Abstract
The purpose of the study was to evaluate the feasibility of laparoscopic approach versus laparotomy in endometrial cancer that extends to the cervix in the form of glandular extension and/or stromal invasion. A retrospective, single-center cohort study was conducted using data between 1995 and 2017 at an urban tertiary academic medical center. We identified patients who were diagnosed with endometrial cancer whose tumor involved the uterine cervix on final pathology. Operative and oncologic outcomes were compared between the patients who underwent minimally-invasive surgery (MIS) versus those who underwent laparotomy. A total of 282 patients with endometrial cancer were reviewed for the study. Among these patients, 76 patients underwent hysterectomy and surgical staging via MIS. There was no conversion from MIS to laparotomy. In the MIS group, shorter hospital stay (4.4 ± 2.3 days for MIS group vs. 7.1 ± 4.7 days for laparotomy group; p-value = 0.002) and less blood loss during the operations (228 mL vs. 478 mL, p-value < 0.001) were observed compared to the laparotomy group. The multivariate Cox regression analysis revealed that age at diagnosis, FIGO stage, histology grades, tumor size, lymph-vascular space invasion were independent prognostic markers for poor oncologic outcomes but the types of surgical approach (MIS vs. laparotomy) were not associated with it. The means by which colpotomy was performed (either intracorporeal or transvaginal) among the MIS group also did not affect patient survivals. Among the women with endometrial cancer that involved the uterine cervix, surgical treatment via MIS compared to laparotomy showed no difference in survival outcomes but better perioperative results. These findings support the use of MIS for these patient group.
Highlights
Endometrial cancer is the sixth most common malignancy worldwide and the most common gynecological malignancy in developed countries with new 380,000 patients diagnosed worldwide in2018 [1]
This was a retrospective cohort study including patients with endometrial cancer who were histologically confirmed with cervical stromal invasion and/or glandular extension on final pathology
We evaluated the patients with endometrial cancer that involved the cervix on final pathology and compared the outcomes between those who received minimally-invasive surgery (MIS) vs. laparotomy
Summary
Endometrial cancer is the sixth most common malignancy worldwide and the most common gynecological malignancy in developed countries with new 380,000 patients diagnosed worldwide in2018 [1]. Endometrial cancer is the sixth most common malignancy worldwide and the most common gynecological malignancy in developed countries with new 380,000 patients diagnosed worldwide in. The incidence of endometrial cancer is increasing due to increasing rates of obesity and life expectancy. Risk factors of endometrial cancer include the use of hormone therapy, diabetes, having. MIS in Endometrial Cancer fewer children and history of breast cancer [2, 3]. Of women, the disease is detected in the early stages, which results in cure rates greater than 90% [4]. The current standard treatment of endometrial cancer is total hysterectomy and bilateral salpingo-oophorectomy. The staging procedure encompasses pelvic and para-aortic lymph node assessment (either by dissection or sentinel lymph node mapping if feasible), omentectomy and peritoneal biopsy, depending on histologic type and stage. Laparotomy was used for surgical treatment, but since the
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