Disease-Free and Survival Outcomes for Total Laparoscopic Hysterectomy Compared With Total Abdominal Hysterectomy in Early-Stage Endometrial Carcinoma: A Meta-analysis

Asher, Rebecca; Obermair, Andreas; Janda, Monika; Gebski, Val

doi:10.1097/igc.0000000000001199

Cited by 30 publications

(15 citation statements)

References 28 publications

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“…In addition, recovery time is faster, therefore the hospital stay is shorter [15,16]. A meta-analysis of the LACE [17] and LAP2 [18] studies showed comparable survival outcomes between laparotomy and minimally invasive surgery in EC patients [19]. Obese women represent a high-risk subset of EC patients, with higher rates of peri-operative complications and longer hospital stays [20].…”

Section: Fertility Sparing Treatments 21 Patients Selectionmentioning

confidence: 99%

Fertility Sparing Treatments in Endometrial Cancer Patients: The Potential Role of the New Molecular Classification

Cavaliere

Perelli

Zaami

et al. 2021

IJMS

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Endometrial cancer is the most frequent gynecological malignancy, and, although epidemiologically it mainly affects advanced age women, it can also affect young patients who want children and who have not yet completed their procreative project. Fertility sparing treatments are the subject of many studies and research in continuous evolution, and represent a light of hope for young cancer patients who find themselves having to face an oncological path before fulfilling their desire for motherhood. The advances in molecular biology and the more precise clinical and prognostic classification of endometrial cancer based on the 2013 The Cancer Genome Atlas classification allow for the selection of patients who can be submitted to fertility sparing treatments with increasing oncological safety. It would also be possible to predict the response to hormonal treatment by investigating the state of the genes of the mismatch repair.

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Section: Fertility Sparing Treatments 21 Patients Selectionmentioning

confidence: 99%

Fertility Sparing Treatments in Endometrial Cancer Patients: The Potential Role of the New Molecular Classification

Cavaliere

Perelli

Zaami

et al. 2021

IJMS

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“…5 The benefit of minimally invasive surgery (MIS) over traditional open surgery for EC has been firmly established with non-inferiority of survival and recurrence rates, and significantly lower levels of postoperative complications. [6][7][8] Initially studies were confined to Strengths and limitations of this study ► The main strength of this study is that it is population based and the large number of procedures has enabled trends to be identified that may not have been seen in smaller datasets. ► Hospital Episode Statistics (HES) data only covers National Health Service (NHS)-funded care in England, therefore, data on hysterectomies undertaken outside of the NHS were not included in this study.…”

Section: Introductionmentioning

confidence: 99%

“…The benefit of minimally invasive surgery (MIS) over traditional open surgery for EC has been firmly established with non-inferiority of survival and recurrence rates, and significantly lower levels of postoperative complications. 6–8 Initially studies were confined to early stage endometrioid cancers, 7 9 however, as the MIS skills of gynaecologists have developed enabling more extensive surgery, including pelvic/para-aortic lymph node dissection, this evidence has been extended to high-risk subtypes and more advanced disease. 10 As a result, MIS is the advocated as the preferred surgical route for the management of endometrial malignancy.…”

Section: Introductionmentioning

confidence: 99%

Surgical trends, outcomes and disparities in minimal invasive surgery for patients with endometrial cancer in England: a retrospective cohort study

Moss

Morgan²,

Martin

et al. 2020

BMJ Open

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ObjectiveTo examine surgical outcomes and trends in the implementation of minimally invasive surgery (MIS) use for endometrial cancer (EC).DesignRetrospective cohort study.SettingEnglish National Health Service hospitals 2011–2017/2018.Population35 304 patients having a hysterectomy for EC identified from Hospital Episode Statistics.MethodsUnivariate and multivariate analyses compared MIS to open hysterectomy (OH) by assessing the association between demographic, clinical and hospital characteristics by using logistic regression. A propensity score was created, to control for confounding factors including demographics, clinical and hospital characteristics, from a logistic regression which enabled the inverse probability weighting of treatment to be applied in order to compare outcomes of treatment.Main outcome measuresThe association between route of surgery on perioperative morbidity and mortality.ResultsThe MIS rate rose from 40.3% in 2011 to 68.7% in 2017/2018, however, there was significant geographical variation (p<0.001). The overall 90-day mortality was significantly higher with OH versus MIS (OR 0.34, 95% CI 0.18 to 0.62, p=0.0002). MIS rates were significantly lower in patients from the lowest socioeconomic group (LSEG) compared with patients from the highest group (HSEG) (55.4% vs 59.9%, p<0.01), and in the black population as compared with white and Asian populations (40.4% vs 58.6% and 56.0%, p<0.0001). When patients from LSEG and black patients were treated in hospitals with high MIS rates, the MIS rate increased close to that of the HSEG and white patients (81.0% and 74.1% vs 83.2% and 82.6%).ConclusionsFurther investigation is needed to understand the barriers to MIS and improve access so that as many patients as possible can benefit from the reduced morbidity/mortality associated with MIS.

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“…THBSO performed by laparoscopy in patients with early-stage EC was associated with less blood loss and pain, faster recovery, and a shorter hospital stay [ 30 ]. A recent meta-analysis of both the LACE [ 31 ] and the LAP2 [ 32 ] trials reported comparable survival outcomes for patients who had minimally invasive and those who had open surgery for EC [ 33 ]. Our group found that older patients with multiple pre-existing comorbidities, increased complexity of surgical procedures, higher American Society of Anesthesiologists (ASA) scores ≥2 (the ASA scoring system classifies patients’ preoperative physiological status and operative risk), and high BMI were independent predictors of any adverse event [ 34 ].…”

Section: Defining Candidates For Fertility-sparing Treatmentmentioning

confidence: 99%

Fertility-sparing treatment in early endometrial cancer: current state and future strategies

et al. 2020

Self Cite

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Endometrial cancer (EC) is the fifth most common cancer in women worldwide. Global estimates show rising incidence rates in both developed and developing countries. Most women are diagnosed postmenopausal, but 14–25% of patients are premenopausal and 5% are under 40 years of age. Established risk factors include age and hyperestrogenic status associated with nulliparity, obesity, and metabolic syndrome. Standard treatment for EC, which involves total hysterectomy and bilateral salpingo-oophorectomy, has excellent survival outcomes, particularly for low-grade endometrioid tumors. However, it leads to permanent loss of fertility among women who wish to preserve their reproductive potential. With current trends of reproductive-age women delaying childbearing, rising EC incidence rates, and a growing epidemic of obesity, particularly in developed countries, research on conservative non-surgical treatment approaches remains a top priority. Fertility-sparing treatment predominantly involves the use of oral progestins and levonorgestrel-releasing intrauterine devices, which have been shown to be feasible and safe in women with early stage EC and minimal or no myometrial invasion. However, data on the efficacy and safety of conservative management strategies are primarily based on retrospective studies. Randomized clinical trials in younger women and high-risk obese patients are currently underway. Here, we have presented a comprehensive review of the current literature on conservative, fertility-sparing approaches, defining the optimal candidates and evaluating tumor characteristics, reproductive and oncologic outcomes, and ongoing clinical trials. We have also summarized current guidelines and recommendations based on the published literature.

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Disease-Free and Survival Outcomes for Total Laparoscopic Hysterectomy Compared With Total Abdominal Hysterectomy in Early-Stage Endometrial Carcinoma: A Meta-analysis

Abstract: Noninferiority of laparoscopy was demonstrated on clinical outcomes and was associated with a reduction in postoperative complications. These results support continued treatment by laparoscopic hysterectomy for early-stage endometrial cancer.

Cited by 30 publications

References 28 publications

Fertility Sparing Treatments in Endometrial Cancer Patients: The Potential Role of the New Molecular Classification

Fertility Sparing Treatments in Endometrial Cancer Patients: The Potential Role of the New Molecular Classification

Surgical trends, outcomes and disparities in minimal invasive surgery for patients with endometrial cancer in England: a retrospective cohort study

Fertility-sparing treatment in early endometrial cancer: current state and future strategies

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