Surgery For Endometrial Cancer Research Articles

Resection of inferior vena cava, abdominal aorta, bilateral common iliac arteries, and bilateral partial external iliac arteries with artificial vessel replacement during radical endometrial cancer surgery: a case report

BackgroundEndometrial carcinoma (EC) is a common malignant tumor of the female reproductive system, often accompanied by lymph node metastasis. Artificial vascular implantation is a common surgical treatment for mediastinal tumors and abdominal aortic aneurysms but is rarely used in gynecological surgery.Case presentationA 54-year-old female patient was first admitted to the hospital in January 2018 due to “irregular vaginal bleeding over 3 months”. CT showed a mass in the uterine cavity, and several swollen lymph nodes in the retroperitoneum and pelvic cavity. The initial diagnosis was an endometrial malignant tumor. We performed radical endometrial cancer surgery with parallel resection of inferior vena cava, abdominal aorta, bilateral common iliac arteries, bilateral external iliac arteries, and artificial vessel replacement, which was successful, with good postoperative recovery and no lesion progression at 3 years postoperative follow-up.ConclusionThis is an early case of gynecological clinical use of prostheses. Through multidisciplinary cooperation, the surgical resection rate of patients with EC in radical surgery was improved without serious fatal complications and achieved a high long-term postoperative survival rate.

46 Incidence of tumor spill during minimally invasive hysterectomy for early-stage, low-grade endometrial cancer

Association of intraoperative tumor spill and adverse oncologic outcome has been reported in various gynecologic and non-gynecologic malignancies. To date, this association has not been examined in endometrial cancer surgery. The objective of this study was to examine the incidence of tumor spill during minimally invasive hysterectomy for early-stage, low-grade endometrial cancer. This is a retrospective observational study examining consecutive patients with stage I, grade 1–2 endometrioid endometrial cancer who underwent minimally invasive hysterectomy (laparoscopic, laparoscopic-assisted vaginal, or robotic-assisted laparoscopic) from 1/2014–12/2020. Three outcome measures were assessed from operative reports: (i) fallopian tubal ligation or ablation, (ii) use of intra-uterine manipulator (IUM) and experience of uterine perforation with the manipulator, and (iii) tumor spill at the time of colpotomy. Descriptive statistics for the outcome measures was performed. A total of 186 patients met inclusion criteria. The median age and body mass index were 55 and 33, respectively. The majority of tumors were stage IA (85.8%) and grade 1 endometrioid histology (88.1%). Fallopian tubal ligation / ablation was reported in 8.5%. IUM was used in 71.5%. Uterine perforation occurred in 1.5% among the IUM cases and 0% in the non-IUM cases (P=0.413). Tumor spill at colpotomy occurred 2.3% and 2.3% in the IUM and non-IUM groups, respectively (P=0.995). This study suggests that tumor spill can occur at minimally invasive hysterectomy for early-stage, low-grade endometrial cancer. Further study is warranted to validate the result of this study and to examine the association for oncologic outcome.

Association of Obesity and Surgery Outcomes in Patients with Endometrial Cancer: A Single-Center Analysis

Although obesity can result in high morbidity and mortality in surgical outcomes because of multiple comorbidities, determinants of outcome in obese patients who underwent endometrial cancer surgery remain unclear. The aim of this study is to assess the relationship between body mass index (BMI) and surgical outcomes in obese patients with endometrial cancer. An institutional retrospective review of the demographic details, clinical characteristics, and follow-up data of 142 patients with endometrial cancer who underwent surgery during a 72-month period was performed. The patients were divided into three groups based on their BMI; patients with BMI < 25 were identified as normal weight, patients with BMI between 25 and 30 were accepted as overweight, and those with BMI ≥ 30 kg/m2 were identified as obese. The groups' demographic and clinical variables were compared. Of the 142 patients, 42 were in the normal weight group, 55 in the overweight group, and 45 in the obese group. Age, surgical procedures, blood loss, preoperative health status, and metastatic lymph nodes did not show a significant difference between groups. However, surgery time and total lymph nodes were higher in the obese group. (p = 0.02, p = 0.00, and p = 0.00, respectively). Common complications were anemia, fever, intestinal injury, deep vein thrombosis, fascial dehiscence and urinary infection. There was no significant difference according to the complications. Our results indicated that higher BMI was significantly associated with a longer duration of endometrial cancer surgery. Minimally invasive surgeries and conventional laparotomy could be performed safely in obese patients.

Challenges in Treatment and the Importance of Radiotherapy in a Synchronous Endometrial and Breast Cancer

Abstract We report the case of a 69-year-old-female with synchronous endometrial and breast cancer. The imaging and pathology results confirmed the diagnosis. The patient underwent surgery and chemotherapy for endometrial cancer, and surgery followed by external beam radiotherapy for breast cancer. The patient’s clinical condition and imaging showed a favorable evolution after 2 months of follow-up.

Evaluation of vaginal brachytherapy for treating early-stage endometrial cancer according to the European Society of Medical Oncology 2020 risk stratification.

The aim was to evaluate vaginal brachytherapy (VB) after surgery in early-stage endometrial cancer. The patients with Stage I-II endometrial adeno-cancer operated between 1998 and 2018 and whose adjuvant therapies had been arranged were evaluated retrospectively. A total of 618 patients were enrolled. In 409 patients in the low-risk group, the vaginal, pelvic recurrence, and distant metastasis rates were found to be higher in the VB group. When the results of 112 patients in the intermediate-risk group were evaluated, there was no statistically significant difference between the vaginal, pelvic recurrence, and distance metastasis rates. In 89 patients in the intermediate-high risk group, vaginal recurrence rates were 0%, 4.8%, 0%, and 25% for VB, external beam radiotherapy, combination radiotherapy, and the follow-up groups, respectively (p=0.010), and pelvic recurrence rates were found to be 18.2%, 0%, 1.9% and 0% (p=0.036). Distant metastasis rates were 0%, 0%, 9.6% and 0% (p=0.229). When the overall survival in all groups was examined, no significant difference was found between the groups. In conclusion, no adjuvant treatment is a proper approach for low-risk patients. Brachytherapy can be considered a suitable option for the intermediate risk group. Combined treatments instead of VB in the high-intermediate risk group would be preferred in terms of local control.

Minimally Invasive Compared With Open Surgery in High-Risk Endometrial Cancer: A Systematic Review and Meta-analysis.

To compare outcomes between minimally invasive surgery and open surgery in patients with high-risk endometrial cancer. A cohort study of all patients who underwent surgery for high-risk endometrial cancer between 1999 and 2016 at Mayo Clinic (Rochester, Minnesota) and a literature search of MEDLINE, EMBASE, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, and Scopus of all published studies until December 2020. The systematic review identified 2,332 patients (14 studies, all retrospective except a subanalysis of a randomized comparison) and the cohort study identified 542 additional patients. Articles were included if reporting original data on overall survival and disease-free survival among patients with high-risk endometrial cancer, defined as International Federation of Gynecology and Obstetrics grade 3 endometrioid, serous, clear cell, mixed histology, or uterine carcinosarcoma. Studies that did not report at least one of the main outcomes, those in which one surgical technique (robotic or laparoscopic surgery) was missing in the comparison analysis with open surgery, and case reports were excluded. Additional data were extracted from a retrospective cohort of patients from Mayo. A random-effect model was used for meta-analysis. This systematic review and meta-analysis was registered in PROSPERO. Literature search and data extraction were performed independently by two reviewers, as well as quality assessment using GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology, and the Newcastle-Ottawa Scale. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Meta-analysis showed that disease-free survival and overall survival in patients with high-risk endometrial cancer who underwent minimally invasive surgery were not statistically different from those of patients who underwent open abdominal surgery (relative risk [RR] 0.93, 95% CI 0.82-1.05, I2 20%, P=.23; and RR 0.92, 95% CI 0.77-1.11, I2 31%, P=.12, respectively). Subgroup analysis by stage (early vs advanced) did not identify a difference between surgical approaches. Minimally invasive surgery and open surgery had similar disease-free survival and overall survival in patients with high-risk endometrial cancer. PROSPERO, CRD42021275535.

GPP02 Presentation Time: 8:10 AM: Evaluating the Relationship Between Vaginal Apex ``Dog Ears'' and Patterns of Recurrence in Endometrial Cancer Following Adjuvant Image Guided Vaginal Cuff Brachytherapy

<h3>Purpose</h3> The vaginal cuff is a common site of tumor recurrence following surgery for endometrial cancer, and adjuvant vaginal cuff brachytherapy (VCB) is indicated to reduce the risk of local recurrence. Following hysterectomy, many patients have redundant tissue at the lateral apex of the vaginal cuff ("dog ears"). This extra tissue may extend irregularly beyond the typical cylindrical dose distribution of radiation delivered during single channel VCB and it is hypothesized that they are a potential site of local treatment failure even after VCB. The effects of the presence and size of vaginal cuff "dog ears" on tumor recurrence is not yet fully understood. The aim of this study is to evaluate the prevalence and size of extra tissue at the vaginal apex, and whether these factors predict disease recurrence in patients treated with adjuvant VCB for endometrial cancer. <h3>Materials and Methods</h3> We retrospectively reviewed the medical records of 219 patients with early-stage endometrial cancer treated with image-guided single channel VCB at our institution from 2012 - 2021 with available brachytherapy planning CT simulation images. "Dog ears" were defined as the presence of additional soft tissue extending at least 10 mm from the apex of the vaginal cuff perpendicular to the surface of the brachytherapy applicator as defined on a coronal or axial CT simulation. Patient characteristics and outcomes including stage, size and laterality of dog ears, presence of air gaps, and patterns of failure were collected. Vaginal cuff recurrence (VCR) failure free survival was calculated from time of first brachytherapy to VCR and was estimated by the product limit method of Kaplan and Meier. Fisher's exact test was used to compare categorical variables and a multivariate logistic regression model was developed to evaluate the association of overall treatment failure with various factors of interest. <h3>Results</h3> We found that 57.5% of patients (n = 126) met our criteria for having "dog ears," which, on average, extended 23.8 mm (SD = 6.4) from the brachytherapy applicator. In total, 13 patients (5.9%) developed a VCR, 12 (5.5%) developed a regional recurrence, and 16 (7.3%) developed distant recurrence. There was no statistically significant difference in VCRs between patients with dog ears and those without dog ears (7.1% vs 4.3%, p=0.56). The various surgical approaches (abdominal, laparoscopic, transvaginal) did not have an increased propensity to result in dog ears (p=0.74). The 3-year probability of VCR failure-free survival is 86%. On multivariate analysis (MVA), no factors predicted for overall treatment failure including the presence of dog ears, maximum dimension of dog ears, FIGO stage, presence of air gaps at the applicator surface on post insertion CT images, or brachytherapy duration. There was a trend toward increased risk of recurrence with higher grade histology on MVA (p=0.0805). <h3>Conclusions</h3> In this investigation of a single institution experience with single-channel image-guided VCB, the presence of "dog ears" at the vaginal apex is prevalent; however, VCR remains low with distant metastases being the predominant site of failure. While dog ears appear to have little impact on overall recurrence patterns, these may be a factor to consider when planning adjuvant brachytherapy including choosing alternate applicators.

PO23 Presentation Time: 7:40 AM: Dosimetric Effects of Model-Based TG-186 Vaginal Cylinder Treatment Plans

<h3>Purpose</h3> The vaginal cuff is the main location of relapse after curative surgery for early-stage endometrial cancer. Adjuvant vaginal cylinder brachytherapy is increasingly used to decrease the risk of postoperative recurrence due to low vaginal cuff recurrence rates and low gastrointestinal toxicity. Current clinical treatment planning follows TG-43 guidance, which assumes that all material is water. Cylinder composition can vary substantially from water equivalent materials, highlighting the importance of investigations into the dosimetric impact of cylinder composition. In the present study, we evaluated dosimetric characteristics of plans utilizing TG-186, which provides a model-based calculation approach to account for heterogeneities in cylinder configuration. <h3>Materials and Methods</h3> Ten graphically planned vaginal cylinder plans were retrospectively evaluated in this study. Each patient was fitted with an Elekta cylinder (part# 084350) comprised primarily of polysulfone (PSU, 1.29g/cc) and secondarily of stainless steel (8.00g/cc) for the stem and rings. Cylinder diameters ranged from 2.5cm to 3.5cm, and treatment lengths from 4.0cm to 7.5cm. Dose prescription was 7Gy/fx x 3fx at 5mm depth for the most proximal 2cm of the cylinder and at cylinder surface for the remainder of the treatment length. Treatment planning was conducted in Oncentra Brachy 4.5.3. The original TG-43 plans (which assume a water-equivalent material, 1.00g/cc) were recalculated using Oncentra's Advanced Collapsed-Cone Engine (ACE) according to TG-186's guidance to account for differences in density. Dwell times were unchanged, so heterogeneity correction accounts for any dosimetric changes. Points placed at the middle of the 5mm depth portion and the middle of the surface depth portion - prescription dose for TG-43 - were compared, as were rectum points. In addition, all isodose lines were converted to contours and compared for the following metrics: percent volume change, Hausdorff distance (HD), mean distance to agreement (MDA), and Dice coefficient. A paired Wilcoxon signed-rank test assessed for significance. <h3>Results</h3> Recalculated TG-186 plans were found to have consistently and statistically significantly (p<0.05) less dose: 5mm depth: -10.5% +/- 2.4%, surface: -15.9% +/- 3.5%, and rectum: -12.1% +/- 3.4% average dose reduction. Compared to TG-43, the TG-186 100% isodose lines as contours show an average volume decrease of 22.2% +/- 2.5%, HD 4.6mm +/- 1.2mm, MDA 1.5mm +/- 0.3mm, and Dice 0.87 +/- 0.02. The high dose region as defined by 150% of prescription (25.7% volume decrease, HD 4.4mm, MDA 1.3mm) and the low dose region of 50% prescription (19.5% volume decrease, HD 8.2mm, MDA 1.9mm) show similar trends. <h3>Conclusions</h3> Ten TG-43 graphical vaginal cylinder plans were recalculated using TG-186 to account for the material composition of the cylinders. ACE calculations show that the dose delivered to target prescription points and to OARs may be less than originally planned, although the impact on treatment efficacy is presently unclear. Further studies on other cylinder models will be useful to evaluate the generalizability of these findings, as well as any potential effect on treatment.

Three Lymphadenectomy Strategies in Endometrial Carcinoma: Analysis of Long-Term Outcomes

<h3>Study Objective</h3> Sentinel node mapping (SNM) has replaced lymphadenectomy for staging surgery in apparent early-stage endometrial cancer (EC). Here, we evaluated the long-term survival of three different approaches of nodal assessment. <h3>Design</h3> This is a multi-institutional retrospective study evaluating long-term outcomes (at least 3 years of follow-up) of EC patients having nodal assessment between 2006 and 2016. In order to reduce possible confounding factors, we applied a propensity-matched algorithm. <h3>Setting</h3> Referral centers. <h3>Patients or Participants</h3> Consecutive patients with EC undergoing surgical staging. <h3>Interventions</h3> Surgical staging including SNM and/or lymphadenectomy. <h3>Measurements and Main Results</h3> Charts of 1,338 patients were evaluated: 398 (29.7%), 174 (13.1%), 187 (13.9%), and 579 (43.3%) no retroperitoneal staging, SNM, SNM followed by backup lymphadenectomy and lymphadenectomy, respectively. Applying a propensity score matching algorithm (1:1:2) we selected 500 patients: 125 SNM vs. 125 SNM plus backup lymphadenectomy vs. 250 lymphadenectomies. Baseline characteristics of the study population were similar between groups. The prevalence of nodal disease was 14%, 16%, and 12% in patients having SNM, SNM followed by backup lymphadenectomy and lymphadenectomy, respectively. Overall, 19 (7.6%) patients were diagnosed with low volume nodal disease. The mean (SD) follow-up time was 62 (±11) months. The survival analysis comparing the three techniques did not show statistical differences in terms of disease-free (p=0.750) and overall survival (p=0.899). Similarly, the type of nodal assessment did not impact survival outcomes after stratification on the basis of uterine risk factors (p>0.2). <h3>Conclusion</h3> Our study highlighted that SNM provides similar long-term oncologic outcomes than lymphadenectomy. Randomized controlled trials are needed to corroborate the value of SNM in EC.

7428 Oncologic Safety of Minimally Invasive Surgery in Non-Endometrioid Endometrial Cancer

<h3>Study Objective</h3> This study was aimed to compare the oncologic outcomes of patients with non-endometrioid endometrial cancer who underwent minimally invasive surgery with the outcomes of patients who underwent open surgery. <h3>Design</h3> retrospective study. <h3>Setting</h3> multi-institutional study. <h3>Patients or Participants</h3> patients with non-endometrioid endometrial cancer who were surgically staged by either minimally invasive surgery or open surgery. <h3>Interventions</h3> Oncologic outcomes of the patients were compared according to surgical approach. <h3>Measurements and Main Results</h3> 113 patients met the inclusion and exclusion criteria. 57 underwent minimally invasive surgery and 56 underwent open surgery. Patients who underwent minimally invasive surgery had smaller tumors (median size, 3.3 vs. 5.2%, <i>p</i>=0.0001) and a lower lymphovascular space invasion rate (29.8% vs. 48.2%, <i>p</i>=0.045). In the overall population, the numbers and rate of recurrence were significantly higher in the open surgery group (<i>p</i> = 0.016). In multivariate analysis, disease stage and tumor size were associated with DFS in contrast to surgical procedure. <h3>Conclusion</h3> Minimally invasive surgery showed similar survival outcomes when compared to open surgery in non-endometrioid endometrial cancer patients, irrespective of disease stage. When minimally invasive surgery is managed by expert surgeons, non-endometrioid histological subtypes should not be considered a contraindication for minimally invasive surgery.

7490 Perioperative Outcomes of the "Chopsticks Technique" Single-Site Laparoscopy Versus Traditional Laparoscopy for Endometrial Cancer

<h3>Study Objective</h3> To describe the new "chopsticks technique" single-site laparoscopic surgery technology and to compare the perioperative outcomes of the new "chopsticks technique" laparoendoscopic single-site surgery (LESS) versus traditional laparoscopic surgery (TLS) in the staging surgery of endometrial cancer (EC). <h3>Design</h3> Retrospective case-control study based on propensity score matching (PSM). <h3>Setting</h3> Department of gynecology at a tertiary medical center. <h3>Patients or Participants</h3> From August 2018 to August 2020 at Southwest Hospital in Chongqing, China, patients diagnosed with endometrial cancer, a total of 26 cases conducted LESS were matched with a cohort of 52 cases who underwent TLS. <h3>Interventions</h3> A propensity score matching was performed to reduce the bias due to the imbalanced baseline features between the two groups, and the perioperative outcomes were compared between matched cohorts. <h3>Measurements and Main Results</h3> We retrospectively reviewed 535 cases of patients diagnosed with endometrial cancer from our institutional database. A 1:2 propensity score matching was conducted matched by age, BMI, history of surgery, FIGO staging between the two groups. After matching, the variables were well balanced with no differences at baseline between groups. The operations in both groups were successfully completed without conversion to laparotomy. There were no statistically significant differences in the amount of intraoperative blood loss, number of lymph nodes removed, postoperative exhaust time, postoperative indwelling drainage time, postoperative hospital stay, etc. between the two groups (P>0.05). Meanwhile, compared with the TLS group, the LESS group has longer operation time, a lower pain score of 24-hour after surgery and a more satisfactory postoperative cosmetic effect, of which the difference was statistically significant (P <0.05). <h3>Conclusion</h3> It is undoubtedly safe and feasible for staging endometrial cancer to employ the "chopsticks technique" single-site laparoendoscopic with minimum scars from abdominal incisions, which results less pain and outstanding cosmetic effects. However, further prospective, randomized studies with larger samples are needed.

8201 The Identifying Renal Artery Variant during Retroperitoneal Laparoscopic Para-Aortic Lymphadenectomy

<h3>Study Objective</h3> To demonstrate of identifying one of the renal artery variants, triple renal artery in left during laparoscopic para-aortic lymphadenectomy <h3>Design</h3> Case study. <h3>Setting</h3> University hospital in Korea. <h3>Patients or Participants</h3> A 54-year-old Korean woman with postmenopausal bleeding and thickened endometrium> 3cm presented to our department. The histopathology of biopsied endometrium revealed grade 2 endometrioid adenocarcinoma. The preoperative MRI shows an about 6cm sized large volume of tumor within the endometrial cavity. <h3>Interventions</h3> Laparoscopy. <h3>Measurements and Main Results</h3> We perform the laparoscopic staging surgery for endometrial cancer. Firstly, we performed peritoneal washing cytology, LAVH, BSO, pelvic lymphadenectomy. We designated four area for para-aortic lymphadenectomy. During the procedure in area 4, it was confirmed that two left renal arteries were derived from the trunk of the aorta below the left renal vein. The left lower segmental artery was derived from the middle part of the inferior mesenteric artery and left renal vein. The middle segmental artery was derived just below left renal vein. The left main renal artery was located on the dorsal side of the left renal vein at its normal position. We carefully resected the para-aortic lymph nodes to prevent variant renal artery damage. <h3>Conclusion</h3> Laparoscopy is a feasible and safe approach to diagnosis of vascular anomaly during para-aortic lymphadenectomy for gynecologic malignancies. It is very important for the gynecologic oncologist to have knowledge of retroperitoneal vascular anatomy, experience in laparoscopic surgery, and an accurate surgical technique to avoid vascular injury during laparoscopic para-aortic lymphadenectomy.

Radiotherapy of an Isolated Port-Site Metastases after Laparoscopic Surgery for Endometrial Cancer: A Case Report

Port-site metastases after gynecologic oncology procedures have a reported incidence of 1-2% and in the 95% of cases had simultaneous carcinomatosis or metastases to other sites at the time of port-site metastasis detection suggesting that the presence of port site implantation is a surrogate for advanced disease. At the moment, only poor cases of isolated port-site metastasis after endometrial cancer have been reported in literature, we reported one of this cases

Locoregional Control Following Adjuvant Chemotherapy and Radiotherapy for Treatment of High-Risk Endometrial Cancer

<h3>Purpose/Objective(s)</h3> Patients with locally advanced stage and aggressive histology endometrial cancer are at high risk of relapse, and usually treatment includes surgery, chemotherapy and radiotherapy. The timing and coordination of chemotherapy and radiotherapy remain controversial, though historically we have delivered adjuvant radiotherapy after completion of chemotherapy. The premise being to avoid delaying chemotherapy, which confers an overall survival benefit. We decided to review oncologic outcomes and patterns of recurrence among our patients and compare them with the published literature. <h3>Materials/Methods</h3> A retrospective review was conducted to evaluate patients who underwent primary surgery for endometrial cancer between 2005 and 2017, had a final pathology demonstrating Stage I-II endometrial cancer of serous or clear cell histology, Stage III endometrial cancer of any histology or Stage IV endometrial cancer of endometrioid adenocarcinoma histology, and were considered appropriate for adjuvant chemotherapy and radiotherapy. Kaplan-Meier analysis was used to calculate progression-free survival (PFS) and overall survival (OS). <h3>Results</h3> A total of 140 patients met the eligibility criteria and were included, with a median age of 65. The distribution according to stage was as follows: 41 (29.3%) Stage I, 24 (17.1%) Stage II, 68 (48.6%) Stage III, and 7 (5.0%) Stage IV. Of these patients, 52 (37.1%) had endometrioid, 75 (53.6%) had serous, and 11 (7.9%) had clear cell histology. All patients received chemotherapy with the median start time being 49 days after initial surgery. In total, 120 (92%) completed 6 cycles of chemotherapy. The median start time for radiotherapy was 35 days after chemotherapy and 192 days after surgery, with 129 (92.1%) completing adjuvant radiotherapy. The median dose of external beam radiotherapy (EBRT) was 4500 cGy in 25 fractions and the median dose of vaginal brachytherapy, when used, was 1800 cGy in 3 fractions. In terms of EBRT technique, 54 were treated with traditional conformal fields and 74 with IMRT techniques. The median follow-up was 63.9 months and the 5-year PFS and OS rates were 69% and 66% respectively. A total of 42 patients (30.0%) developed a recurrence; of which 2 (1.4%) were local, 10 (7.1%) were locoregional (any with component of locoregional failure), 8 (5.7%) were isolated para-aortic and 27 (19.3%) were distant. Among the 129 patients receiving radiotherapy, 6 (4.6%) patients had locoregional failure. Only 7 (5.4%) of patients had an "in-field" recurrence after EBRT, with 4 (3.1%) among patients treated with conformal fields and 3 (2.3%) among those treated with IMRT. <h3>Conclusion</h3> Adjuvant radiotherapy given after completion of surgery and adjuvant chemotherapy leads to favorable outcomes with regards to PFS and OS (compared to published randomized studies), and still results in excellent locoregional control.

Transperitoneal vs extraperitoneal approach for aortic sentinel node detection in endometrial cancer

Although the sentinel lymph node technique in endometrial cancer is currently replacing pelvic and aortic lymphadenectomy for the evaluation of lymph node status in endometrial cancer, its performance is not yet standardized. This study aimed to describe the detection rates and locations of aortic sentinel lymph node detection after dual cervical and fundal indocyanine green injection in patients with endometrial cancer, using the transperitoneal and extraperitoneal approaches. Between June 26, 2014 and December 31, 2019, 278 patients underwent laparoscopic surgery for endometrial cancer at our institution. In all cases, we performed sentinel lymph node biopsy with dual cervical and fundal indocyanine green injection, and back-up lymphadenectomy in high-risk cases. A post hoc analysis was performed to evaluate differences between the transperitoneal and extraperitoneal approach to aortic sentinel lymph nodes. The detection rates were as follows: overall detection rate: 93.2% (259/278); pelvic detection rate: 90.3% (251/278); bilateral pelvic detection rate: 68.0% (189/278); aortic detection rate: 66.9% (186/278); and isolated aortic detection rate: 2.88% (8/278). Transperitoneal and extraperitoneal aortic detection rates were similar (65.0% and 69.6%, respectively), with no significant differences (P=.441). Isolated aortic metastases were similar in both groups (2% vs 4.7%, respectively; P=.185). The laterality of aortic sentinel lymph node detection was influenced by the surgical approach (P=.002), but not its location above or below the inferior mesenteric artery (P=.166 and P=.556, respectively). The detection rates at the aortic level were similar between the transperitoneal and extraperitoneal approaches, with no impact on subsequent pelvic detection. The transperitoneal approach detected more laterocaval, precaval, and interaortocaval nodes, whereas the extraperitoneal approach detected more preaortic and left lateroaortic nodes.

Clinical Application of Digital 3D Reconstruction and 3D Printing Technology in Endometrial Cancer (EC) Surgery.

Aims We use CTA and magnetic resonance data to use digital three-dimensional reconstruction and 3D printing technology to reproduce the solid replication of the uterus and surrounding tissues in vitro, fully evaluate the adjacency of tumor tissues with surrounding important organs, blood vessels, and lymph nodes, and reduce the impact. The normal organ structure and function of the surgeon can shorten the operation time, reduce the bleeding during the operation, and reduce the perioperative complications of the patient to improve the prognosis of the patient. Materials and Methods Select 40 EC patients and divide them into group A (3D reconstruction data is transmitted to 3D printing equipment according to the results of CTA and MRI examination, and a 3D model is printed out according to the ratio of 1 : 1 for evaluation and judgment before surgery) and group B (according to MRI imaging examination, there were 20 cases each). Different surgical conditions, quality of life, adverse reactions, and clinical efficacy were evaluated in each group. Results The operation time, the time of the first anus exhaust, the hospitalization time after the operation, and the blood loss of the operation in group A were significantly lower than those in group B. Statistics showed that the difference was significant (P < 0.05). The quality of life scores of emotion, cognition, society, and overall health of group A were significantly higher than those of group B, while physical score, fatigue, nausea, vomiting, and pain were lower than those of group B, which were statistically significant (P < 0.05). Both groups of patients had complications after the operation, and they were asked to be followed up at the outpatient clinic 3 months after the operation. All patients recovered well. There were 19 and 18 patients in groups A and B, respectively, complaining of improvement in clinical symptoms, and the difference was not statistically significant (P < 0.05). Conclusion With the support of digital three-dimensional reconstruction and 3D printing technology, complex operations can be accurately performed, improving the efficacy and safety of patients after EC surgery, improving patient outcomes and quality of life, improving EC positioning accuracy, and reducing tumor residue.

The RECOURSE Study: Long-term Oncologic Outcomes Associated With Robotically Assisted Minimally Invasive Procedures for Endometrial, Cervical, Colorectal, Lung, or Prostate Cancer: A Systematic Review and Meta-analysis.

To assess long-term outcomes with robotic versus laparoscopic/thoracoscopic and open surgery for colorectal, urologic, endometrial, cervical, and thoracic cancers. Minimally invasive surgery provides perioperative benefits and similar oncological outcomes compared with open surgery. Recent robotic surgery data have questioned long-term benefits. A systematic review and meta-analysis of cancer outcomes based on surgical approach was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines using Pubmed, Scopus, and Embase. Hazard ratios for recurrence, disease-free survival (DFS), and overall survival (OS) were extracted/estimated using a hierarchical decision tree and pooled in RevMan 5.4 using inverse-variance fixed-effect (heterogeneity nonsignificant) or random effect models. Of 31,204 references, 199 were included (7 randomized, 23 database, 15 prospective, 154 retrospective studies)-157,876 robotic, 68,007 laparoscopic/thoracoscopic, and 234,649 open cases. Cervical cancer: OS and DFS were similar between robotic and laparoscopic [1.01 (0.56, 1.80), P =0.98] or open [1.18 (0.99, 1.41), P =0.06] surgery; 2 papers reported less recurrence with open surgery [2.30 (1.32, 4.01), P =0.003]. Endometrial cancer: the only significant result favored robotic over open surgery [OS; 0.77 (0.71, 0.83), P <0.001]. Lobectomy: DFS favored robotic over thoracoscopic surgery [0.74 (0.59, 0.93), P =0.009]; OS favored robotic over open surgery [0.93 (0.87, 1.00), P =0.04]. Prostatectomy: recurrence was less with robotic versus laparoscopic surgery [0.77 (0.68, 0.87), P <0.0001]; OS favored robotic over open surgery [0.78 (0.72, 0.85), P <0.0001]. Low-anterior resection: OS significantly favored robotic over laparoscopic [0.76 (0.63, 0.91), P =0.004] and open surgery [0.83 (0.74, 0.93), P =0.001]. Long-term outcomes were similar for robotic versus laparoscopic/thoracoscopic and open surgery, with no safety signal or indication requiring further research (PROSPERO Reg#CRD42021240519).

Effects of Quantitative Nursing Combined with Psychological Intervention in Operating Room on Stress Response, Psychological State, and Prognosis of Patients Undergoing Laparoscopic Endometrial Cancer Surgery.

Objective To investigate the effects of quantitative nursing and psychological interventions on stress response, mental health, and prognosis in endometrial cancer patients having laparoscopic surgery. Methods The random number table approach was used to identify and split 98 patients with endometrial cancer undergoing laparoscopic surgery at our hospital's Obstetrics and Gynecology Hospital (n = 49) into observation and control groups (n = 49) from May 2020 to February 2022. Both groups received standard care in the operating room, while those in the observation group received quantitative and psychological interventions in the operating room. Both groups were compared for perioperative markers, stress indicators, coping strategies, and pain levels. Results In terms of age, TNM stage, or pathology, there was no statistically significant difference between the two groups (P > 0.05). Both the observation and control groups experienced statistically significant (P < 0.05) reductions in the perioperative markers of operation time, intraoperative blood loss, and overall hospital stay. Both groups' SAS and SDS scores were lower than they had been prior to surgery, but the observation group had lower scores than the control group, and these differences were statistically significant (P < 0.05). Postsurgery, the observation group's cortisol and adrenaline levels were lower than those of the control group, and both groups' levels were higher than before surgery, with statistical significance (P < 0.05) in both groups. Neither coping style nor pain level differed significantly between the two groups before surgery (P > 0.05). Postoperatively, while yield item scores were lower and faces scores were higher than the control group, the observation group's avoidance item score was lower than the control group. All with statistical significance. There were substantial differences in NRS SCORE between observers and controls. Conclusion After laparoscopic surgery to remove endometrial cancer, patients may benefit from the combination of quantitative nursing and psychological intervention in the operating room to alleviate postoperative anxiety and sadness and reduce stress reaction.

Does the use of a uterine manipulator in robotic surgery for early-stage endometrial cancer affect oncological outcomes?

To investigate the impact of the use of a uterine manipulator in robot-assisted surgery for early-stage endometrial cancer on oncological outcome. Eighty sixrobotic surgeries and sixty seven open surgeries were performed for early-stage endometrial cancer. Disease-free survival and overall survival at 5years, and surgical results and postoperative complications were compared between surgeries. In robotic surgery, a uterine manipulator was used in all cases. There was no significant difference in oncological outcome between surgeries. Robotic surgery showed significantly longer operative time, less blood loss, and shorter hospital stay compared to open surgery. In robotic surgery, complications occurred significantly less frequently, and no patients required conversion to laparotomy. There were no clear correlations of positive lavage cytology with The International Federation of Gynecology nd Obstetricsstage, recurrence, and site of recurrence in either surgery. The use of a uterine manipulator during robotic surgery for early-stage endometrial cancer did not influence recurrence or survival.

A new technique for performing interstitial implants for gynecologic malignancies using transvaginal ultrasound guidance

ObjectivesThis study concerns a new technique that aims to achieve precise interstitial brachytherapy of pelvic recurrent tumors under transvaginal ultrasound (US) guidance, enhance the conformity index of the brachytherapy (BT), and improve the curative effect of radiotherapy for gynecological oncology patients with pelvic relapse.MethodsA real-time transvaginal US-guided interstitial implant device was developed to assist in implant BT. Prior to implant brachytherapy, the size and location of the tumor in the pelvis and the interrelationship with adjacent organs were first assessed with intracavitary ultrasound. The transvaginal US-guided interstitial implant device was then placed on the endoluminal ultrasound probe, the probe was oriented intravaginally to determine a safe needle path, the implant needle was placed into the needle passage of the device, and the implant needle was inserted into the tumor tissue in the direction guided by the ultrasound puncture guide line. After the implant needle was placed in place, the cover of the transvaginal US-guided interstitial implant device was opened perpendicular to the ultrasound probe, and the needle was separated from the ultrasound probe smoothly, and then the cover was re-covered for subsequent implantation.ResultsIn this study, 56 patients who underwent real-time transvaginal ultrasound-guided implantation for gynecologic oncology were enrolled, and insertion of 736 implant needles was completed. Among them, 13 patients had recurrent pelvic tumors after cervical cancer surgery and 6 patients had recurrent pelvic tumors after endometrial cancer surgery. Thirty-two patients who underwent radical radiation therapy for cervical cancer did not have adequate regression of parametrial invaded tissue after completion of standard EBRT treatment; and 5 patients had recurrent tumors in the radiation field after previous standard course of pelvic radiotherapy. The accuracy of the implant therapy was improved. The radiotherapy dose for recurrent pelvic masses was successfully increased, and the cumulative dose of external irradiation combined with BT was augmented to 80–100 Gy. The use of a new device for transvaginal implant for recurrent masses located in the lateral wall of the pelvic cavity was successful.ConclusionThis intravascular US-guided interstitial implant device can realize interstitial implant with the shortest path under transvaginal US guidance. With convenient operation, high precision, and good security, the device not only improves the accuracy of implant therapy, but it also reduces the risks of anesthesia and organ injury, so it is suitable for widespread promotion and use.