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Background:To compare the accuracy of five major risk stratification systems (RSS) in classifying the risk of recurrence and nodal metastases in early-stage endometrial cancer (EC).Methods:Data of 553 patients with early-stage EC were abstracted from a prospective multicentre database between January 2001 and December 2012. The following RSS were identified in a PubMed literature search and included the Post Operative Radiation Therapy in Endometrial Carcinoma (PORTEC-1), the Gynecologic Oncology Group (GOG)-99, the Survival effect of para-aortic lymphadenectomy (SEPAL), the ESMO and the ESMO-modified classifications. The accuracy of each RSS was evaluated in terms of recurrence-free survival (RFS) and nodal metastases according to discrimination.Results:Overall, the ESMO -modified RSS provided the highest discrimination for both RFS and for nodal metastases with a concordance index (C-index) of 0.73 (95% CI, 0.70–0.76) and an area under the curve (AUC) of 0.80 (0.78–0.72), respectively. The other RSS performed as follows: the PORTEC1, GOG-99, SEPAL, ESMO classifications gave a C-index of 0.68 (0.66–0.70), 0.65 (0.63–0.67), 0.66 (0.63–0.69), 0.71 (0.68–0.74), respectively, for RFS and an AUC of 0.69 (0.66–0.72), 0.69 (0.67–0.71), 0.68 (0.66–0.70), 0.70 (0.68–0.72), respectively, for node metastases.Conclusions:None of the five major RSS showed high accuracy in stratifying the risk of recurrence or nodal metastases in patients with early-stage EC, although the ESMO-modified classification emerged as having the highest power of discrimination for both parameters. Therefore, there is a need to revisit existing RSS using additional tools such as biological markers to better stratify risk for these patients.

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Objective: To assess the impact of type of surgery for colorectal endometriosisrectal shaving, discoid or colorectal segmental resection-on complications and surgical outcomes.Data Sources: We performed a systematic review of all English and French language fulltext articles addressing surgical management of colorectal endometriosis and compared the postoperative complications according to surgical technique by meta-analysis. The PubMed, Clinical Trials.gov Cochrane Library and Web of Science databases were searched for relevant studies published before March 27, 2020. The search strategy used the following MeSH terms: ("bowel endometriosis" or "colorectal endometriosis") AND ("surgery for endometriosis" or "conservative management" or "radical management" or "colorectal resection" or "shaving" or "full thickness resection" or "disc excision") AND ("treatment", "outcomes", "long term results" and "complications"). Methods of Study Selection:Two authors conducted the literature search and independently screened abstracts for inclusion, with resolution of any difference by three other authors. Studies were included when data on surgical management (shaving, disc excision and/ or segmental resection) were provided and when postoperative outcomes were detailed with at least the number of complications. The risk of bias was assessed according to the Cochrane recommendations. Tabulation, Integration, and Results: Of the168 full-text articles assessed for eligibility, 60 were included in the qualitative synthesis. Seventeen of these were included in the metaanalysis on rectovaginal fistula, 10 on anastomotic leakage, five on anastomotic stenosis, and nine on voiding dysfunction <30 days. The mean complication rate according to shaving, discoid excision and segmental resection were 2.2%, 9.7% and 9.9%, respectively. Rectal shaving was less associated with rectovaginal fistula than discoid excision (OR=0.19; 95% CI [0.10-0.36], p<0.00001, I 2 =33%) and segmental colorectal resection (OR=0.26, 95% IC [0.15-0.44], p<0.00001, I 2 =0%). No difference was found in the occurrence of rectovaginal fistula between discoid excision and segmental colorectal resection (OR=1.07, 95%CI [0.70-1.63], p=0.76, I 2 =0%). Rectal shaving was less associated with leakage than disc occurrence of voiding dysfunction <30 days between segmental resection and rectal shaving (OR=3.05, 95% IC [0.55-16.87], p=0.20, I 2 =0%) or between segmental colorectal and discoid resection (OR=0.99, 95% IC [0.54-1.85], p=0.99, I 2 =71%). Conclusion:Colorectal surgery for endometriosis exposes patients to a risk of severe complications such as rectovaginal fistula, anastomotic leakage, anastomotic stenosis and voiding dysfunction. Rectal shaving appears to be less associated with postoperative complications than disc excision and segmental colorectal resection. However, this technique is not suitable in all patients with large bowel infiltration. Compared to segmental colorectal resection, disc excision has several advantages including shorter operating time, short...

Background:Lymphovascular space invasion (LVSI) is one of the most important predictors of nodal involvement and recurrence in early stage endometrial cancer (EC). Despite its demonstrated prognostic value, LVSI has not been incorporated into the European Society of Medical Oncology (ESMO) classification. The aim of this prospective multicentre database study is to investigate whether it may improve the accuracy of the ESMO classification in predicting the recurrence risk.Methods:Data of 496 patients with apparent early-stage EC who received primary surgical treatment between January 2001 and December 2012 were abstracted from prospective multicentre database. A modified ESMO classification including six risk groups was created after inclusion of the LVSI status in the ESMO classification. The primary end point was the recurrence accuracy comparison between the ESMO and the modified ESMO classifications with respect to the area under the receiver operating characteristic curve (AUC).Results:The recurrence rate in the whole population was 16.1%. The median follow-up and recurrence time were 31 (range: 1–152) and 27 (range: 1–134) months, respectively. Considering the ESMO modified classification, the recurrence rates were 8.2% (8 out of 98), 23.1% (15 out of 65), 25.9% (15 out of 58), and 45.1% (28 out of 62) for intermediate risk/LVSI−, intermediate risk/LVSI+, high risk/LVSI−, and high risk/LVSI+, respectively (P<0.001). In the low risk group, LVSI status was not discriminant as only 7.0% (14 out of 213) had LVSI+. The staging accuracy according to AUC criteria for ESMO and ESMO modified classifications were of 0.71 (95% CI: 0.68–0.74) and 0.74 (95% CI: 0.71–0.77), respectively.Conclusions:The current modified classification could be helpful to better define indications for nodal staging and adjuvant therapy, especially for patients with intermediate risk EC.

Background: The purpose of this study was to develop a nomogram to predict 'poor prognosis recurrence' (PPR) in women treated for endometrial cancer (EC).