Surgery for endometrial cancers with suspected cervical involvement: is radical hysterectomy needed (a GOTIC study)?

Abstract

Background:Radical hysterectomy is recommended for endometrial adenocarcinoma patients with suspected gross cervical involvement. However, the efficacy of operative procedure has not been confirmed.Methods:The patients with endometrial adenocarcinoma who had suspected gross cervical involvement and underwent hysterectomy between 1995 and 2009 at seven institutions were retrospectively analysed (Gynecologic Oncology Trial and Investigation Consortium of North Kanto: GOTIC-005). Primary endpoint was overall survival, and secondary endpoints were progression-free survival and adverse effects.Results:A total of 300 patients who underwent primary surgery were identified: 74 cases with radical hysterectomy (RH), 112 patients with modified radical hysterectomy (mRH), and 114 cases with simple hysterectomy (SH). Median age was 47 years, and median duration of follow-up was 47 months. There were no significant differences of age, performance status, body mass index, stage distribution, and adjuvant therapy among three groups. Multi-regression analysis revealed that age, grade, peritoneal cytology status, and lymph node involvement were identified as prognostic factors for OS; however, type of hysterectomy was not selected as independent prognostic factor for local recurrence-free survival, PFS, and OS. Additionally, patients treated with RH had longer operative time, higher rates of blood transfusion and severe urinary tract dysfunction.Conclusion:Type of hysterectomy was not identified as a prognostic factor in endometrial cancer patients with suspected gross cervical involvement. Perioperative and late adverse events were more frequent in patients treated with RH. The present study could not find any survival benefit from RH for endometrial cancer patients with suspected gross cervical involvement. Surgical treatment in these patients should be further evaluated in prospective clinical studies.

Oncological Outcomes of Stage II Endometrial Cancer: A Retrospective Analysis of 250 Cases

“…In addition, they also reported that perioperative and late adverse events were more common in patients treated with radical hysterectomy. 23 In the present study, we compared 51 patients who had radical hysterectomy, with 199 patients with simple hysterectomy. In our multivariate analysis, radical hysterectomy improved neither DFS nor OS.…”

ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow-up

“…In a recent study from Japan, radical surgery in stage II endometrial cancer did not result in any survival benefit compared with simple hysterectomy but was associated with more peri-operative and late adverse events 104. Another recent study found that parametrial spread cannot be predicted by cervical involvement alone but may be predicted by various lymphovascular space invasion (LVSI)-related histopathological factors 105.…”

“…104 Another recent study found that parametrial spread cannot be predicted by cervical involvement alone but may be predicted by various lymphovascular space invasion (LVSI)-related histopathological factors. 105 However, radical hysterectomy is considered in cases of obvious involvement of the parametrium.…”

Is Modified Radical Hysterectomy Needed for Patients with Clinical Stage I/II Endometrial Cancers? A Historical Control Study

“…Risk factors of PMI included depth of myometrial invasion, lymphovascular space invasion, and cervical involvement [2,3]; cervical involvement alone could not be a predictor of PMI [5]. Therefore, it is not clear whether parametrial resection is necessary for clinical stage I/II patients, particularly for patients with deep myometrial invasion or lymphovascular space invasion, and it is also undetermined if RH is needed for clinical stage II patients with cervical involvement [6]. …”