Surgery For Endometrial Carcinoma Research Articles

Improvement of Gasless Laparoscopic Single-Site Lifting and Use in Surgery for Endometrial Carcinoma

Background: The operative field in gasless surgery is limited, and it is difficult to adequately expose the operative field when compared to the use of gas surgery. Gasless laparoscopic single-site (GLESS) is difficult to apply to endometrial cancer surgery. The aim of this study is to investigate the improvement in GLESS lifting style for use in surgery for endometrial cancer as well as to compare the outcome of different surgical approaches in endometrial cancer. Methods: A tissue retractor is added to the routine step of GLESS to lift the abdominal wall. The lateral umbilical ligament is exposed, a 2-0 buckwheat thread is passed through the lateral umbilical ligament and abdominal wall in order to lift the umbilical ligament. We measured the changes of space length or height in different dimensions of the improved GLESS approach. Also, we measured the vertical height from the upper edge of the umbilical site to the abdominal cavity, the length from the lower edge of the umbilical site to the right Michaelis point, the height from the bottom of the uterus to the peritoneal cavity of the anterior abdominal wall, and the length from the lateral umbilical ligament to the ipsilateral psoas major muscle. We analyzed the differences in procedures in 177 cases of endometrial carcinoma. We collected data on operative time, hemoglobin change, number of lymph nodes removed, postoperative recovery time and postoperative complications for open surgery, multi site laparoscopic surgery, single site laparoscopic surgery and gasless laparoscopic single-site surgery. Results: The vertical height from the upper edge of the umbilical foramen to the abdominal cavity (4.395 ± 1.593 cm vs. 7.418 ± 1.626 cm, p < 0.001), the length from the lower edge of the umbilical foramen to the right Michaelis point (9.850 ± 2.089 cm vs. 12.795 ± 2.094 cm, p < 0.001), the height from the bottom of the uterus to the peritoneal cavity of the anterior abdominal wall (6.900 ± 1.052 cm vs. 9.827 ± 1.366 cm, p < 0.001), and the length from the lateral umbilical ligament to the ipsilateral psoas major muscle and iliac vessels were measured (2.345 ± 0.515 cm vs. 4.318 ± 0.558 cm, p < 0.001) and showed improvement with GLESS. Also, the operative visualization increased significantly with GLESS. No significant difference was observed in operative time (p = 0.670), hemoglobin change (p = 0.065), number of lymph nodes removed (p = 0.179), postoperative recovery time (p = 0.331), or postoperative complications (p = 0.442) in cases of endometrial cancer utilizing GLESS. Conclusions: The use of GLESS can increase surgical exposure. This method of suspending the umbilical ligament through abdominal silk thread can increase exposure of the anatomical structure of the obturator position. The application of GLESS as the procedure for endometrial cancer is safe and feasible.

Post-operative agranulocytosis caused by intravenous cefazolin: A case report with a discussion of the pathogenesis

A case of post-operative agranulocytosis which occurred in a 66-year-old woman following surgery for endometrial carcinoma is reported. The agranulocytosis had a rapid onset, being detected on the first post-operative day. The causative agent, cefazolin was given to the patient intraoperatively. The agranulocytosis persisted until the 22nd postoperative day. A bone marrow biopsy performed on post-operative day four showed a left-shifted myeloid maturation pattern but not a maturation arrest. The pathogenesis of drug-induced neutropenia/agranulocytosis is discussed. It is postulated that reversible binding of cefazolin to albumin accounts for the prolonged duration of agranulocytosis.

Sensitivity of cervico-vaginal cytology in endometrial carcinoma: A systematic review and meta-analysis.

Cervico-vaginal cytology is primarily a cervical cancer screening test. The anatomical continuity of the uterine cavity with the cervix makes the Papanicolaou (Pap) test accessible to evaluate signs of disease shed from the endometrium. Our aim was to determine the sensitivity of routine Pap test in endometrial carcinoma detection and its relationship with clinico-pathologic factors. We performed a systematic review of studies reporting Pap test results prior to diagnosis of or surgery for endometrial carcinoma between 1990 and 2018 in PubMed or Web of Science. Two independent reviewers extracted data and assessed study quality using an adapted Newcastle-Ottawa Quality Assessment Scale and Quality Assessment of Diagnostic Accuracy Studies tool. We identified 45 studies including a total of 6599 women with endometrial cancer. Abnormal Pap test results prior to diagnosis of or surgery for endometrial carcinoma were observed in 45% (95% CI, 40%-50%) of study participants. This percentage was significantly higher among those of non-endometrioid histology compared with endometrioid subtypes (77% [95% CI, 66%-87%] vs 44% [95% CI, 34%-53%], respectively; P heterogeneity <.001). Several clinico-pathologic factors were related to a higher percentage of abnormal Pap test results, including high-stage, myometrial invasion >50%, high histological grade, positive peritoneal cytology, presence of lymph node metastasis, cervical involvement, and lymphovascular invasion (P heterogeneity <.05 for all variables). Routine cervical cytology can detect endometrial cancer in almost half of patients, whereas sensitivity is higher among individuals with non-endometrioid histology or more advanced cancers. This review summarizes the current clinical and prognostic value of cervical cytology in endometrial carcinoma. Recent technological developments using molecular biomarkers may improve accuracy for early cancer detection.

Surgicopathological Outcomes and Survival in Carcinoma Body Uterus: A Retrospective Analysis of Cases Managed by Laparoscopic Staging Surgery in Indian Women.

Objectives:The context of this article is based on two main titles those being Gynecologic Oncology and Minimal invasive surgery. The aim of this study was to report the laparoscopic management of a series of cases of endometrial carcinoma managed by laparoscopic surgical staging in Indian women.Materials and Methods:This study was conducted in a private hospital (referral minimally invasive gynecological center).This was a retrospective study (Canadian Task Force Classification II-3). Eighty-eight cases of clinically early-stage endometrial carcinoma staged by laparoscopic surgery and treated as per final surgicopathological staging. All patients underwent laparoscopic surgical staging of endometrial carcinoma, followed by adjuvant therapy when needed. Data were retrieved regarding surgical and pathological outcomes. Recurrence-free and overall survival durations were measured at follow-up. Survival analysis was calculated using Kaplan–Meier survival analysis.Results:The median age of presentation was 56 years, whereas the median body mass index was 28.3 kg/m2. Endometroid variety was the most commonly diagnosed histopathology. There were no intraoperative complications reported. The median blood loss was 100 cc, and the median intraoperative time was 174 min. There were a total of 5 recurrences (5.6%). The outcome of this study was comparable to studies conducted in Caucasian population. The predicted 5-year survival rate according to Kaplan–Meier survival analysis is 95.45%, which is comparable to Caucasian studies.Conclusion:Laparoscopic management of early-stage endometrial carcinoma is a standard practice worldwide. However, there is still a paucity of data from the Indian subcontinent regarding the outcomes of laparoscopic surgery in endometrial carcinoma. The Asian perspective has been highlighted by a number of studies from China and Japan. To our knowledge, this study is the first from India to analyze the surgicopathological outcomes following laparoscopic surgery in endometrial carcinoma. The outcome of this study was comparable to studies conducted in Caucasian population.

Patient-reported outcomes after surgery for endometrial carcinoma: Prevalence of lower-extremity lymphedema after sentinel lymph node mapping versus lymphadenectomy

ObjectiveTo compare the prevalence of patient-reported lower-extremity lymphedema (LEL) with sentinel lymph node (SLN) mapping versus comprehensive lymph node dissection (LND) for the surgical management of newly diagnosed endometrial carcinoma. MethodsPatients who underwent primary surgery for endometrial cancer from 01/2006-12/2012 were mailed a survey that included a validated 13-item LEL screening questionnaire in 08/2016. Patients diagnosed with LEL prior to surgery and those who answered ≤6 survey items were excluded. ResultsOf 1275 potential participants, 623 (49%) responded to the survey and 599 were evaluable (180 SLN, 352 LND, 67 hysterectomy alone). Median BMI was similar among cohorts (P = 0.99). External-beam radiation therapy (EBRT) was used in 10/180 (5.5%) SLN and 35/352 (10%) LND patients (P = 0.1). Self-reported LEL prevalence was 27% (49/180) and 41% (144/352), respectively (OR, 1.85; 95% CI, 1.25–2.74; P = 0.002). LEL prevalence was 51% (23/45) in patients who received EBRT and 35% (170/487) in those who did not (OR, 1.95; 95% CI, 1.06–3.6; P = 0.03). High BMI was associated with increased prevalence of LEL (OR, 1.04; 95% CI, 1.02–1.06; P = 0.001). After controlling for EBRT and BMI, LND retained independent association with an increased prevalence of LEL over SLN (OR, 1.8; 95% CI, 1.22–2.69; P = 0.003). Patients with self-reported LEL had significantly worse QOL compared to those without self-reported LEL. ConclusionsThis is the first study to assess patient-reported LEL after SLN mapping for endometrial cancer. SLN mapping was independently associated with a significantly lower prevalence of patient-reported LEL. High BMI and adjuvant EBRT were associated with an increased prevalence of patient-reported LEL.

Implementation of Enhanced Recovery after Surgery for Endometrial Carcinoma: A Non-Randomized Controlled Trial

Implementation of Enhanced Recovery after Surgery for Endometrial Carcinoma: A Non-Randomized Controlled Trial

Patient-reported outcomes after surgery for endometrial carcinoma: Prevalence of lower extremity lymphedema after sentinel lymph node mapping (SLNM) compared to lymphadenectomy

Patient-reported outcomes after surgery for endometrial carcinoma: Prevalence of lower extremity lymphedema after sentinel lymph node mapping (SLNM) compared to lymphadenectomy

Role of Intraoperative Frozen Section in Defining the Extent of Surgery in Endometrial Carcinoma: An Indian Experience

Purpose The role of frozen section in the intraoperative decision making about the extent of surgical staging is controversial. The study was undertaken to evaluate the role of the frozen section and its agreement to histopathology in determining the tumor grade and depth of the tumor invasion in carcinoma endometrium at our center.

Minimizing Minimally Invasive Surgery for Endometrial Carcinoma.

Minimizing Minimally Invasive Surgery for Endometrial Carcinoma.

Minimizing Minimally Invasive Surgery for Endometrial Carcinoma

Minimizing Minimally Invasive Surgery for Endometrial Carcinoma

Exacerbation of Migraines Following Robotic Surgery for Endometrial Carcinoma

Objective: Robotic hysterectomies are becoming increasingly common in the United States. Although benefits exist, risks are also present. The purpose of this study was to see what percentage of women with migraine headaches had a post-operative exacerbation.Study design: Records were examined for the diagnosis of migraine headaches as well as post-operative diagnosis of a headache. Records were also examined for age, estimated blood loss, total skin to skin operative time and body mass index.Results: Surgeries and records for 100 women were examined. Only 6% of women complained of post-operative headaches. However, 45% of women with history of migraines complained of post-operative headaches (p &lt;0.001). Age was the only significant factor with women having post-operative headaches being significantly younger (p = 0.009).Conclusion: Post-operative headaches were more common in women with a pre-operative history of migraine headaches than in those without a history. Patients with a history of migraines should be warned of this risk.

The guidance of intraoperative frozen section for staging surgery in endometrial carcinoma: frozen section in endometrial carcinoma.

The objective of this study was to evaluate the reliability of an intraoperative frozen section during the endometrial carcinoma staging surgery procedure. The paraffin section reports of 291 cases with endometrial carcinoma were compared with intraoperative frozen section reports, which were diagnosed in the Pathology Department of Cukurova University, Medical Faculty between June 2006 and December 2012. The reports were reviewed for diagnostic accuracy of the frozen section in terms of histological subtype, grade, and myometrial invasion. Concordance values between frozen and paraffin section reports were 86, 84.3, and 91.6% for histological subtype, grade, and myometrial invasion, respectively. When collectively evaluated, two (0.7%) of 291 patients were inappropriately operated on due to frozen section reports. Intraoperative frozen section is a reliable guide for surgeons to evaluate the risk group of patients with endometrial cancer and prevent an unnecessary staging surgery operation.

Laparoscopic vs robotic-assisted surgery for endometrial carcinoma in a centre with long laparoscopic experience

Surgical outcomes and costs of laparoscopic and robotic hysterectomy for the treatment of endometrial carcinoma were compared in a centre with lengthy experience with laparoscopic surgery. The robotic cohort (n = 67) had a longer operative time than the laparoscopic cohort (n = 150) (p < 0.0001). Lymph node yields were similar for both surgical modalities, but the median of estimated blood loss was lower in the robotic group (50 ml vs 100 ml; p < 0.0001). The proportion of patients with hospital stay > 2 days and rate of overall complications were similar in both groups. Operative costs were (Euros) €1,680 and €3,860 for the laparoscopic and robotic procedure, respectively. We conclude that robotic technology is feasible but does not provide short-term benefits for the treatment of endometrial carcinoma in a centre where laparoscopy has been established as the standardised minimally invasive surgical method.

Retrieval and in vitro maturation of human oocytes from ovaries removed during surgery for endometrial carcinoma: a novel strategy for human oocyte research

To collect human oocytes from ovaries removed as part of surgical treatment for endometrial carcinoma, and to induce in vitro maturation of such oocytes to obtain material for research on human ovarian aging. Prospective clinical study. University Hospital. Eight patients aged 35-44years with a preoperative diagnosis of Stage I endometrial cancer agreed to participate in this project. Surgically removed ovaries were punctured; oocytes were collected from follicular fluid and matured in vitro. Immunofluorescent detection of microtubules and DNA labeling were performed after in vitro maturation. Number of oocytes collected and their in vitro maturation stage. In total, 87 oocytes were collected, 11 of which had completed metaphase II. Of the oocytes collected, 75% were from three patients in their 30s, while the remaining 25% were from five patients in their 40s. Several stages of oocytes were collected and the detection of microtubule arrangement and chromatin in various stages using fluorescence was possible. Material for research on human ovarian aging can be obtained from ovaries removed during surgery for endometrial cancer.

Intraoperative frozen section is essential for assessment of myometrial invasion but not for histologic grade confirmation in endometrial cancer: a ten-year experience

To evaluate the accuracy of endometrial biopsy (EB), transvaginal ultrasonography (TVS) and intraoperative frozen section (FS) for assessment of myometrial invasion and histologic grade to predict more conservative surgery in endometrial carcinoma. Demographic and clinical data of 220 patients with endometrial carcinoma were retrospectively reviewed. Preoperatively, the subjects were evaluated by EB and TVS. Intraoperatively, FS was also performed to evaluate histological grading and myometrial invasion. All patients underwent surgical-pathological staging after removal of the uterus, adnexa and pelvic lymph nodes. Sensitivity and specificity values were calculated for EB, TVS and FS with regard to detection of histological grading and neoplastic invasion of the myometrium according to the final histopathologic examination. Bilateral pelvic and common iliac lymphadenectomy was performed in 80 patients without performing intraoperative biopsy because of preoperative high risk. Evaluation of the tumor grade by preoperative EB showed a sensitivity, specificity and accuracy of 73, 97 and 91%, respectively. Evaluation of the tumor grade by intraoperative biopsy showed a sensitivity, specificity and accuracy of 73, 96 and 90%, respectively. Evaluation of the depth of myometrial invasion with TVS showed a sensitivity, specificity and accuracy of 52, 91 and 79%, respectively. Evaluation of the depth of myometrial invasion with intraoperative biopsy showed a sensitivity, specificity and accuracy of 86, 94 and 92%, respectively. Evaluation of the histologic grade by EB and of the depth of myometrial invasion by intraoperative biopsy is a good option for deciding the necessity of lymphadenectomy.

Abnormal cervical cytology: a risk factor for endometrial cancer recurrence

The objective of this study was to evaluate the relationship between cervical cytology, histologic type, and risk of endometrial cancer recurrence. We performed a retrospective study of patients undergoing surgery for endometrial carcinoma. Risk factors for recurrence including histology, tumor grade, nodal status, myometrial invasion, peritoneal washings, stage, and cervical cytology were assessed. Abnormal cervical cytology was defined as the presence of any endometrial cells on Pap smear. Papillary serous and clear cell carcinomas were considered high-risk histologies. Univariate and multivariate analyses of risk factors for recurrence were performed. Thirty-nine (9%) patients developed recurrent endometrial cancer. More patients with abnormal Pap smears recurred (12% versus 4%,P&lt; 0.05). For endometrioid adenocarcinoma, abnormal cervical cytology occurred in 61% and 7% recurred, while with high-risk histologies, 84% had abnormal cervical cytology and 19% recurred (P&lt; 0.05). Other significant predictors of recurrence on univariate analysis were myometrial invasion, nodal status, washings, stage, and histology. On multivariate analysis, only nodal status remained a significant predictor of recurrence. Abnormal cervical cytology is associated with increased risk of endometrial cancer recurrence. Abnormal cervical cytology occurs more frequently in high-risk histologies, which are known to have a higher risk of recurrence. On multivariate analysis, only nodal spread remains a significant predictor of recurrence.

Omentectomy, peritoneal biopsy and appendectomy in patients with clinical stage I endometrial carcinoma.

The aim of this study was to evaluate whether omentectomy, appendectomy, and peritoneal biopsy should be a routine part of staging surgery in endometrial carcinoma. Data of 97 patients who had been diagnosed with clinical stage I endometrial carcinoma were reviewed. Associations in the data obtained, pelvic and para-aortic lymph node status, depth of myometrial invasion, grade, and histology were investigated. The chi-square (chi2) test was used for statistical analysis. Of 97 patients, six (6%) had omental metastases, which was microscopic in four. There was a statistically significant relationship between omental metastasis and tumor grade (P < 0.01). Deep myometrial invasion was significantly more common in patients with omental metastases. Tumor was found in one of 55 appendectomy specimens (2%). Omentectomy may be included in surgical staging in patients with deeply invasive or grade 3 endometrial cancer because of the possibility of omental metastasis in spite of what appears to be stage I disease in laparotomy. In other cases, omentectomy and appendectomy and biopsies from peritoneal sites should be performed in the presence of grossly suspicious disease.

Preoperative radiotherapy and surgery for endometrial carcinoma: prognostic significance of the sterilization of the specimen

Introduction: We report a retrospective study on the analysis of the operative specimen after preoperative radiotherapy for FIGO (1971) stage I or II endometrial carcinoma. Methods and Materials: From 1976 to 1996, 221 patients were treated with external radiotherapy (XRT) and/or low-dose-rate brachytherapy (BT) followed by surgery (S). Patients with cervical involvement (89 patients) or with high-grade tumors (49 patients) received XRT and BT. Patients stage FIGO Ia (89 patients) or with low-grade tumors (57 patients) received BT alone. Surgery was performed 5 to 6 weeks after irradiation. Results: The mean follow-up is 78 months (12–216). The 5-year survival was 90% for FIGO Ia, 80% for FIGO Ib, and 84% for FIGO II ( p = 0.51). According to the differentiation, 5-year survival was 87% for grade 1, 84% for grade 2, 84% for grade 3 ( p = 0.10). Grade 3 complications were registered in 2% (no grade 4). The tumors were sterilized in 37 patients (17%), sterilized but with dystrophic glands in 34 patients (16%), only modified and altered in 21 patients (9.5%), with viable cells in 56 patients (26%). After preoperative radiotherapy, 37/148 specimens were sterilized (25%), 14/74 after brachytherapy and surgery (19%), 23/74 after external radiotherapy–brachytherapy and surgery (31%). According to the response of the specimen, 5-year survival was 87% when the tumor was sterilized, 96% when altered glands were present, 85% when modified, and 76% if residual tumor with viable cells was identified ( p = 0.043). Conclusion: Preoperative radiotherapy followed by surgery is a safe and effective treatment of FIGO stage I or II endometrial carcinomas. BT with two uterine tubes seems to be of interest in the contribution of the treatment of the uterus to sterilize the specimen. The analysis of this new prognostic factor remains important to select a population with worst prognosis.

Hormonal Therapy in the Patient With Surgical Menopause

Removal of both ovaries in the premenopausal patient is performed infrequently, but when it is, attention must be paid to hormone replacement. The benefits of hormone replacement include protection from osteoporosis, elimination of vasomotor symptoms, improvement in general well-being, and some decrease in the risk of cardiovascular disease. Some evidence suggests that the addition of androgen therapy to estrogen replacement in the premenopausal woman can also be beneficial. Administration of hormonal therapy to certain premenopausal patients who have had a bilateral oophorectomy is controversial. These include patients who are disease-free after surgery for endometrial carcinoma and patients who are post-therapy for breast carcinoma. The most common question is whether a progestin should be given to the patient receiving estrogen therapy after a hysterectomy. Prevention of endometrial carcinoma is unnecessary in this patient, but the effects of the progestin on the breast and the cardiovascular system should be considered.

Morphologic prognostic criteria in endometrial cancer with special reference to nuclear grading

The prerequisite for the implementation and later assessment of new concepts of therapy is a description of the tumor that is as exact and objective as possible, that corresponds to the actual extent of the tumor and its morphological appearance, and is thus reproducible. Only if results are based on precise postoperative staging can they be compared. Between 1963 and 1981, the average unadjusted 5-year survival probability for patients in Erlangen, a total of 719 endometrial carcinomas, was 69.3%. The 5-year survival probability with primary surgery for endometrial carcinoma in all tumor stages is 81.9%, 81.5% for simple adenocarcinoma, 87.5% for adenoacanthoma, and 40% for clear cell carcinoma. With primarily irradiated endometrial carcinomas the 5-year survival probability is 45.4%; it is 44.2% for adenocarcinoma, and 52.2% for adenoacanthoma. The prognosis for patients with slight myometrium infiltration is better than that for women deep carcinoma infiltration. While 70% of grade I endometrial carcinoma consists of very highly differentiated tumor cells, 30% consists of tumor cells with less differentiation. Two-thirds of grade III carcinoma consist of undifferentiated tumor cells, one-third of very highly differentiated tumor cells.