of histology. The primary objective was to compare 3-year Recurrence-Free Survival (RFS) rates between robotic and laparotomy surgical approaches in patients with early-stage endometrial cancer.

RESULTS

In a study of 297 patients, 81.5 % underwent robotic surgeries and 18.5 % underwent open surgeries. Median age was 47.5 years. After a median follow-up period of 36 months, RFS rates of 92.5 % and 86.1 % in robotic and laparotomy groups, respectively (p = 0.6). Most recurrences were found at distant sites (77 %). No significant differences in recurrence sites between surgical groups (p > 0.05), but vaginal vault and para-aortic lymph node recurrences were exclusive to the robotic group. Median time to recurrence was significantly shorter in open group than robotic group (p = 0.01). Patients with focal LVSI (lymphovascular space invasion) had significantly higher recurrence rates compared to THOSE without LVSI (p = 0.04).

CONCLUSION

No significant difference in RFS rates between two surgical approaches. However, robot-assisted surgery leads to a longer median time before recurrence. Most recurrences are distant, and focal LVSI is significantly associated with these recurrences. It's important to consider focal LVSI in histopathology reports, and patients with early-stage endometrial cancer should be monitored for potential recurrences.

Treatment of endometrial cancer from 2000 to 2020 in Germany: a retrospective population based cohort study

PURPOSE

Endometrial cancer (EC) is one of the most common malignancies among women in western countries. This study aimed to assess data on patient treatment in Germany throughout two decades to evaluate the development and effect of surgery, radiation, and chemotherapy.

METHODS

This retrospective registry study included 34,349 EC patients diagnosed between 2000 and 2020. Patients were classified into five risk groups. Overall survival was analyzed by Kaplan-Meier method as well as univariable and multivariable Cox regression to evaluate risk factors and treatment options.

RESULTS

Over the study period, minimal invasive surgery was used more often compared to open surgery and was associated with better overall survival. Patients with advanced EC were more likely to receive multimodal therapy. Patients with intermediate risk EC had a good prognosis upon surgery, which further improved when radiotherapy was added. High-risk patients showed poorer prognosis but clearly benefited from additional radiotherapy. Survival of elderly high-risk patients with a non-endometrioid histology was improved when chemotherapy was added to surgery and radiotherapy.

CONCLUSION

Our study includes a large analysis of data from German clinical cancer registries on the care of endometrial cancer during two decades. We observed an increase of minimal invasive surgery. There is evidence that minimal invasive surgery is not inferior to open surgery. Adjuvant radio- and chemotherapy further improves survival depending on risk group and age.

A Review of Laparoscopic Para-aortic Lymphadenectomy for Early-stage Endometrial Cancer: Extraperitoneal Approach May Have the Advantage over Intraperitoneal Approach

The importance of lymphadenectomy, including para-aortic nodes, for the accurate staging of endometrial cancer, is well established. Although the therapeutic role of lymph node resection in endometrial cancer is still under debate, some studies support its usefulness for survival benefit. To predict the necessity of lymphadenectomy, several preoperative scoring systems have been proposed as being effective. For endometrial cancer, there is a trend towards minimally invasive surgery, including para-aortic lymphadenectomy. For para-aortic lymphadenectomy, there are two different approaches: the extraperitoneal approach and the transperitoneal approach. The extraperitoneal approach has advantages over the transperitoneal approach in terms of better access to the left aortic nodes, no interference of the bowel, and possibly better options for obese or elderly patients. However, the extraperitoneal approach may have a longer learning curve than the transperitoneal approach. Robot-assisted extraperitoneal para-aortic lymphadenectomy is feasible and safe and may be suitable for patients irrespective of their baseline characteristics.

Desmoid Tumor Mimicking Port Site Metastasis after Laparoscopic Surgery for Endometrial Cancer

Desmoid tumors are rare; however, they sometimes form in the abdominal wall after surgery or trauma. We report a case of desmoid tumors in the abdominal wall mimicking port-site metastasis after laparoscopic surgery for endometrial cancer. A 53-year-old woman with familial adenomatous polyposis presented to our hospital with vaginal bleeding and was diagnosed with endometrial cancer. We performed a total laparoscopic hysterectomy and began observation. Two years after surgery, follow-up computed tomography revealed three nodules with a size of approximately 15 mm in the abdominal wall at the trocar sites. Tumorectomy was performed because endometrial cancer recurrence was suspected, but desmoid fibromatosis was finally diagnosed. This is the first report of desmoid tumors at the trocar site after laparoscopic surgery for uterine endometrial cancer. Gynecologists should be aware of this disease because differentiating it from metastatic recurrence is challenging.

Association between subtypes of metabolic syndrome and prognosis in patients with stage I endometrioid adenocarcinoma: A retrospective cohort study

Purpose

To investigate the association between subtypes of metabolic syndrome (MetS) and prognosis of patients with stage I endometrioid adenocarcinoma.

Patients and methods

Patients with stage I endometrioid adenocarcinoma who received surgical treatment as primary therapy at the Department of Gynecology of the Sun Yat-sen Memorial Hospital between June 2015 and December 2019 were retrospectively enrolled. According to the diagnosis criteria of MetS, the patients were categorized as patients without MetS, patients with MetS but without raised fasting plasma glucose (FPG, including previously diagnosed diabetes), and patients with MetS and raised FPG. All the included patients were followed from the dates of surgery until death, June 2021, or loss to follow-up, whichever came first, and cancer recurrence (including metastasis) was studied as the main outcome. Cox regression was used to evaluate the associations between subtypes of MetS and the study outcome adjusting for potential confounding factors.

Results

Among the included 387 patients with stage I endometrioid adenocarcinoma, 193 (49.9%) were without MetS, 65 (16.8%) were with FPG not involving MetS, and 129 (33.3%) were with raised FPG involved MetS. With a median follow-up of 1,253 days, the cumulative incidence of cancer recurrence was 8.76% (95% confidence interval (CI) 2.5%-14.62%), 28.31% (95% CI 2.33%-47.38%), and 7.54% (95% CI 1.54%-13.17%), respectively. After adjusting for age, menopause, histological grade, tumor size, lymph-vascular space invasion, deep myometrial invasion, and treatments, comorbid FPG not involving MetS is a stronger risk factor of cancer recurrence than comorbid raised FPG involving MetS (hazard ratio 2.82 (95% CI 1.10-7.24) versus 1.18 (95% CI 0.45-3.13)) when compared to patients without MetS.

Conclusion

Comorbid MetS generally presents as a risk factor of poor prognosis in patients with stage I endometrioid adenocarcinoma after surgical treatment, but the magnitude of the association may vary between subtypes, in which FPG not involving MetS appears to be predominant.

[Non endometroid endometrial cancer guidelines evaluation: A multicentric retrospective study]

Introduction

Les carcinomes de l’endomètre de type 2 sont des cancers peu fréquents et de mauvais pronostique. Il existe très peu d’étude analysant leur prise en charge. L’objectif de l’étude était d’étudier la prise en charge des carcinomes de type 2 dans nos centres en évaluant l’application des recommandations.

Matériel et méthode

Il s’agit d’une étude multicentrique rétrospective enregistrant les cancers de l’endomètre de type 2 pris en charge de janvier 2009 à décembre 2019. Les analyses ont été adaptées aux dernières recommandations françaises appliquées par rapport à l’année de prise en charge.

Résultats

Soixante-quatorze carcinomes de type 2 ont été analysés dans dix centres: 34 carcinosarcomes (45,9 %), 29 carcinomes séreux (39,2 %), neuf carcinomes à cellules claires (12,2 %) et deux carcinomes indifférenciés (2,7 %). Lors de la prise en charge initiale, les recommandations étaient appliquées dans 45,9 % des cas. Le principal motif de non-application des recommandations était la non-réalisation d’une stadification ganglionnaire chirurgicale pour 20 patientes (57,1 %). Lors de la prise en charge adjuvante, les recommandations étaient appliquées dans 37,8 % des cas. Le principal motif de non-application des recommandations était la non-réalisation d’une restadification ganglionnaire chirurgicale ou radiologique pour 25 patientes (67,6 %).

Discussion

L’applicabilité des recommandations pour la prise en charge des carcinomes de type 2 reste difficile en raison de l’âge élevé et des comorbidités des patientes notamment pour la réalisation d’une stadification chirurgicale ganglionnaire pelvienne et lombo-aortique. L’utilisation de nouvelles techniques de stadification permettrait de mieux sélectionner les indications de curages ganglionnaires.