Surgical Treatment Of Endometrial Cancer Research Articles

Survival disadvantage associated with delayed surgical treatment of endometrial cancers

Survival disadvantage associated with delayed surgical treatment of endometrial cancers

Single-access laparoscopic approach in the surgical treatment of endometrial cancer: A single-institution experience and review of literature.

BACKGROUND:The aim of this study was to assess the surgical and oncological outcome for the management of endometrial cancer (EC) by laparoendoscopic single-site surgery (LESS).PATIENTS AND METHODS:We performed a retrospective chart review of patients who underwent a LESS for EC. All the patients were treated by the same surgical team between July 2009 and June 2013 at the Gynaecologic Oncologic Unit, Regina Elena National Cancer Institute, Rome, Italy.RESULTS:A total of 50 women were included, with a median age of 45 years (range, 39-84 years) and a median body mass index (BMI) of 21.8 kg/m2 (range, 19-48 kg/m2). Median operative time was 100 min (range, 50-240 min), median blood loss was 90 mL (range, 10-300 mL) and median hospital stay was 3 days (range, 2-9 days). The median number of pelvic lymph nodes retrieved was 14 (range, 5-20). No intraoperative complications occurred, but there were 4 postoperative complications. Two patients required a laparoscopic conversion. The median follow-up was 36 months (range, 16-62 months) and no recurrence occurred.CONCLUSION:Our report showed that the LESS approach in the treatment of early EC can be a safe and reliable technique in terms of surgical and oncological outcomes.

Outcome of ovarian preservation during surgical treatment for endometrial cancer: A Taiwanese Gynecologic Oncology Group study

ObjectiveThe goal of this study was to investigate the impact of ovarian preservation on the survival of women with early-stage endometrial cancer, particularly young women. Materials and methodsA study cohort of 64 patients with histologically confirmed early-stage endometrial cancer was retrospectively collected from 10 member hospitals of the Taiwanese Gynecologic Oncology Group between 1998 and 2009. Survivorship and overall survival were compared between these two groups using a log-rank test. ResultsAll patients who underwent surgery were adult women with a mean age of 40.4 ± 9.2 years (range 24–63 years). Ovary-preserving surgery was performed in 38 (59.4%) patients who desired to preserve their ovaries, incidentally in 19 (29.7%) patients with a preoperative diagnosis other than endometrial carcinoma, and in seven patients (10.9%) with unknown reasons. The 5-year recurrence-free survival rate was 98.3% with a median follow up of 44.6 months (range 1.0–126.9 months). Eight patients required adjuvant treatment (12.5%); one patient had documented local recurrence (1.6%); and no metachronous ovarian malignancy occurred during follow up. ConclusionPreservation of bilateral ovaries does not increase cancer-related mortality. A more conservative approach to surgical staging may be considered in premenopausal women with early-stage endometrial cancer without risk factors.

Impact of Obesity on Surgical Treatment for Endometrial Cancer: A Multicenter Study Comparing Laparoscopy vs Open Surgery, with Propensity-Matched Analysis

ObjectiveTo evaluate the impact of obesity on the outcomes of surgical treatment for endometrial cancer in general and also comparing laparoscopic and open abdominal approach. DesignRetrospective case-control study (Canadian Task Force classification II-1). SettingObstetrics and Gynecology Department, University of Insubria, Varese, Catholic University of the Sacred Heart, Rome, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, and Sant'Orsola-Malpighi Hospital, Bologna, Italy. PatientsData of consecutive patients who underwent surgery for endometrial cancer in 4 centers were reviewed. Univariate and multivariable analyses were performed. Adjustment for potential selection bias in surgical approach was made using propensity score (PS) matching. InterventionsLaparoscopic or open surgical treatment for endometrial cancer. Measurements and Main ResultsA total of 1266 patients were included, including 764 in the laparoscopy group and 502 in the open surgery group. A total of 391 patients (30.9%) were obese, including 238 (18.8%) with class I obesity, 89 (7%) with class II obesity, and 64 (5.1%) with class III obesity. The total number of complications, risk of wound complications, and venous thromboembolic events were higher in obese women compared with nonobese women. Blood transfusions, incidence/severity of postoperative complications, and postoperative hospital stay were significantly higher in the open surgery group compared with the laparoscopy group, irrespective of obesity. These differences remained significant in both multivariable analysis and PS-matched analysis. The percentage of patients who received lymphadenectomy declined significantly in patients with BMI ≥40 in both the laparoscopy and open surgery groups. Conversions from the initially intended minimally invasive approach to open surgery were 1.1% to 2.2% for women with BMI <40, but increased in those with BMI ≥40 (8.6%; p = .05). PS analysis showed a lower complication rate, shorter hospital stay, and greater likelihood of receiving lymphadenectomy in obese women in the laparoscopic group. ConclusionLaparoscopy for endometrial cancer retains its advantages over open surgery, even in obese patients. However, operating on obese patients can be challenging regardless of the surgical approach taken, especially in cases of morbid adiposity.

Surgical treatment of endometrial cancer in developing countries: reasons to consider systematic two-step surgical treatment

OBJECTIVE:The aim of this study was to determine the lymph node status in a large cohort of women with endometrial cancer from the public health system who were referred to an oncology reference center in Brazil to identify candidates for the omission of lymphadenectomy based on clinicopathological parameters.METHODS:We retrospectively analyzed a cohort of 310 women with endometrial cancer (255 endometrioid, 40 serous, and 15 clear cell tumors) treated between 2009 and 2014. We evaluated the histological type, grade (low vs. high), tumor size (cm), depth of myometrial invasion (≤50%, >50%) and lymphovascular space invasion to determine which factors were correlated with the presence of lymph node metastasis.RESULTS:The factors related to lymph node involvement were tumor size (p=0.03), myometrial invasion (p<0.01), tumor grade (p<0.01), and lymphovascular space invasion (p<0.01). The histological type was not associated with the nodal status (p=0.52). Only twelve of 176 patients (6.8%) had low-grade endometrioid carcinoma, tumor size ≤2 cm and <50% myometrial infiltration.CONCLUSIONS:The omission of lymphadenectomy based on the histological type, grade, tumor size and depth of myometrial invasion is not likely to have a large impact on the surgical treatment of endometrial cancer in our population because most patients present with large and advanced tumors. New strategies are proposed that prioritize hysterectomy performed in a general hospital as soon as possible after diagnosis, followed by an evaluation of the need for lymph node dissection at a reference center.

Feasibility study on the effectiveness of Goreisan-based Kampo therapy for lower abdominal lymphedema after retroperitoneal lymphadenectomy via extraperitoneal approach.

To evaluate the efficacy and safety of Kampo therapy based on Goreisan for lower abdominal lymphedema after surgical treatment of endometrial cancer or cervical cancer. Radical surgery, including retroperitoneal lymphadenectomy, was performed for endometrial cancer and cervical cancer. After surgery, Kampo therapy based on Goreisan and integrated physical therapy were provided for patients with lower abdominal lymphedema, especially lymphedema affecting the pubic-inguinal-vulval region. Goreisan (7.5 g/day) was given orally three times a day (tds). If a significant response was not observed, Saireito (9 g/day; 3 g tds) or Gosyajinkigan (7.5 g/day; 2.5 g tds) was administered concomitantly. A total of 21 patients received treatment. The response rate to Goreisan monotherapy was 78%, with 22% being non-responders. Median reduction of abdominal circumference was 2.1cm (95% CI 1.3-2.85). When Goreisan was combined with another Kampo agent, the response rate was 92% and the non-response rate was 8%. The median reduction of the abdominal circumference was 2.85 cm (95% CI: 2.25-3.3). In particular, concomitant Goreisan and Saireito therapy achieved satisfactory results. No severe adverse reactions occurred. Goreisan-based Kampo therapy might be effective and safe for lower abdominal lymphedema after retroperitoneal lymphadenectomy. We will perform a prospective control study in the near future.

The role of laparoscopy in the surgical treatment of endometrial cancer.

IntroductionEndometrial carcinoma is one of the most common neoplasms in gynecological oncology and the most common genital cancer in women in developed countries. The 5-year overall survival rate depends on the FIGO stage. For patients with stage I endometrial cancer it is estimated as 80%. Traditionally, the main treatment of endometrial cancer consists of total abdominal hysterectomy with bilateral salpingo-oophorectomy and, in some histological or clinical stages, with additional pelvic lymphadenectomy. The main surgical approach so far for women with endometrial cancer has been laparotomy. However, in the last decades there have been many reports stating that the survival rate in such cases is similar after laparoscopy and laparotomy. Some researchers claim that laparoscopy is as effective as laparotomy, and it might be much more precise than laparotomy thanks to its special optic system.AimTo establish the method of choice for treatment of stage I endometrial cancer.Material and methodsComparing the preliminary results from data collected during surgical procedures performed at the First Department of Obstetrics and Gynecology of the Medical Centre of Postgraduate Education in Warsaw and the Department of Obstetrics and Gynecology of the Rural Hospital in Garwolin.ResultsLaparoscopy is as effective as laparotomy, and it might be much more precise than laparotomy.ConclusionsTaking into consideration all the above arguments, if an experienced endoscopic surgeon and proper laparoscopic equipment are available, laparoscopy might become the method of choice for treatment of stage I endometrial cancer.

Sexual functioning in women after surgical treatment for endometrial cancer: a prospective controlled study.

Endometrial cancer (EC) can affect sexual functioning based on anatomical, physiological, psychological, and relational mechanisms. The aim of this study was to prospectively investigate sexual adjustment of women with EC during a follow-up period of 2 years after surgical treatment and to compare the results with women who underwent a hysterectomy for a benign gynecological condition and healthy control women. In this prospective controlled study, participants completed the Short Sexual Functioning Scale, Specific Sexual Problems Questionnaire, Beck Depression Inventory Scale, World Health Organization-5 Well-being Scale, and Dyadic Adjustment Scale to assess various aspects of sexual and psychosocial functioning before undergoing a hysterectomy and 6 months, 1 year, and 2 years after surgery. Eighty-four women with EC, 84 women with a benign gynecological condition, and 84 healthy controls completed the survey. In EC survivors, no differences were found in sexual functioning during prospective analyses. In comparison with women with a benign gynecological condition, significantly more EC patients reported entry dyspareunia 1 year after surgical treatment. Moreover, compared with healthy women, pre- and postoperatively, significantly more EC patients reported sexual dysfunctions, including sexual desire dysfunction, arousal dysfunction, entry dyspareunia, and a reduced intensity of orgasm. Furthermore, compared with healthy controls, EC patients reported significantly lower overall well-being 1 year after surgical treatment. Nevertheless, consensus in the partner relationship was significantly higher in EC patients compared with healthy controls. Moreover, before treatment, quality of partner relationship was negatively associated with sexual arousal dysfunction and orgasm dysfunction. In EC patients, no differences were found in sexual functioning when prospectively comparing the situation before surgery with the situation after surgery. However, when compared with healthy controls, EC patients are at high risk for sexual dysfunctions, both before and after surgical treatment.

Surgical treatment of clinically early-stage endometrial carcinoma without systematic lymphadenectomy.

the main aim of this study was to describe the authors' experience with the surgical treatment of endometrial cancer without systematic lymphadenectomy. a retrospective cohort study was carried out on a subset of patients suffering of clinically early-stage endometrial carcinoma who underwent hysterectomy and salpingo-oophorectomy without systematic (radical) lymph nodes dissection at our centers from June, 2002, to November, 2011. Descriptive statistics were explored as medians (interquartile range) or frequencies (percentages), as appropriated, and the Kaplan-Meier method was applied for survival estimation. eighty-three patients who underwent surgical treatment with no lymph node dissection (n = 20; 24.1%) or with only a sampling procedure (n=63; 75.98%) were selected for analysis. Among these patients, 27 (32.53%) underwent surgery alone and 56 (67.46%) received some adjuvant treatment. Postoperative complications occurred in five patients (6.02%). Over a median follow-up of 27.4 months (Q25 = 13.7 - Q75 = 46.5), 15 (18.07%) patients suffered from relapses and 11 deaths occurred as result of disease recurrence. Cumulative 1, 2 and 3-year disease- free survivals were 97.32, 91.18 and 78.02%, respectively. on a case-by-case basis, the surgical treatment of clinically early-stage endometrial carcinoma without systematic lymphadenectomy did not seem to decrease survival outcomes and presented low rates of surgical morbidity in our experience, but was also related to a high rate use of adjuvant therapy.

Proposal of a concept and design of a randomized phase III trial investigating the survival effect of para‐aortic lymphadenectomy in endometrial cancer

Although prospective studies have failed to show the therapeutic effect of lymphadenectomy in the surgical treatment of endometrial cancer, several retrospective studies including the SEPAL study revealed the survival effect of lymphadenectomy. To prospectively investigate the survival benefit of para-aortic lymphadenectomy shown in the SEPAL study, we are proposing a new concept of a randomized phase III trial. An appropriate study population will be selected according to the preoperative assessments (evaluation of myometrial invasion and cervical invasion with magnetic resonance imaging, extrauterine spread with computed tomography, and histological type and grade by pathological evaluation) to estimate the risk of lymph node metastasis. Patients relevant to potential International Federation of Gynecology and Obstetrics (2008) stage IB, II and III diseases will be eligible, and randomly assigned to two arms: pelvic lymphadenectomy alone (control), or pelvic and para-aortic lymphadenectomy (experimental). After initial surgery, patients with postoperative pathological risk factors for recurrence will receive adjuvant chemotherapy. Because we aim to investigate the therapeutic significance of primary treatments, including surgery and adjuvant chemotherapy, the primary end-point could be recurrence-free survival. One of the most important issues to successfully perform this prospective study is to assure the quality of lymphadenectomy (extent and area), which could be evaluated based on the number of harvested nodes and objective evaluation of dissected area by videos and/or photos.

Surgical treatment for apparent early stage endometrial cancer

Most experts would agree that the standard surgical treatment for endometrial cancer includes a hysterectomy and bilateral salpingo-oophorectomy; however, the benefit of full surgical staging with lymph node dissection in patients with apparent early stage disease remains a topic of debate. Recent prospective data and advances in laparoscopic techniques have transformed this disease into one that can be successfully managed with minimally invasive surgery. This review will discuss the current surgical management of apparent early stage endometrial cancer and some of the new techniques that are being incorporated.

Laparoscopy vs Robotics in Surgical Management of Endometrial Cancer: Comparison of Intraoperative and Postoperative Complications

Study ObjectiveTo compare the rates of intraoperative and postoperative complications of robotic surgery and laparoscopy in the surgical treatment of endometrial cancer. DesignUnicentric retrospective study (Canadian Task Force classification II-2). SettingTertiary teaching hospital. PatientsThe study was performed from January 2002 to December 2011 and included patients with endometrial cancer who underwent laparoscopic or robotically assisted laparoscopic surgical treatment. Data collected included preoperative data, tumor characteristics, intraoperative data (route of surgery, surgical procedures, and complications), and postoperative data (early and late complications according to the Clavien-Dindo classification, and length of hospital stay). Morbidity was compared between the 2 groups. Measurements and Main ResultsThe study included 146 patients, of whom 106 underwent laparoscopy and 40 underwent robotically assisted surgery. The 2 groups were comparable in terms of demographic and preoperative data. Intraoperative complications occurred in 9.4% of patients who underwent laparoscopy and in none who underwent robotically assisted surgery (p = .06). There was no difference between the 2 groups in terms of postoperative events. ConclusionRobotically assisted surgery is not associated with a significant difference in intraoperative and postoperative complications, even when there were no intraoperative complications of robotically assisted surgery.

Evaluation of total laparoscopic hysterectomy with lymphadenectomy in surgical treatment of endometrial cancers

The study was conducted to evaluate the efficacy feasibility and safety of total laparoscopic hysterectomy (TLH) with lymphadenectomy in the treatment of endometrial cancer The retrospective study included 31 patients with endometrial cancer who underwent TLH with lymphadenectomy and 42 patients with endometrial cancer who were operated by laparotomy. In both groups the following parameters were analyzed: age, BMI, accompanying diseases, previous surgeries, parity duration of the surgery blood loss (complete blood count before and after the operation was compared), necessity of blood transfusion, length of hospital stay uterine volume, grade, stage of endometrial cancer (FIGO), and intra/ postoperative complications. Mean age of patients was lower in the laparoscopic group than in women operated by laparotomy: 54 and 64, respectively (p = 0.0001). There were no significant differences between both groups in BMI, uterine volume, grade, staging (FIGO), and parity The percentage of patients with accompanying chronic diseases in the TLH group was lower than in the laparotomy group: 48.39% and 83.34%, respectively (p = 0,032). There were no significant differences between both group in the history of previous laparotomies (p = 0.704). Mean duration of surgery was shorter in the case of laparotomy than in case of laparoscopy: 130.6 and 151.77, respectively (p = 0.003). Laparotomy was associated with greater blood loss during surgery Statistically significantly higher decrease in the Hb concentration and Hct values was noted in the group operated by laparotomy when compared to laparoscopy (mean values.: Hb-1.1 7 g/dl, Hct-3.49% for the TLH technique and Hb-7.8 g/dl Hct-5.47% for laparotomy; p = 0.011-Hb; p = 0.003-Hct). Mean hospital stay after laparoscopy was shorter than after laparotomy--4 and 9 days, respectively (p = 0,0001). The influence of the operational technique on the number of pelvic lymph nodes taken for histopathological examination was evaluated. No statistically significant correlation between the number of lymph nodes taken for histopathological examination during the surgery and the operational technique was noted (p = 0.083). Mean number of nodes taken for examination was 15 during the TLH surgery and 19 during laparotomy Postoperative complications were observed in 2 patients from the TLH and in 12 patients from the laparotomy groups (p = 0.038). The most statistically significantly frequent complication in the laparotomy group was postoperative wound infection: 8 (19.05%) patients. Total laparoscopic hysterectomy with lymphadenectomy in endometrial cancer therapy is a safe and feasible procedure. It is characterized by significantly smaller percentage of complications and shorter hospital stay This technique offers an alternative for laparotomy when it is performed by a highly experienced surgeon.

Analysis of 168 cases with primary surgical treatment for endometrial cancer

Analysis of 168 cases with primary surgical treatment for endometrial cancer

Editorial [Hot Topic: Surgical Treatment of Endometrial Cancer (Guest Editor: Maite Cusido Gimferrer)

Editorial [Hot Topic: Surgical Treatment of Endometrial Cancer (Guest Editor: Maite Cusido Gimferrer)

Comparative Analysis of Robotic Versus Laparoscopic Surgery in the Surgical Treatment of Early Stage Endometrial Cancer: A Three Year Interim Analysis of Outcome and Pattern of Recurrence

To compare and determine a 3 year outcome and identify the pattern of recurrence between robotic and laparoscopic surgery in the surgical treatment of early stage endometrial cancer. A prospective analysis of the first 136 patients who underwent Robotic hysterectomy with lymphadenectomy (RHLND) was compared to a historical cohort of 177 patients who underwent a total laparoscopic hysterectomy with lymphadenectomy (LHLND) in the surgical treatment of endometrial cancer. The rate of recurrence and pattern of recurrence was determined and analyzed between the two surgical groups. A solo experienced minimally invasive gynecological oncologic practice in a tertiary hospital. All 313 patients diagnosed with endometroid adenocarcinoma of the uterus who underwent minmally invasive surgical treatment. The surgical stages for each surgical treatment was determined. The incidence of rate of recurrence was determined and analyzed for different stage and site of recurrence. Overall, there was no difference in the rate of recurrence between the two surgical groups during a 3 year followup: 11/177 (6.2%) and 7/136 (5.1%) for LHLND and RHLND resepctively. Detail analysis of stage I disease showed no statistical difference in the incidence of recurrence for stage IA: 1/87 (1.2%) and 1/79 (1.3%) and intermideate and high risk stage I group 5/67 (7.5%) and 2/56 (3.6%) for LHLND and RHLND resepctively. Further analysis of pattern of recurrence also showed majority of recurrence were distant metastasis 5/11 (45.4%) vs. 2/7 (28.6%) for LHPLND and RHLND respectively and there was no statistical difference. Robotic hysterectomy with lymphadenectomy appears to have same incidence and pattern of recurrence as LHLND in the surgical treatment for early stage endometrial cancer.

Application of 1.5 T magnetic resonance imaging in endometrial cancer

To determine the diagnostic accuracy, sensitivity and specificity of magnetic resonance imaging (MRI) in detecting myometrial invasion, cervical involvement and disease stage in endometrial cancer. 168 consecutive patients with endometrial carcinoma underwent preoperative MRI. We classified myometrial invasion as no invasion, ≤50% invasion or >50% invasion and cervical involvement as positive or negative. The preoperative MRI findings and stagings were compared with final surgical and histological staging; the latter was taken as the gold standard. Standard statistical calculations were used. The sensitivity, specificity, and accuracy of MRI for the detection of myometrial invasion >50% were 64.7, 92.5, and 86.9%, respectively. Positive and negative predictive values were 68.8 and 91.2%, respectively. The sensitivity, specificity, and accuracy of MRI for the detection of cervical invasion were 52.63, 93.08, and 83.93%, respectively. Positive and negative predictive values were 68.97 and 87.05%, respectively. 102 cases were classified as stage IA (early disease) by histology. MRI accurately predicted the degree of invasion in 88 cases and overestimated in 14, giving a sensitivity of 86.3% and specificity of 69.1%. However, MRI showed reduced sensitivity for predicting stage IB and advanced endometrial cancer (stages III and IV) at 33.3 and 30.3%, respectively, but was found to be specific for predicting these stages; the specificity were 94.7 and 85.1%, respectively. MRI also showed good accuracy for predicting stage IA, IB, II and advanced endometrial cancer at 80.4, 86.9, 91.7, and 83.9, respectively. MRI assists in planning the surgical treatment of endometrial cancer with good accuracy and specificity, although sensitivity is suboptimal.

The effect of incision in the surgical treatment of endometrial cancer and long-term follow-up of a randomized trial of lymphadenectomy: Results of the MRC ASTEC trial.

e15583 Background: Total abdominal hysterectomy and bilateral salpingo-oophorectomy is standard treatment for early stage endometrial cancer (EC). Pelvic lymphadenectomy had never been fully evaluated in early endometrial cancer until the ASTEC trial. The primary objective was to determine the benefit or otherwise of lymphadenectomy on overall survival (OS). Primary analyses showed no evidence of an OS benefit with a hazard ratio (HR) of 1.16 (95%CI 0.87-1.54; p=0.31) in favour of standard surgery. A secondary objective was to investigate whether type of incision affects outcome. Methods: Patients with histologically proven EC were randomised to receive no lymphadenectomy (No LN) or lymphadenectomy (LN). The protocol recommended a vertical incision but transverse incisions could be used if appropriate. The updated analysis was planned when 110 deaths were observed in each incision group to detect a 10% difference in 5-year OS with 5% significance level and 90% power. Results: Between 07/1998 and 04/2005, 1408 patients (704 No LN, 704 LN) were randomised. 1286 patients had open (vs laparoscopic) surgery, of these 672 (52%), 522 (40%) and 92 (7%) had vertical, Pfannenstiel and other transverse incisions respectively. More patients in the LN arm had a vertical incision (386) compared to the no LN arm (287). With a median follow-up of 60 months, 251 (18%) patients (115 No LN, 136 LN) had died with a HR of 1.22 (95%CI 0.95-1.56), p=0.12 in favour of standard surgery. 128 (19%) and 102 (17%) deaths were reported in vertical and Pfannenstiel/other transverse groups. There was no evidence of an interaction between type of incision and surgical randomisation for OS (p=0.74). Conclusions: Long term follow-up supports previous findings, with no evidence of a benefit from lymphadenectomy and no evidence that type of surgical incision influences OS.

Independent prognostic factors in endometrial cancer: a single institution review

AbstractThe purpose of this study was to conduct a clinical and pathologic review of endometrial cancers diagnosed and surgically treated in our institution to evaluate results of treatment in relation to current international recommendations. We retrospectively evaluated the clinical history, treatment and follow-up of patients with histologically confirmed endometrial cancer treated in Faculty Hospital Nitra, Slovakia from 1990 to 2005. Data were abstracted regarding tumor histology, grade, age, parity, stage, diabetes, use of oral contraceptives, BMI, survival and treatment modalities including surgery, radiation therapy, chemotherapy, hormonal therapy, and combinations thereof. One hundred and thirty nine patients received surgical treatment for endometrial cancer: stage I -101 (72,6%), stage II - 9 (6,5%), stage III - 23 (16,6%) and stage IV - 6 (4,3%). Tumors were well differentiated in 87(62,6%), moderately differentiated in 32 (23%) and poorly differentiated in 20 (14,4%). There were 45 (32,4%) premenopausal patients and 94 (67,6%) postmenopausal. In multivariate statistical analysis we identified FIGO stage, tumor type, tumor grade, nodal status and depth of myometrial invasion as independent prognostic factors for overall survival, and FIGO stage, nodal status, and tumor grade as independent prognostic factors for recurrence-free interval.

Surgical Treatment of Endometrial Cancer and Atypical Hyperplasia: A Trend Shift from Laparotomy to Laparoscopy

Background. Laparoscopic hysterectomy has proved to be a safe alternative to open surgery in women with benign indications. Few studies compare laparotomy and laparoscopy in gynecologic oncology, and the objective of this study was to analyze the feasibility and development of laparoscopic surgery in endometrial cancer patients. Material and Methods. Records from all women having a hysterectomy due to premalignant or malignant endometrial changes during the years 2002–2009 were examined retrospectively. Results. A total of 521 hysterectomies were performed during the study period. Laparoscopy was performed in about 20% of the cases in the first two years, increasing to 83% in the last year of the period. Moreover, the laparoscopic technique was increasingly applied in older women, more obese women and in women with high-risk preoperative diagnosis, without increasing the complication rate. Conclusions. As for benign indications, laparoscopic hysterectomy in endometrial cancer patients should be preferred whenever possible.