Abstract
ObjectiveTo evaluate the feasibility and efficacy of embryologically based compartmental surgery for locoregional tumor control in intermediate and high risk endometrial cancer: peritoneal mesometrial resection with therapeutic pelvic and para-aortic lymphadenectomy by robotically assisted laparoscopy.Methods75 consecutive surgically treated patients with uterine malignancies have been analyzed. 68 patients with histologically proven endometrial cancer and complete robotically assisted surgery have been included in this study on morbidity and oncological outcome. 56 % of the patients were at intermediate/high risk with either stage IAG3 or IB (n = 22) or stage II–IV (n = 16). Adjuvant EBRT was offered to three patients only (4 %), whereas five received isolated vaginal brachytherapy (7 %). Indocyanine-green (ICG) fluorescence lymphography is demonstrated being useful for additional intraoperative visualization of the compartment borders and lymphatic drainage to the postponed lymph compartments.ResultsAfter a mean follow-up of 32 months, there were only two loco-regional recurrences (2.9 %). Both recurrences were apparently cured by salvage therapy. 9 patients died; 6 (8.8 %) from metastatic disease (5) or unknown cause (1), 3 (4.4 %) from intercurrent disease without evidence of disease. One patient (1.4 %) experienced a peritoneal carcinosis and is alive. There were 8/68 perioperative complications (12 %). No perioperative mortality was observed.ConclusionsEmbryologically defined compartmental surgery by robotically assisted laparoscopy seems to be feasible and safe in endometrial cancer. The low loco-regional recurrence rate of 2.9 % in spite of a very low percentage of adjuvant radiotherapy and 56 % of intermediate/high risk tumors should stimulate to initiate a multicentre trial to evaluate the value of compartmental surgery for prevention of locoregional recurrence in endometrial cancer.
Highlights
Endometrial Cancer develops within the embryologically determined Mullerian compartment
The low loco-regional recurrence rate of 2.9 % in spite of a very low percentage of adjuvant radiotherapy and 56 % of intermediate/high risk tumors should stimulate to initiate a multicentre trial to evaluate the value of compartmental surgery for prevention of locoregional recurrence in endometrial cancer
For clinical perioperative analysis and follow-up the following inclusion criteria were defined: endometrial cancer including carcinosarcoma, hysterectomy and/or therapeutic lymphadenectomy performed by robotic surgery and no distant metastases at primary treatment
Summary
Endometrial Cancer develops within the embryologically determined Mullerian compartment. The ontogenetic theory suggests clinical cancer as the result of pathological reactivation of normally blocked developmental programs during embryogenesis in retrograde order [3]; tumor progression is confined for a very long time to the mature tissue embryologically derived from the same organ compartment as could be demonstrated for cervical cancer [4]. This is true for the spread to the corresponding draining lymphatic system of the compartment which is developed by sprouting from embryonal veins [5]; it is connected to the embryologically derived lymphatic compartments along the main pelvic and aortic vessels via so called ‘‘intercalated’’ lymph nodes. Since regional draining lymph nodes contain the same topic information as the drained organ compartment, this lymph compartment is permissive for growth since tumor cells are identified to be intrinsic [3]
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