Surgical Treatment Of Endometrial Cancer Research Articles

Surgical Treatment for Endometrial Cancer, Hysterectomy Performed via Minimally Invasive Routes Compared with Open Surgery: A Systematic Review and Network Meta-Analysis.

Background: Total hysterectomy with bilateral salpingo-oophorectomy via minimally invasive surgery (MIS) has emerged as the standard of care for early-stage endometrial cancer (EC). Prior systematic reviews and meta-analyses have focused on outcomes reported solely from randomised controlled trials (RCTs), overlooking valuable data from non-randomised studies. This inaugural systematic review and network meta-analysis comprehensively compares clinical and oncological outcomes between MIS and open surgery for early-stage EC, incorporating evidence from randomised and non-randomised studies. Methods: This study was prospectively registered on PROSPERO (CRD42020186959). All original research of any experimental design reporting clinical and oncological outcomes of surgical treatment for endometrial cancer was included. Study selection was restricted to English-language peer-reviewed journal articles published 1 January 1995-31 December 2021. A Bayesian network meta-analysis was conducted. Results: A total of 99 studies were included in the network meta-analysis, comprising 181,716 women and 14 outcomes. Compared with open surgery, laparoscopic and robotic-assisted surgery demonstrated reduced blood loss and length of hospital stay but increased operating time. Compared with laparoscopic surgery, robotic-assisted surgery was associated with a significant reduction in ileus (OR = 0.40, 95% CrI: 0.17-0.87) and total intra-operative complications (OR = 0.38, 95% CrI: 0.17-0.75) as well as a higher disease-free survival (OR = 2.45, 95% CrI: 1.04-6.34). Conclusions: For treating early endometrial cancer, minimal-access surgery via robotic-assisted or laparoscopic techniques appears safer and more efficacious than open surgery. Robotic-assisted surgery is associated with fewer complications and favourable oncological outcomes.

Clinical and Surgical Evaluation of Sentinel Node Biopsy in Patients with Early-Stage Endometrial Cancer and Atypical Hyperplasia.

The medical and surgical treatment of endometrial cancer (EC) is evolving toward a more patient-centered and personalized approach. The role of laparoscopic sentinel node biopsy (SNB) for early-stage EC is unclear, and very few data are available for atypical endometrial hyperplasia (AEH). The present study investigated the effectiveness of SNB combined with laparoscopic hysterectomy in patients with early-stage EC and AEH. This was a retrospective, single-center cohort study for the period from January 2018 to December 2023. A total of 102 patients with atypical hyperplasia (n=20) and early-stage EC (n=82) findings on diagnostic curettage underwent pelvic sentinel node biopsy during the final operation. Eleven patients (55%) who had initially been diagnosed with AEH were found to have EC in the final pathology report. No lymph node metastases were detected in patients who had initially been diagnosed with AEH; a 3.6% rate of positive SNBs was found in patients with EC. Changes in tumor grade occurred in 31.3% of the patients and changes in FIGO stage in 33%. Bilateral sentinel node (SN) mapping was successful in 94.1% of the patients. The postoperative outcomes were comparable to those of routine clinical practice without SNB. SNB can be safely offered to patients who have precursor lesions and early-stage EC without notably extending surgical times or increasing postoperative morbidity. This approach can be considered and is safe for patients diagnosed with AEH, but it appears to have a rather small impact on these patients.

Sentinel Lymph Node Impact on the Quality of Life of Patients with Endometrial Cancer.

Given the improvement in the surgical treatment of endometrial cancer with the inclusion of sentinel lymph node biopsy (SLNB), our aim was to evaluate the impact of this minimally invasive and tailored nodal assessment on patients' quality of life (QoL). This was a cross-sectional study conducted in a single-centre, tertiary-level hospital. Patients diagnosed with preoperative early-stage endometrial cancer, who underwent primary surgical treatment between August 2015 and November 2021, were included. The enrolled patients were divided into two cohorts according to the nodal staging performed: the first group underwent only SLNB (SLNB group); the second group underwent pelvic and/or para-aortic lymphadenectomy (LND group). We evaluated the overall QoL using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life core 30-item questionnaire (EORTC QLQ-C30) and a sexual health questionnaire (EORTC SHQ-C20). The scores were compared between the groups. Ninety patients were enrolled in the study: 61 (67.8%) in the SLNB group and 29 (32.2%) in the LND group. In the LND group, 24 (82.7%) patients underwent pelvic and para-aortic LND, while 5 (17.3%) patients underwent pelvic LND. The assessment of the functional scales showed better results for the SLNB group than for the LND group, with a significantly lower impact on physical status (8.2% vs. 25%, respectively; p = 0.031). In terms of the symptom scales, the SLNB group reported a significantly lower negative impact on sleep quality (4.9% vs. 27.6%, respectively; p < 0.01), pain (1.6% vs. 13.8%, respectively; p = 0.019), and dyspnoea (0% vs. 10.3%, respectively; p = 0.011) than the LND group. The SLNB group had better results for all analysed items regarding sexual QoL. The implementation of a surgical technique with SLNB improved patients' overall QoL by increasing their well-being in the functional and symptom spheres.

Rehabilitation effectiveness after radical surgical treatment of endometrial cancer

Aim: to assess an effectiveness of medical rehabilitation after radical surgical treatment of endometrial cancer (EC). Materials and Methods. Post-surgery EC patients were stratified into two groups: the main group included 29 women who underwent the proposed program of complex "active" medical rehabilitation, the comparison group – 32 patients treated in accordance with the approved clinical guidelines. Body mass index (BMI), waist and hip measurements, atherogenic index, serum glucose, leptin, tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) levels were analyzed at week 1, as well as 3, 6 and 12 months later. Results. Significant inter-group differences were observed 6 and 12 months later during the follow-up. Starting from 6 months after EC surgical treatment, in the main group BMI decreased reaching 31.14, whereas in the comparison group, it increased up to 35.07 (p &lt; 0.05). Differences in waist and hip measurements became significant by month 6 and 12, respectively, after the onset. The glucose level in the main and comparison group 6 months later was 6.16 ± 0.24 mmol/l and 6.16 ± 0.33 mmol/l, respectively; in the main group it decreased to the norm at month 12 comprising 5.09 ± 0.30 mmol/l, whereas in the comparison group it was higher than normal range reaching up to 5.87 ± 0.27 mmol/l (p &lt; 0. 05). The decrease in the atherogenic index in the main vs. comparison group, which plateaued, became significant at month 6 and 12, respectively. A decrease in serum leptin, TNF-α and IL-6 level was found in the main group, but not in the comparison group. Conclusion. For the first time, a phenomenon of dynamically decreased level of serum pro-inflammatory markers was established during the complex "active" medical rehabilitation of women after radical surgical EC treatment. In addition to the previously verified improvement in the quality of life based on subjective questionnaires and scales, the effectiveness of the proposed medical rehabilitation program for such patients was confirmed by objective methods. This rehabilitation program can be recommended to all EC females in the recovery period after surgical treatment.

COMPARATIVE ANALYSIS OF THE USE OF MAINTENANCE THERAPY DRUGS IN WOMEN IN THE PROCESS OF RADIOTHERAPY AFTER SURGICAL TREATMENT OF ENDOMETRIAL CANCER

Aim. To carry out a comparative analysis of the cost of a "unit of effect" of emoxipin, ethoxidol and mexidol used to improve the quality of life of women receiving radiation therapy after surgical treatment of endometrial cancer. Materials and methods. The pharmacoeconomic analysis was carried out in accordance with the Guidelines for Calculating Costs in Conducting Clinical and Economic Studies of Medicinal Products and included determining the position of the study and the list of costs, the time period for cost accounting and cost calculation. The results of the use of the studied drugs were evaluated according to the previously published dynamics of integrative indicators of QL according to the generic questionnaire SF-36 and the cancer-specific questionnaire for patients with endometrial cancer FACT-En. In the course of the analysis, a comparison was made of the direct costs (Cost, in rubles) for the purchase of each of the studied drugs with the consequences (Ef) of their course use. The result of the pharmacoeconomical analysis was expressed in the form of a cost-effectiveness coefficient (CER = Cost / Ef) per patient. Results. As a result of the clinical and economic analysis, it was found that in most cases mexidol is characterized by the lowest cost-effectiveness ratio. This concerns the calculation of CER according to the dynamics of the integral indicator (TS) of the questionnaire for the functional assessment of endometrial cancer therapy (FACT-En) and the psychological component of health (MH) according to SF-36. The exception was the result of the calculation of "cost-effectiveness" according to the criterion of increasing PH – the physical component of health according to SF-36. In this situation, mexidol was inferior to ethoxidol in terms of pharmacoeconomic efficiency. In all cases, without exception, the most expensive was the use of emoxipin. Conclusion. According to the pharmacoeconomic criterion "costs - effectiveness", the most expensive is the use of emoxipin, and the least expensive is the use of mexidol. In all cases, the "cost per unit effect" of emoxipin was 3-6 times higher than the corresponding indicators of mexidol and ethoxidol.

Oncological Outcomes of Obese Patients in Treatment of Endometrial Cancer. Comparative Analysis of Robotic Versus Laparoscopic Surgery

<h3>Study Objective</h3> To compare and evaluate long term oncological outcomes of robotic versus laparoscopic surgery in the treatment of endometrial cancer for obese, morbidly obese, and super morbidly obese patients. <h3>Design</h3> A prospective cohort of patients who underwent robotic-assisted hysterectomy with lymphadenectomy (RHLND) were compared to total laparoscopic hysterectomy with lymphadenectomy (LHLND) were analyzed for the long-term oncological outcomes of recurrence rate and overall survival (OS). <h3>Setting</h3> Tertiary Hospital <h3>Patients or Participants</h3> From 03/1999-03/2018, patients with BMI >30 who underwent minimally invasive surgical treatment for endometrial cancer. <h3>Interventions</h3> Demographics, pathologic characteristics for stage, grade and histology and adjuvant treatment received were compared between the two surgical treatment groups and analyzed for the oncological outcomes of recurrence rate and overall survival (OS). <h3>Measurements and Main Results</h3> Total of 330 patients were evaluated with 254/330 (77%) underwent RHLND and 76/330 (23%) underwent LHLND. Demographics and pathological outcomes were comparable between LHLND and RHLND when matched for age, histology, grade, and stage (FIGO 2019) with the exception of stage IB and II. Adjuvant treatment required for LHLND 28/76 (36.8%) and for RHLND 93/254 (36.6%) were equivalent. The rate of recurrence between the two groups for 10 year follow up was 7/76 (9.2%) and 36/254 (14.2%) for LHLND and RHLND respectively. The rate of recurrence showed no significant difference between the two surgical treatment groups when analyzed for Stage I disease [22/211 (10.4%) for RHLND and 6/69 (8.7%) for LHLND] and advanced stage disease [14/43(32.5%) for RHLND and 1/7 (14.2%) for LHLND]. The 10-year OS was 4/79 (5.2%) and 15/254 (5.9%) for LHLND and RHLND respectively were equivalent. <h3>Conclusion</h3> The long-term oncological outcomes between LHLND and RHLND showed no difference in recurrence rate and overall survival in a subset of obese patients with endometrial cancer.

8796 Comparative Analysis of Surgical Outcomes of Morbidly Obese Patients in Endometrial Cancer: Robotic Versus Laparoscopic Surgery

<h3>Study Objective</h3> Compare the surgical outcomes of robotic versus laparoscopic surgery in the treatment of endometrial cancer for morbidly obese patients. <h3>Design</h3> A cohort of morbidly obese patients who underwent robotic assisted hysterectomy with lymphadenectomy (RHLND) was compared to a historical cohort of patients who underwent laparoscopic hysterectomy with lymphadenectomy (LHLND) for the treatment of endometrial cancer. The estimated blood loss (EBL), average operative times (AOT), intraoperative and postoperative outcomes, number of pelvic (PLN) and paraaortic (PALN) lymph nodes retrieved, and number of conversions to open laparotomy were evaluated. <h3>Setting</h3> A tertiary hospital. <h3>Patients or Participants</h3> From 1999 to 2018, all patients with BMI >30 who underwent RHLND or LHLND. <h3>Interventions</h3> The surgical outcomes measured were EBL, operative times, intraoperative and postoperative complications, number of PLN and PALN retrieved, and rate of conversion to open laparotomy. Fisher exact tests or two tailed t-tests were used to analyze for difference. <h3>Measurements and Main Results</h3> 330 patients underwent surgical treatment for endometrial cancer between 1999-2018. 254 (77%) patients were RHLND and 76 (23%) patients were LHLND. The mean age and BMI were comparable. The AOT (123 minutes) and EBL (50cc) for RHLND was significantly less compared to AOT (169 minutes) and EBL (198cc) for LHND. The average number of pelvic lymph nodes in RHLND (18) and aortic lymph nodes (9) retrieved were significantly less than LHLND pelvic lymph nodes (24) and aortic lymph nodes (17). The rate of conversion to open procedures favor the RHLND group 0/254 (0%) compared to the LHLND 7/76 (9.2%). No significant difference for intraoperative RHLND 5/254 (2%) vs LHLND 2/76 (3%) and postoperative RHLND 17/254 (7%) vs LHLND 4/76 (5%) complication rate was noted. <h3>Conclusion</h3> The surgical outcomes for treatment of endometrial cancer in obese patients with RHLND compared to LHLND is associated with less blood, shorter operative time, less conversion to open with no difference in postoperative complication rate.

Preoperative sampling in endometrial cancer: evaluation of the histopathological agreement with definitive surgical specimen.

The main goal of this study is to assess the diagnostic agreement between preoperative biopsy and definitive histology of the surgical specimen to determine which sampling method is most suitable for diagnosis of early-stage endometrial cancer. We performed a retrospective multicentric study to assess the correlation between three endometrial sampling methods (hysteroscopy, pipelle and D&C) in patients who had undergone preoperative endometrial biopsy and received primary surgical treatment for endometrial cancer. The primary objective was the agreement rate between hysteroscopy (HSC), endometrial biopsy (pipelle) and dilatation and curettage (D&C). A total of 1833 women who underwent preoperative sampling at 15 centers were included: 1042 biopsies were performed by HSC, 703 by pipelle and 88 by D&C. All three methods presented a moderate diagnostic concordance (κ = 0.40-0.61) with the definitive specimen's histology: HSC (κ = 0.47), pipelle sampling (κ = 0.48) and D&C (κ = 0.48). Likewise, a subgroup analysis was performed by histological subtype comparing HSC and endometrial biopsy, showing that neither is superior as a diagnostic method. According to this study, the use of pipelle sampling could become an adequate diagnostic method in endometrial cancer due to its similar agreement to HSC, ease of use and affordability.

Oncological safety of hysteroscopy in endometrial cancer

ObjectiveIt has been suggested that the manipulation of neoplastic tissue during hysteroscopy may lead to dissemination of tumor cells into the peritoneal cavity and worsen prognosis and overall survival. The...

The effect of antioxidant drugs on the self-assessment of clinical symptoms in women during radiation therapy after surgical treatment of endometrial cancer: Placebo-controlled randomized trial

Aim. Comparative analysis of the effect of methylethylpiridinol (Emoxipine), ethylmethylhydroxypyridine malate (Ethoxidol) and ethylmethylhydroxypyridine succinate (Mexidol) on the self-assessment of nonspecific clinical symptoms in women receiving adjuvant radiation therapy after radical surgical treatment of uterine body cancer.&#x0D; Materials and methods. A short-term, prospective, simple blind, placebo-controlled, randomized study of the effect of 14-day course use of emoxipine (150 mg [0.87 mmol] per day intravenously), ethoxidol (225 mg [0.83 mmol] per day intravenously) and mexidol (225 mg [0.88 mmol] daily intravenously) on the dynamics of self-assessment of nonspecific clinical symptoms in patients during radiotherapy after surgical treatment of endometrial cancer was conducted. Self-assessment of clinical symptoms and quality of life (QOL) was studied using the MDASI questionnaire (M.D. Anderson Symptom Inventory). The emotional complaints were assessed using the Giessen questionnaire.&#x0D; Results. The 14-day use of Emoxipine, Ethoxidol and Mexidol in almost eqimolar single doses prevented the negative impact of radiation therapy on the self-assessment of clinical symptoms and QOL according to MDASI. This was manifested by a significant decrease in weakness, sadness and depression, as well as the prevention of nausea and appetite disorders during radiation therapy. At the same time, the emotional coloring of stomach and heart complaints, exhaustion and pressure of complaints decreased according to the Giessen questionnaire. The positive effect of Emoxipine, Ethoxidol and Mexidol on the self-assessment of the clinical condition and the emotional coloring of the corresponding complaints was accompanied by an improvement in such components of QOL as general activity, mood, ability to work, relationships with other people and ability to enjoy life. The studied drugs did not differ in the intensenty of the identified effects.&#x0D; Conclusion. Emoxipine, Ethoxidol and Mexidol significantly improve the multidimensional self-assessment of the clinical condition of patients receiving radiation therapy after surgical treatment of endometrial cancer. The results obtained allow us to consider Emoxipine, Ethoxidol and Mexidol as equally effective means of maintenance therapy at the stage of postoperative radiation treatment of patients with endometrial cancer.

Personalized comprehensive rehabilitation program after surgical treatment of endometrial cancer: results of a prospective randomized comparative study

Aim: to evaluate effectiveness of a personalized comprehensive rehabilitation program in patients after surgical treatment of endometrial cancer (EC).Material and Methods. There were enrolled 61 patients of reproductive age (44.46 ± 3.84 years) after radical treatment of endometrioid adenocarcinoma by stratifying subjects into 2 groups: group I – «active» rehabilitation with a comprehensive program of restorative measures (n = 29), group II – «passive» rehabilitation with standard management of the postoperative period in accordance with volume and timeframe determined by clinical recommendations (n = 32). Quality of life (QоL) was determined using the following questionnaires: Functional Assessment of Cancer Therapy for Patients with Endometrial Cancer (FACT-En), Kupperman-Uvarova Modified Menopausal Index (MMI), The Female Sexual Function Index (FSFI), Hospital Anxiety and Depression Scale (HADS). The program was based on four patient visits expected to occur at week 1 as well as 3, 6, 12 months after surgery, respectively.Results. In was found that 12 months post-surgery MMI in group I was decreased from 40.75 ± 5.69 down to 26.45 ± 4.84 score corresponding to mild postovariectomy syndrome (POES), whereas in group II – from 39.62 ± 5.37 to 36.15 ± 4.06 score estimated as moderate POES. In addition, at this time point patients in group I were noted to virtually fully recover sexual function assessed by FSFI (24.93 ± 2.86 score), whereas in group II it was at markedly lower level (13.39 ± 2.55 score; p &lt; 0.001). According to the HADS, all subjects had level exceeding score of 11 at week 1 post-surgery corresponding to clinically significant anxiety and depression. Moreover, 6- and 12-months post-surgery subjects in group I lacked significant symptoms (score &lt; 7 for each parameter), whereas in group II 12-month follow-up demonstrated subclinical level of anxiety and depression. According to the FACT-En, subjects in group I vs. group II revealed markedly higher QoL on visit 4 reaching 141.31 ± 6.45 and 112.84 ± 6.48 score, respectively.Conclusion. The «active» personalized comprehensive rehabilitation program proposed here demonstrated high efficacy in EC patients after radical surgery compared to subjects underwent standard management in rehabilitation period. Use of the program during 12 months post-surgery allowed to minimize negative manifestations related to POES, positively impacted psycho-emotional status, significantly improved sexual function as well as QoL. Organizing comprehensive rehabilitation in post-surgical EC patients should be considered as one of high-priority approaches in public healthcare.

The Accuracy of Endometrial Sampling and Clinical Affecting Factors as a Predictor of Final Surgical Pathology in Endometrial Cancer

Background: We conducted a retrospective study to evaluate the correlation between preoperative and final histologic diagnoses of endometrial cancer and to identify clinicopathologic factors associated with the concordance between initial and final hysterectomy specimens. Methods: Patients who underwent primary surgical treatment for endometrial cancer at our institute from January 2016 through December 2020 were enrolled. The International Federation of Gynecology and Obstetrics (FIGO) grade and histologic subtype in the pathologic reports were recorded. The level of agreement of tumor grade and histologic type were analyzed. Results: A total of 425 cases were recruited. The overall level of agreement between preoperative grading was moderate according to kappa statistics (κ = 0.469, 95% confidence interval [CI]: 0.385, 0.553). Furthermore, agreement related to the histologic subtype was substantial (κ = 0.778, 95% CI: 0.682, 0.874). The most frequently used endometrial sampling methods were the office endometrial sampling and endometrial curettage (49.2% and 32%, respectively). Among each diagnostic method, manual vacuum aspiration and endometrial curettage had high tumor grade correlation between the preoperative sampling and final pathology (κ = 0.743, 95% CI: 0.549, 0.937 and κ = 0.624, 95% CI: 0.512, 0.736, respectively). Negative peritoneal cytology was was the significant factor associated with concordance between preoperative endometrial sampling and final surgical pathology, with an adjusted odds ratio (OR) of 2.01 (95% CI: 1.03, 3.92; p = 0.040). Conclusions: Regardless of the different diagnostic methods, preoperative endometrial biopsy has limitations in predicting tumor grade compared with final hysterectomy specimens in women with endometrial cancer.

Minimally invasive approach for endometrial cancer: robotic assisted vs. straight stick laparoscopy

: The introduction of laparoscopic surgery in the early 1990’s presented an improved alternative to laparotomy, slowly shifting the surgical treatment for Endometrial Cancer (EC) toward minimally invasive surgery (MIS), with equivalent oncologic outcome and reduced perioperative morbidity. Robotic assisted surgery (RAS) introduced multiple technical improvements to straight stick laparoscopy (LS), associated with improved perioperative outcome including reduced blood loss, fewer conversions to laparotomy and shorter hospital stay, whereas other perioperative outcomes appear similar. Due to its technical advantages, adaptation of RAS involves a shorter learning curve than LS and offers improved ergonomics compared to straight stick instrumentation. The advantages of RAS are more pronounced in patients with increased body mass index (BMI). Both LS and RAS have been shown to be safe in elderly patients and although available data shows benefit compared to laparotomy, it does not suggest superiority of one MIS approach over the other. Even though RAS and LS have comparable oncologic outcomes, the integration of RAS facilitated the shift toward MIS, where LS had failed to significantly reduce the rate of laparotomy. This shift to MIS was associated with reduced postoperative length of stay and complication rates, offsetting the increased costs involved with RAS. By introducing a computer interface, RAS is allowing augmented reality and digital analysis, leading surgery towards precision surgery and a high-tech future.

Surgical treatment of endometrial cancer in a patient with tuberous sclerosis complex and an enlarged polycystic liver and lymphangioleiomyomatosis

Surgical treatment of endometrial cancer in a patient with tuberous sclerosis complex and an enlarged polycystic liver and lymphangioleiomyomatosis

Vaginal hysterectomy using the ERBE BiClamp® bipolar vessel sealing system as a surgical approach for endometrial cancer—single surgeon experience from a district general hospital

Uterine cancer is the most common gynaecological malignancy with increasing incidence due to rising ageing, increasing obesity within the population and falling rates of hysterectomy for benign disease. European and British guidelines advocate a minimally invasive surgery (MIS) even in patients with high-risk endometrial cancer (EC). The standard surgical procedure is total hysterectomy with bilateral salpingo-oophorectomy. Our study examines vaginal hysterectomy (VH) performed using the ERBE BiClamp® bipolar vessel sealing system as a surgical approach for EC following studies demonstrating its safety in VH for benign disease. Retrospective review of a single surgeons practice of patients booked for VH as the surgical treatment of EC (2011–2019). Patients’ electronic records and paper charts were reviewed. Primary outcome was oncological safety and secondary outcomes were intra-operative blood loss, complications encountered, and length of hospital stay (LOS). The comparison group where previously studied patients undergoing BiClamp® VH by the same surgeon for benign/pre-malignant conditions. A total of 127 patients were included (median age 64 years, median BMI 32 kg/m2). Mean Hb drop was 9.3 g/L. 50.4% of patients were discharged on the 1st post-operative day and 82.7% by day 2. A total of 35 patients received adjuvant treatment. There were 2 cases of vault recurrence and 2 patients died from disease progression. Overall, 5 year survival was 92.9% with the majority of deaths dues to cardiac causes or a separate malignancy. The rate of disease progression was 3.1%. This study suggests that BiClamp® VH is an oncologically safe procedure and could be considered as an alternative MIS approach in the cohort of patients who are not suitable for laparoscopic or robot-assisted staging surgery. The technique affords a short operative time, minimal bloods loss, short LOS with acceptable surgical outcomes and similar oncologic outcomes to other surgical approaches.

Prognostic significance of histological grade in low-risk endometrial cancer.

Objective: Investigate the risk factors for recurrence in patients with low-risk endometrial cancer. Method: A retrospective review was performed to identify patients who underwent primary surgical treatment for endometrial cancer from December 2009 to December 2020. Patients who met the following criteria were included in the study: (a) International Federation of Gynecology and Obstetrics stage IA, (b) endometrioid-type histology, (c) histological grade 1 or 2. Univariate and multivariate analyses using Cox proportional hazards model to evaluate effects of prognostic factors. Disease-free survival and overall survival were calculated using the Kaplan-Meier method. Results: A total of 171 patients with low-risk endometrial cancer were included in the study. Recurrence was detected in 9 patients. Histological grade was found to be independent risk factors for recurrence in women with low-risk endometrial cancer (OR 8.255, 95% confidence interval (CI) 1.585 - 42.981; p = 0.012). Conclusion: The results of this study suggest that grade 2 disease should be considered a significant prognostic factor for the recurrence of low-risk endometrial cancer.

Five-Year Experience in the Surgical Treatment of Endometrial Cancer: Comparing Laparotomy with Robotic and Minimally Invasive Hysterectomy

To compare surgical and oncological outcomes in the treatment of endometrial cancer between laparotomy and minimally invasive surgery. The secondary objective was to determine which MIS approach was the most beneficial. This was a single-centre retrospective review of all endometrial cancer surgeries performed between November 1, 2012 and October 31, 2017 in a gynaecologic oncology unit of a university hospital. Descriptive statistics were used to compare histopathologic results and oncological outcomes, and Kaplan-Meier estimates were used to compare survival. A total of 735 cases were reviewed. The majority of patients (77%) underwent either laparotomy (35%) or robotic-assisted hysterectomy (42%); the remaining patients underwent total laparoscopic hysterectomy (12%) or a laparoscopic-assisted vaginal hysterectomy (8.7%). There was a statistically significant overall survival benefit (P=0.02), a shorter hospital stay (P < 0.0001), and fewer early surgical complications (<30 d; P=0.0002), as well as a survival benefit in elderly patients (>70 y) in the robotic-assisted hysterectomy group (P=0.043) than the laparotomy group. Operating time was shorter in the laparotomy group (P < 0.0001). Recurrence rates in stage 1 low-risk disease were similar between groups. Minimally invasive surgical approaches, particularly robotic surgery, do not compromise oncologic outcomes, especially for early-stage low-risk disease. In addition, these approaches are associated with fewer early surgical complications and shorter hospital stay, with significantly more same-day discharges. Overall survival and survival in a subgroup of elderly patients were significantly better in the robotic-assisted hysterectomy group.

Testing methods for surgical treatment of endometrial cancer

Annotation. The urgency of the study is due to an increase in the incidence (more than 50%) of newly diagnosed uterine endometrial cancer, especially among young people. The main method of treatment for stage I-II endometrial cancer remains surgery. The study aimed to identify possible cytological conversion during laparoscopic procedures. The main method of research was a non-randomized, prospective cohort study with subsequent observation of the duration of hospitalization and 30 days after discharge for the period from 2010 to 2019. The duration of hospitalization was estimated, while in the perioperative period and within 30 days after discharge – the presence of postoperative complications. A total of 812 patients with stage I-IV endometrial cancer were analyzed, with a mean age of 52±5 years (25 to 75 years). The first group included patients who underwent laparotomy, the second – laparoscopic surgery. The presence of metastases and recurrences was confirmed by morphological, radiological, echoscopic and clinical methods. Standard methods of descriptive statistics were used for data processing; in particular, the average values were calculated with their standard errors when using the standard Student’s t-test at p&lt;0.05 using Microsoft Excel software packages. Conclusions were made about the volume and type of surgery, taking into account the histological type of tumor, lymphovascular invasion, clinical stage, presence or absence of obesity and other comorbidities that may affect metabolism, life history and the presence of surgery. The obtained data confirm the safety of laparoscopic hysterectomy for women with stage I endometrial cancer. However, there are no data on whether laparoscopy can lead to intra-abdominal dissemination of tumor cells.

Risk Factors for Surgical Treatment of Endometrial Cancer Using Traditional and Laparoscopic Methods.

Surgical treatment is the most important part of therapy for endometrial cancer. The aim of the study was to define factors having the most significant impact on surgical treatment of endometrial cancer when using traditional and laparoscopic methods. In the study, we evaluated 75 females who were treated for endometrial cancer via laparoscopic surgery in 2019 and used a historical control of 70 patients treated by laparotomy in 2011. The evaluated risk factors included the method of surgery, type of lymphadenectomy, patient’s age, various obesity parameters, histological grading, cancer clinical staging, pelvic dimensions, previous abdominal surgeries, comorbidities, and number of deliveries. The duration of hospitalization, operation time, loss of hemoglobin, and procedure-related complications were used as parameters of perioperative outcomes. Multivariable linear regression analysis confirmed the following factors as being predictors of worse perioperative outcomes: laparotomy, abdominal obesity (waist circumstance and waist-to-hip ratio), range of lymphadenectomy, prior abdominal surgeries, and larger pelvic dimensions. Abdominal obesity is a significant risk factor in the treatment of endometrial cancer. Laparotomy continues to be utilized frequently in the management of endometrial cancer in Poland as well as elsewhere, and adopting a minimally invasive approach is likely to be beneficial for patient outcome.

Impact of obesity on surgical and oncologic outcomes in patients with endometrial cancer treated with a robotic approach.

The surgical treatment of endometrial cancer (EC) can be more complicated in obese patients. Robotic surgery could simplify the surgical approach in these patients. The aim of our study was to compare the outcomes of robotic surgery in obese (body mass index ≥30 kg/m2 ) and nonobese patients. We performed a retrospective study on patients with EC benefitting from a robotic approach in our institution. The primary outcome was the 5-year overall survival (OS). We also assessed the 5-year recurrence-free survival (RFS), type of surgery, laparotomy conversion rate, adjuvant treatment and postoperative morbidity. We analyzed 175 consecutive patients with EC who underwent robotic surgery, 42 patients with obesity and 133 patients without. The median follow-up length was 37 months [1-120]. The OS rate was 97% in the whole population and the RFS was 74%. Obesity did not impact prognosis. Laparotomy conversion rate was low in both groups (5% in patients with obesity vs 3%, P = 0.619). There were no significant differences in terms of postoperative complications (5 vs 9%, P = 0.738). There were significantly less pelvic lymphadenectomies in patients with obesity (5 vs 12%, P = 0.005). In the subgroup of patients with high-risk EC, rate of lymphadenectomy and of adjuvant treatments did not differ between patients with or without obesity. Obese patients with EC can be safely treated with a robotic approach, with a low complication rate and similar oncological outcomes compared to nonobese patients.