Treatment Of Early-stage Endometrial Cancer Research Articles

RELEVANCE OF OVARIAN PRESERVATION
 IN YOUNG WOMEN WITH EARLY-STAGE
 ENDOMETRIAL CANCER AFTER HORMONAL
 AND SURGICAL TREATMENT:
 A COMPREHENSIVE LITERATURE REVIEW

Relevance: Ovarian preservation in young women with early-stage endometrial cancer after surgical treatment has been conventionally associated with complications. Nevertheless, recent randomized studies suggest a different perspective.
 The study aimed to clarify the occurrence of complications, in particular relapses, associated with ovarian preservation in young
 women after hormonal and surgical treatment for early-stage endometrial cancer.
 Methods: The analysis included articles published in full text over the past 10 years. We identified relevant observations from studies using a comprehensive search in the following databases: PubMed, Medline, Embase, and Cochrane Library. The search strategy
 included terms related to endometrial cancer: premenopausal, young woman, endometrial cancer, ovarian conservation. The study
 followed the PRISMA guidelines for systematic reviews.
 Results: A total of 178 articles were studied, of which 111 articles (literature reviews and meta-analyses) (62%) described the
 cases of ovarian preservation. Of these, 84 were excluded for various reasons; 29 eligible articles were included in this analysis.
 Notably, factors such as younger age (P<0.0001), later year of diagnosis (P=0.03), residence in Central and Southern Europe and
 the United States (P=0.02), and lower-grade tumors in Asian countries (P<0.002) correlated with the desire of women to preserve
 their ovaries. The conducted literature review showed that ovarian preservation did not significantly affect cancer-specific survival
 (risk ratio (HR) =0.78, 95% CI 0.17-2.74) or overall survival (HR=0.78, 95% CI 0.24-1.75).
 This study’s results remained practically unchanged even after excluding women after radiation and hormone therapy.
 Conclusion: This literature review revealed no statistically significant difference in relapse-free survival between patients after
 ovarian preservation at stage IA and partially at stage II com-pared to those after bilateral salpingo-oophorectomy.

Evaluation of survival outcomes between minimally invasive and open surgery in the treatment of early-stage endometrial cancer: a population-based study in Osaka Japan.

To compare the oncological outcomes between Japanese women who underwent minimally invasive surgery and those who underwent open surgery for early-stage endometrial cancer. This population-based retrospective cohort study was conducted using data from the Osaka Cancer Registry from 2011 to 2018. Surgically treated patients for localized (uterine-confined) endometrial cancer were identified. Patients were classified into two groups according to the type of surgery (minimally invasive surgery group and open-surgery group), pathological risk factors (low-risk and high-risk), and year of diagnosis (Group 1, 2011-14; Group 2, 2015-18). Overall survival was compared between the minimally invasive surgery and open-surgery groups. In the analyses including all patients, there was no difference in overall survival between the minimally invasive surgery and open-surgery groups (P=0.0797). The 4-year overall survival rate was 97.1 and 95.7% in the minimally invasive surgery and open-surgery groups, respectively. When investigated according to pathological risks, there were no differences in overall survival between the minimally invasive surgery and open-surgery groups in both the low- and high-risk groups. In the low-risk group, the 4-year overall survival rates in the minimally invasive surgery and open-surgery groups were 97.7 and 96.5%, respectively. In the high-risk group, the 4-year overall survival rates in the minimally invasive surgery and open-surgery groups were 91.2 and 93.2%, respectively. Similarly, there were no differences in overall survival between the minimally invasive surgery and open-surgery groups in both Group 1 (P=0.4479 in low-risk and P=0.1826 in high-risk groups) and Group 2 (P=0.1750 in low-risk and P=0.0799 in high-risk groups). Our study provides epidemiological evidence that minimally invasive surgery is an effective alternative to open surgery in Japanese patients with early-stage endometrial cancer.

A Multicentric Randomized Trial to Evaluate the ROle of Uterine MANipulator on Laparoscopic/Robotic HYsterectomy for the Treatment of Early-Stage Endometrial Cancer: The ROMANHY Trial.

ObjectiveThis prospective randomized trial aimed to assess the impact of the uterine manipulator in terms of lymph vascular space invasion (LVSI) in patients undergoing minimally invasive staging for early-stage endometrial cancer.MethodsIn this multicentric randomized trial, enrolled patients were randomly allocated in two groups according to the no use (arm A) or the use (arm B) of the uterine manipulator. Inclusion criteria were G1-G2 early-stage endometrial cancer at preoperative evaluation. The variables collected included baseline demographic characteristics, perioperative data, final pathology report, adjuvant treatment, and follow-up.ResultsIn the study, 154 patients (76 in arm A and 78 in arm B) were finally included. No significant differences were recorded regarding the baseline characteristics. A statistically significant difference was found in operative time for the laparoscopic staging (p=0.005), while no differences were reported for the robotic procedures (p=0.419). The estimated blood loss was significantly lower in arm A (p=0.030). No statistically significant differences were recorded between the two study groups in terms of peritoneal cytology, LVSI (p=0.501), and pattern of LVSI (p=0.790). No differences were detected in terms of overall survival and disease-free survival (p=0.996 and p=0.480, respectively). Similarly, no differences were recorded in the number of recurrences, 6 (7.9%) in arm A and 4 (5.2%) in arm B (p=0.486). The use of the uterine manipulator had no impact on DFS both at univariable and multivariable analyses.ConclusionsThe intrauterine manipulator does not affect the LVSI in early-stage endometrial cancer patients undergoing laparoscopic/robotic staging.Clinical Trial Registrationhttps://clinicaltrials.gov, identifier (NCT: 02762214)

Fertility preserving management of early endometrial cancer in a patient cohort at the department of women\u2019s health at the university of Tuebingen

PurposeTo investigate the oncologic and reproductive outcome of a conservative treatment with progestin agents in early-stage grade 1 endometrial cancer (G1EC), grade 2 endometrial cancer (G2EC) or complex atypical hyperplasia (CAH) in young premenopausal women.MethodsWomen treated for early-stage endometrial cancer or atypical hyperplasia of the endometrium with a conservative therapy between 2006 and 2018 were enrolled in this retrospective analysis. Progestin agents were orally administered on a daily basis for 3 months for at least one cycle. Endometrial tissue was obtained by hysteroscopy and Dilatation & Curettage (D&C) being performed before and after end of treatment. Therapeutic response was assessed by pathological examination.ResultsA total of 14 patients were included. After treatment with progestin agents, 11 of these patients initially showed a complete or partial response. Three patients with early-stage endometrial cancer did not respond.Of the three patients with initially diagnosed atypical hyperplasia, none showed any remaining disease later. Of the eight patients with initially diagnosed endometrial cancer, who had responded to first treatment, three patients were re-diagnosed with endometrial cancer later. One patient with initial endometrial cancer became pregnant but aborted in the 10th week.ConclusionDue to its good efficacy, progestin agents offer a feasible therapeutic option in the fertility-preserving treatment of early-stage endometrial cancer in young premenopausal women. However, recurrence rate remains high. Therefore, a close follow-up is mandatory, also in responders. Patients should be informed of limitations and risks of conservative treatment. Yet after completion of family planning, hysterectomy should be performed.

Cost-effectiveness of robotic hysterectomy versus abdominal hysterectomy in early endometrial cancer

ObjectivesTo compare total costs for hospital stay and post-operative recovery between robotic and abdominal hysterectomy in the treatment of early-stage endometrial cancer provided in an enhanced recovery after surgery (ERAS)...

The Mirena coil is a suitable treatment of early-stage endometrial cancer in obese women: AGAINST: Please follow the manufacturer's advice.

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Medically unfit women with early-stage endometrial cancer treated with the levonorgestrel intrauterine system

ObjectiveTo assess the clinical efficacy of the levonorgestrel intrauterine system (LNG-IUS) in the treatment of early-stage endometrial cancer in elderly morbidly obese women, whose multiple co-morbidities made the standard surgical treatment too risky to undertake.MethodsA retrospective review was conducted and case series reports were prepared of all women diagnosed with endometrial cancer, from April 2011 to December 2016 at the Queen's Hospital, London, to identify women unfit for surgery and treated with the LNG-IUS.ResultsOut of 438 women with endometrial cancer, Eight women with early-stage endometrial cancer were deemed unfit for surgery and underwent treatment with the LNG-IUS. All had grade 1 endometrioid endometrial adenocarcinoma, radiologically staged as 1a. Four women died of their co-morbidities, not related to endometrial cancer. One of them had 68 months of progression-free survival before death due to co-morbidities. One patient required a hysterectomy after 32 months of treatment with LNG-IUS and oral progestogens due to heavy vaginal bleeding. Three women have continued the LNG-IUS treatment with no evidence of progressive disease symptoms till date at a mean follow-up of 35.7 months.ConclusionFor women with multiple co-morbidities, the LNG-IUS offers an effective and safe treatment for early-stage, low-grade endometrial cancer, with no cases of symptomatic progression reported in our case series. In the frail and elderly, where the quality of life is of paramount importance, surgical treatment may not offer additional long-term survival benefits.

Laparoscopic and Robotic Hysterectomy in Endometrial Cancer Patients with Obesity: A Systematic Review and Meta-Analysis of Conversions and Complications

Study Objective Robotic assistance may facilitate completion of minimally invasive hysterectomy, which is the standard of care for the treatment of early-stage endometrial cancer, in patients for whom conventional laparoscopy is challenging. The aim of this systematic review was to assess conversion to laparotomy and perioperative complications after laparoscopic (LH) and robotic hysterectomy (RH) in endometrial cancer patients with obesity. Design We systematically searched MEDLINE, EMBASE, and Evidence-Based Medicine Reviews (January 1, 2000 to July 18, 2018) for studies of endometrial cancer patients with obesity (body mass index, BMI≥30 kg/m2) undergoing primary hysterectomy. We generated pooled proportions of conversion, organ/vessel injury, venous thromboembolism (VTE), and blood transfusion. We assessed risk of bias with the Institute of Health Economics Quality Appraisal Checklist for single-arm studies, and Newcastle-Ottawa Scale for double-arm studies. Setting N/A Patients or Participants N/A Interventions N/A Measurements and Main Results We identified 51 observational studies reporting on 10,800 endometrial cancer patients with obesity (study-level BMI: 31.0-56.3). The pooled proportions of conversion from LH and RH were 6.5% (95% CI 4.3-9.9) and 5.5% (3.3-9.1) respectively among patients with BMI≥30, and 7.0% (3.2-14.5) and 3.8% (1.4-9.9) among patients with BMI≥40. Inadequate exposure due to adhesions/visceral adiposity was the most common reason for conversion for both LH (32%) and RH (61%); however, intolerance of Trendelenburg caused 31% of LH conversions and 6% of RH conversions. The pooled proportions of organ/vessel injury (LH 3.5% [2.2-5.5]; RH 1.2% [0.4-3.4]), VTE (LH 0.5% [0.2-1.2]; RH 0.5% [0.1-2.0]), and blood transfusion (LH 2.8% [1.5-5.1]; RH 2.1% [1.6-3.8]) were low and not appreciably different between arms. Conclusion RH and LH have similar rates of perioperative complications in endometrial cancer patients with obesity, but RH reduces conversions due to positional intolerance in patients with morbid obesity. Existing literature is limited by selection and confounding bias, and randomized trials are needed to inform practice standards in this population.

Treatment outcomes of early stage endometrial cancer patients: single center experience

Purpose:Endometrium cancers are the most common gynecological cancer type in women. Surgery is the standard treatment for women with early stage endometrial cancer patients. The adjuvant treatment of early stage endometrial cancer is based on the risk and expected type (local vs systemic) of relapse. In this study, we evaluated clinicopathological characteristics and treatment outcomes of endometrial cancer patients in our center.Materials and Methods:This study was a hospital-based retrospective observational case-series study. 116 patients were included in the study from Baskent University Department of Medical Oncology and Gynecological Oncology between the years of 2009-2015. De-novo metastatic patients were not included in the study. Results:The median age of the patients was 58 (range 27-81) years. All of patients had European Cooperative Oncology Group (ECOG) performance score 0 (n:116). Endometrioid histology was the most common histopathological subtype (n:103, 88%). All of the patients were in local and local advanced stage. The significant percentage of patients had grade 2 tumor (n:55, 47.4%). Myometrial invasion was less than 50% in 78 patients (67.2 %). The median follow-up time was 61 months and 8 (6.9%) patients died. All patients underwent standard surgical staging with standard lymphadenectomy. Overall survival (OS) was not reached. There were 14 patients (12.1 %) and 34 patients (29.3 %) treated with adjuvant chemotherapy and radiotherapy, respectively.Conclusion:Though endometrial cancer is the most common gynecological tumors in women, cure rate is very high. Relapse rate was 6 % (7 patients) and most of the relapse were local, 71.4% (5 patients).

Incidence, patterns and prognosis of first distant recurrence after surgically treated early stage endometrial cancer: Results from the multicentre FRANCOGYN study group

Patterns of distant metastatic failure of endometrial cancer (EC) by specific anatomic site are not well described in the literature. In this manuscript, we evaluated the metastatic patterns of EC cancer and analysed the potential distribution of metastatic disease in this malignancy. MethodsA total of 1444 women with EC were identified. Of which we extracted women with locoregional and distant recurrence or with distant recurrence alone. Women were scored based on first site of metastasis: multiple versus one site: bone, brain, lung, liver or sus diaphragmatic lymph nodes. Results110 women developed distant metastatic disease with (n = 37(33.6%)) or without (n = 73(66.4%)) locoregional recurrence, including 39 women with exclusive first site of metastatic disease and 34 women with multiple sites of metastatic disease. When considering all women, the most common exclusive first site of metastasis was lung (42.8%). The median time to develop distant metastases was shorter after the completion of treatment for exclusive brain metastatic disease compared with other sites of metastatic− disease (7 months vs, 9 for lung, 10 for liver, 19 for bone and 27 months for sus-diaphragmatic LN; P = 0.004). The rate of 3-year overall survival was higher in the sus-diaphragmatic LN metastase group (83.3% vs 50.6% for lung, 37.3% for bone, 16.7% for brain and 0% for liver; P = 0.0059). ConclusionThe present study has demonstrated the site-specific patterns of metastases. These data support current clinical practice of screening for site-specific metastatic disease after initial treatment of early stage EC based on concerning women-specific signs or symptoms.

Chemotherapy as Adjuvant Treatment for Early Stage Endometrial Cancer With High Intermediate Risk Factors.

The aim of this study was to explore the role of chemotherapy as adjuvant treatment for early-stage endometrial cancer (EC) with high-intermediate-risk (HIR) factors. A prospective study of patients with early-stage EC with HIR factors for recurrence was performed between 2006 and 2014. A total of 96 patients were enrolled, and 50 patients received 3 cycles of platinum-based chemotherapy after surgery. Five-year disease-free survival and overall survival were evaluated. A total of 11 (11.5%) of the 96 patients had recurrence, with a median recurrent time of 15.4 months. Of these 11 patients with recurrence, 2 received adjuvant chemotherapy after surgery, whereas 9 did not receive any treatment. Patients without adjuvant chemotherapy exhibited a significantly higher recurrence rate than those with adjuvant chemotherapy (19.6% vs 4%; P = 0.024). Meanwhile, patients with adjuvant chemotherapy had significantly higher 5-year disease-free survival compared with the control group (92.1% vs 70.0%, P = 0.024). Chemotherapy is feasible and safe as adjuvant treatment for early-stage EC with HIR factors. Three cycles of platinum-based chemotherapy are sufficient for reducing the risk of recurrence. Further, large sample randomized studies are needed to confirm these results.

Hormone replacement therapy for women previously treated for endometrial cancer.

Endometrial cancer is the sixth most common cancer in women worldwide and most commonly occurs after the menopause (75%) (globocan.iarc.fr). About 319,000 new cases were diagnosed worldwide in 2012. Endometrial cancer is commonly considered as a potentially 'curable cancer,' as approximately 75% of cases are diagnosed before disease has spread outside the uterus (FIGO (International Federation of Gynecology and Obstetrics) stage I). The overall five-year survival for all stages is about 86%, and, if the cancer is confined to the uterus, the five-year survival rate may increase to 97%. The majority of women diagnosed with endometrial cancer have early-stage disease, leading to a good prognosis after hysterectomy and removal of the ovaries (oophorectomy), with or without radiotherapy. However, women may have early physiological and psychological postmenopausal changes, either pre-existing or as a result of oophorectomy, depending on age and menopausal status at the time of diagnosis. Lack of oestrogen can cause hot flushes, night sweats, genital tract atrophy and longer-term adverse effects, such as osteoporosis and cardiovascular disease. These changes may be temporarily managed by using oestrogens, in the form of hormone replacement therapy (HRT). However, there is a theoretical risk of promoting residual tumour cell growth and increasing cancer recurrence. Therefore, this is a potential survival disadvantage in a woman who has a potentially curable cancer. In premenopausal women with endometrial cancer, treatment induces early menopause and this may adversely affect overall survival. Additionally, most women with early-stage disease will be cured of their cancer, making longer-term quality of life (QoL) issues more pertinent. Following bilateral oophorectomy, premenopausal women may develop significant and debilitating menopausal symptoms, so there is a need for information about the risk and benefits of taking HRT, enabling women to make an informed decision, weighing the advantages and disadvantages of using HRT for their individual circumstances. To assess the risks and benefits of HRT (oestrogen alone or oestrogen with progestogen) for women previously treated for endometrial cancer. We searched the Cochrane Register of Controlled Trials (CENTRAL 2017, Issue 5), MEDLINE (1946 to April, week 4, 2017) and Embase (1980 to 2017, week 18). We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of review articles. We included randomised controlled trials (RCTs), in all languages, that examined the efficacy of symptom relief and the safety of using HRT in women treated for endometrial cancer, where safety in this situation was considered as not increasing the risk of recurrence of endometrial cancer above that of women not taking HRT. Two review authors independently assessed whether potentially relevant studies met the inclusion criteria. We used standard methodological procedures expected by Cochrane. We identified 2190 unique records, evaluated the full text of seven studies and included one study with 1236 participants. This study reported tumour recurrence in 2.3% of women in the oestrogen arm versus 1.9% of women receiving placebo (risk ratio (RR) 1.17, 95% confidence interval (CI) 0.54 to 2.50; very low-certainty evidence). The study reported one woman in the HRT arm (0.16%) and three women in the placebo arm (0.49%) who developed breast cancer (new malignancy) during follow-up (RR 0.80, 95% CI 0.32 to 2.01; 1236 participants, 1 study; very low-certainty evidence). The study did not report on symptom relief, overall survival or progression-free survival for HRT versus placebo. However, they did report the percentage of women alive with no evidence of disease (94.3% in the HRT group and 95.6% in the placebo group) and the percentage of women alive irrespective of disease progression (95.8% in the HRT group and 96.9% in the placebo group) at the end of the 36 months' follow-up. The study did not report time to recurrence and it was underpowered due to closing early. The authors closed it as a result of the publication of the Women's Health Initiative (WHI) study, which, at that time, suggested that risks of exogenous hormone therapy outweighed benefits and had an impact on study recruitment. No assessment of efficacy was reported. Currently, there is insufficient high-quality evidence to inform women considering HRT after treatment for endometrial cancer. The available evidence (both the single RCT and non-randomised evidence) does not suggest significant harm, if HRT is used after surgical treatment for early-stage endometrial cancer. There is no information available regarding use of HRT in higher-stage endometrial cancer (FIGO stage II and above). The use of HRT after endometrial cancer treatment should be individualised, taking account of the woman's symptoms and preferences, and the uncertainty of evidence for and against HRT use.

Pelvic floor functional outcomes after total abdominal vs total laparoscopic hysterectomy for endometrial cancer

Pelvic floor functioning is an important concern for women requiring a hysterectomy for endometrial cancer. The incidence of pelvic floor symptoms has not been reported in women who have undergone a hysterectomy for early-stage endometrial cancer. We sought to evaluate pelvic floor function in women who have had surgical treatment for early-stage endometrial cancer as part of the multinational Laparoscopic Approach to Cancer of the Endometrium trial and to compare patients' outcomes who had total abdominal vs total laparoscopic hysterectomy. A multinational, phase III, randomized noninferiority trial compared disease-free survival of patients who had total abdominal hysterectomy vs total laparoscopic hysterectomy. This substudy analyzes the results from a self-administered validated questionnaire on pelvic floor symptoms (Pelvic Floor Distress Inventory) administered preoperatively, and at follow-up visits 6, 18, 30, 42, and 54 months postoperatively. Overall, 381 patients with endometrial cancer were included in the analysis (total abdominal hysterectomy, n= 195; total laparoscopic hysterectomy, n= 186). At 6 months postsurgery both groups experienced an improvement in Pelvic Floor Distress Inventory scores compared to presurgical pelvic floor well-being (total abdominal hysterectomy: mean change -11.17; 95% confidence interval, -17.11 to -5.24; total laparoscopic hysterectomy: mean change -10.25; 95% confidence interval, -16.31 to -4.19). The magnitude of change from baseline in pelvic floor symptoms did not differ between both treatment groups up to 54 months postsurgery. These findings suggest that pelvic floor function in terms of urinary, bowel, and prolapse symptoms are unlikely to deteriorate following abdominal or laparoscopic hysterectomy and are reassuring for women undergoing hysterectomy for early-stage endometrial cancer.

Utilization of laparoscopy in the treatment of early-stage endometrial cancer: a single center experience

Utilization of laparoscopy in the treatment of early-stage endometrial cancer: a single center experience

Extraction of a specimen through an umbilical zigzag incision during laparoscopic surgery for endometrial cancer

BackgroundThough laparoscopic surgery has recently been applied in the treatment of early-stage endometrial cancer, the presence of a large uterus is a hindrance to specimen extraction from the abdominal cavity. We describe a laparoscopic surgical technique for endometrial cancer involving the extraction of the resected specimen through an umbilical zigzag incision.Case presentationA 63-year-old woman with endometrial cancer underwent a total hysterectomy and bilateral salpingo-oophorectomy that was performed laparoscopically. The surgical specimen was extracted through an umbilical zigzag incision. This umbilical zigzag incision created a larger fascial and peritoneal opening, facilitating the removal of the specimen. The final histopathologic results revealed stage 1A G1 endometrioid adenocarcinoma and multiple uterine leiomyomas. Three months after surgery, the wound in the umbilical region was inconspicuous, along with the inward movement of the umbilicus.ConclusionsA laparoscopic surgical technique for endometrial cancer involving the extraction of the specimen through an umbilical zigzag incision seems to reduce the difficulties associated with laparoscopic surgery and maintains cosmesis. Further analyses involving larger numbers of cases and long-term follow-up periods are warranted to evaluate this surgical method.

Oral Progestin Treatment for Early-Stage Endometrial Cancer: A Systematic Review and Meta-analysis.

This study aimed to evaluate the efficacy and safety of oral progestin treatment for early-stage endometrial cancer. We conducted a systematic review and meta-analysis of the proportions from observational studies. Original studies were selected if patients with early-stage endometrial cancer, especially those of reproductive age, were treated with oral progestin. We conducted searches on studies listed in MEDLINE, EMBASE, and Cochrane that were published through June 2014, and relevant articles were also searched. The methodological quality of the included studies was assessed using the Newcastle-Ottawa quality assessment scale. Funnel plots and metaregression analyses were used to assess bias. The final sample included 25 articles involving 445 patients. Based on a random-effects model, patients achieved a disease regression rate of 82.4% (95% confidence interval [CI], 75.3%-88.7%), a relapse rate of 25.0% (95% CI, 15.8%-35.2%), a pregnancy rate of 28.8% (95% CI, 22.5%-35.5%), and a live birth rate of 19.6% (95% CI, 12.8%-27.4%). Body weight gain, liver dysfunction, and abnormal blood coagulation test results were the most common treatment-related adverse effects. Only 2 disease-related deaths were reported during the follow-up duration. Based on the present systematic review and meta-analysis, oral progestin treatment is feasible and safe for patients of reproductive age.

Therapeutic role of systematic lymphadenectomy in early-stage endometrial cancer: A systematic review.

The purpose of the current review was to examine whether systematic lymphadenectomy is safe and effective for treating early-stage endometrial cancer. PubMed, Embase, the Cochrane Library and the China National Knowledge Infrastructure databases were systematically searched during April 2014 to identify studies comparing the use of systematic lymphadenectomy and no systematic lymphadenectomy in parallel for the treatment of early-stage endometrial cancer. A total of 13 eligible studies involving 51,155 patients were included in this review. The median overall survival (OS) rate at 5 years following lymphadenectomy was 90% (range, 73.1-98.3%) for patients undergoing the systematic procedure and 88.2% (range, 68-98.4%) for patients not undergoing the systematic procedure. For the two types of lymphadenectomy, OS has tended to improve over the last 20 years. The combined rate of disease-free and progression-free survival was higher in patients who underwent systematic lymphadenectomy, and the recurrence rate was lower. In particular, systematic lymphadenectomy was associated with markedly higher OS than the non-systematic procedure for patients with intermediate- and high-risk endometrial cancer when ≥11 lymph nodes were removed. Systematic lymphadenectomy demonstrates clinical benefit in patients with early-stage endometrial cancer and should thus be a standard treatment option. In conclusion, systematic lymphadenectomy leads to higher OS than no systematic lymphadenectomy in intermediate- and high-risk patients with early-stage endometrial cancer, particularly when the procedure removes ≥11 lymph nodes.

Laparoscopic treatment of early-stage endometrial cancer with and without uterine manipulator: Our experience and review of literature

ObjectiveThe aim of this study was to retrospectively compare in a series of 110 patients with early-stage endometrial cancer recurrence rate and surgical outcomes after total laparoscopic (LPS) hysterectomy with lymphadenectomy performed with or without uterine manipulator. Study design110 patients with clinical stage I endometrial cancer were enrolled in a retrospective study and underwent surgical staging comprised of LPS hysterectomy, bilateral salpingo-oophorectomy, and in all cases we performed systematic bilateral pelvic lymphadenectomy with uterine manipulator (Group 1, 55 patients) or without (Group 2, 55 patients). ResultsThe rate of positive cytology and LVSI did not significantly differ between Group 1 and Group 2. 1 patient of the Group 1 had a bladder injury and another patient of Group 2 had an ureteral stricture temporarily treated with a stent. 1 patient of the Group 1 had a bowel occlusion due to a port site hernia under the left 10 mm port, resolved with a bowel resection and an end-to-end anastomosis. In 1 patient of the Group 1 and 2 patients of Group 2 we observed a vaginal cuff dehiscence and in 1 case of Group 2 a pelvic lymphocyst was reported. Postoperative fever was reported in 3 patients of the Group 1 and in 5 patients of group 2 (p = 0.07). ConclusionsOur study confirms that use of uterine manipulator for laparoscopic treatment of endometrial cancer does not increase positive peritoneal citology, LVSI and recurrence rate.

The Experience of Robotic-Assisted Laparoscopic Hysterectomy for Women Treated for Early-Stage Endometrial Cancer: A Qualitative Study.

An increasing number of women are offered robotic-assisted laparoscopic hysterectomy as treatment for early-stage endometrial cancer in the developed world. The aim of this study was to explore how women diagnosed with early-stage endometrial cancer experienced robotic-assisted laparoscopic hysterectomy. Semistructured interviews were carried out with 12 women, and interview data were analyzed by qualitative content analysis. Four overarching themes emerged: "surgery was a piece of cake," "recovering physically after surgery," "going from being off guard to being on guard," and "preparing oneself by seeking information." The women had confidence in the robotic technique and experienced fast recovery after robotic-assisted laparoscopic hysterectomy; however, they had uncertainties and unanswered questions concerning the postoperative course. Shortly after discharge, the women did not consider themselves surviving cancer patients but as cured. The women searched for information from various sources, for example, the Internet and the online patient chart, to prepare for surgery and to come to terms with the diagnosis. Although the women had confidence in the robotic technique and recovered quickly physically, they lacked information about what went on in the operation theatre and about their new anatomy. Patient education about the normal postoperative course in regard to vaginal bleeding, bowel function, and level of physical activity is needed. Individualized information about anatomical changes after surgery is warranted, preferably using anatomical drawings. Potentially, the women could benefit from attending a nursing clinic during the first postoperative months.

Survey of Current Practice Patterns in the Treatment of Early-Stage Endometrial Cancer.

Our aim was to assess current surgical practices and use of adjuvant therapy in the treatment of FIGO (International Federation of Gynecology and Obstetrics) stage I endometrioid endometrial cancer. A 19-question survey was developed and sent to all Society of Gynecologic Oncologist members by e-mail. Data were collected anonymously using Internet-based survey software. Respondents were asked questions regarding preoperative evaluation, surgical approach, lymph node dissection (LND), and adjuvant therapy. A total of 1399 surveys were distributed, 320 (23%) members completed the survey. Ninety-seven percent of respondents were gynecologic oncologists or fellows, and 87% treat 30 or more endometrial cancer patients yearly. Respondents were more likely to order preoperative tests such as computed tomography abdomen/pelvis and CA-125 for biopsy-proven grade 3 disease versus grade 1 (82% vs 29%). Robot-assisted laparoscopy was the preferred surgical approach (66%), followed by conventional laparoscopy (21%). Twenty-six percent of respondents perform LND in all cases. Forty-eight percent describe their LND as complete, to the level of the inferior mesenteric artery. Adjuvant therapy was recommended more often with increasing myometrial invasion, tumor grade, and lymphovascular space invasion. Vaginal brachytherapy was the most commonly recommended adjuvant therapy for stage IA. For stage IB, grade 3, positive lymphovascular space invasion disease, respondents were more likely to combine vaginal brachytherapy with external beam radiotherapy and/or chemotherapy. Older patients were more likely to have adjuvant therapy in earlier stages of disease than younger patients. Our findings demonstrate that respondents are individualizing care based on preoperative, intraoperative, and pathologic findings. As expected, adjuvant treatment is recommended for patients with higher stage and grade disease. Robot-assisted hysterectomy and chemotherapy are now commonly used in the management of this disease. We anticipate that new trends will continue to emerge as results from additional studies become available.