Abstract
ObjectiveThe aim of this retrospective study was to compare surgical and survival outcome in only patients with early-stage UCSs managed by laparotomic surgery (LPT) versus minimally invasive surgery (MIS).MethodsData were retrospectively collected in four Italian different institutions. Inclusion criteria were UCS diagnosis confirmed by the definitive histological examination, and stage I or II according to the FIGO staging system.ResultsBetween August 2000 and March 2019, the data relative to 170 patients bearing UCSs were collected: of these, 95 were defined as early-stage disease (stage I–II) based on the histological report at the primary surgery, and thus were included in this study. Forty-four patients were managed by LPT, and 51 patients were managed by MIS. The operative time was lower in the MIS group versus the LPT group (p value 0.021); the median estimated blood loss was less in the MIS group compared to the median of LPT group (p value < 0.0001). The length of hospital stay days was shorter in the MIS patients (p value < 0.0001). Overall, there were eight (8.4%) post-operative complications; of these, seven were recorded in the LPT group versus one in the MIS group (p value 0.023). There was no difference in the disease-free survival (DFS) and overall survival (OS) between the two groups.ConclusionThere was no difference of oncologic outcome between the two approaches, in face of a more favourable peri-operative and post-operative profile in the MIS group.
Highlights
Uterine carcinosarcomas (UCSs) are rare and aggressive malignancies characterized by the concomitant presence of carcinomatous and sarcomatous components (Akahira et al 2006; Cantrell et al 2015)
Assessment of pelvic lymph node status was carried out by lymphadenectomy (N = 47, 49.5%), or sampling (N = 9, 9.5%), while very old and/or unfitted patients, and patients intraoperatively judged to harbour excessive tissue fragility (N = 39) were not triaged to pelvic lymph node assessment; there was no difference in the distribution of lymph node procedures between the laparotomic surgery (LPT) and the minimally invasive surgery (MIS) group (p value 0.83)
UCSs are aggressive tumors, and are included in the “highrisk” group according to the ESMO-ESGO-ESTRO classification (Colombo et al 2016); the clinical outcome of UCSs is even worse than clear cell, and serous endometrial carcinomas (EC) (Koskas et al 2016; Fader et al 2016), emphasizing the need to better define the role of MIS focusing on this specific clinical setting
Summary
Uterine carcinosarcomas (UCSs) are rare and aggressive malignancies characterized by the concomitant presence of carcinomatous and sarcomatous components (Akahira et al 2006; Cantrell et al 2015). High grade, older age, and lymphovascular space invasion are more frequently documented in UCSs than in other EC types (Cantrell et al 2015; Abdulfatah et al 2019). In this context, it has to be acknowledged that UCSs display a mutational profile endowed with high copy number, and unfavourable clinical outcome (The Cancer Genome Atlas Research Network and Levine 2013; Leskela et al 2019; Carlson and McCluggage 2019). In early-stage disease, surgery represents the milestone of treatment, and includes total hysterectomy, bilateral salpingo-oophorectomy, pelvic and aortic lymphadenectomy, and peritoneal biopsies (Baekelandt and Castiglione 2009; Denschlag and Ulrich 2018) www.nccnguidelines.gov (2020); even though omentectomy or omental al sampling are not formally recommended, these procedures often carried out probably because microscopic involvement has been shown to account for 35% of omental disease, and could be missed (Ross et al 2018)
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