Long-term oncological safety of minimally invasive surgery in high-risk endometrial cancer

Koskas, Martin; Jozwiak, Marta; Fournier, Marie; Vergote, Ignace; Trum, Hans; Lok, Christianne; Amant, Frédéric

doi:10.1016/j.ejca.2016.07.001

Cited by 38 publications

(41 citation statements)

References 19 publications

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“…Only one of the studies included in the review, however, included carcinosarcomas. Koskas et al 15 investigated the oncologic outcomes of patients undergoing minimally invasive surgery versus an open procedure for endometrial cancer at three institutions. Fifteen percent of the cohort had carcinosarcoma, and on univariate and multivariate analyses, histology (specifically carcinosarcoma) was found to be associated with worse disease-free and overall survival.…”

Section: Discussionmentioning

confidence: 99%

Comparison of minimally invasive versus open surgery in the treatment of endometrial carcinosarcoma

Nobre

Mueller

Gardner

et al. 2020

Int J Gynecol Cancer

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ObjectiveThe aim of this study was to compare perioperative and oncologic outcomes between minimally invasive and open surgery in the treatment of endometrial carcinosarcoma.MethodsWe retrospectively identified all patients with newly diagnosed endometrial carcinosarcoma who underwent primary surgery via any approach at our institution from January 2009 to January 2018. Patients with known bulky disease identified on preoperative imaging were excluded. The χ2 and Mann–Whitney U tests were used to compare categorical and continuous variables, respectively. Kaplan–Meier curves were used to estimate survival, and compared using the log rank test.ResultsWe identified 147 eligible patients, of whom 37 (25%) underwent an open approach and 110 (75%) underwent minimally invasive surgery. Within the minimally invasive group, 92 (84%) of 110 patients underwent a robotic procedure and 14 (13%) underwent a laparoscopic procedure. Four minimally invasive cases (4%) were converted to open procedures. Median age, body mass index, operative time, stage, complication grade, and use of adjuvant treatment were clinically and statistically similar between groups. Median length of hospital stay in the open group was 4 days (range 3–21) compared with 1 day (range 0–6) in the minimally invasive group (p<0.001). The rates of any 30-day complication were 46% in the open and 8% in the minimally invasive group (p<0.001). The rates of grade 3 or higher complications were 5.4% and 1.8%, respectively (p=0.53). Median follow-up for the entire cohort was 30 months (range 0.4–121). Two-year progression-free survival rates were 52.8% (SE±8.4) in the open group and 58.5% (SE±5.1) in the minimally invasive group (p=0.7). Two-year disease-specific survival rates were 66.1% (SE±8.0) and 81.4% (SE±4.1), respectively (p=0.8).ConclusionsIn patients with clinical stage I endometrial carcinosarcoma, minimally invasive compared with open surgery was not associated with poor oncologic outcomes, but with a shorter length of hospital stay and a lower rate of overall complications.

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Section: Discussionmentioning

confidence: 99%

Comparison of minimally invasive versus open surgery in the treatment of endometrial carcinosarcoma

Nobre

Mueller

Gardner

et al. 2020

Int J Gynecol Cancer

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“…There is strong evidence for the role of laparoscopy in the management of low-grade EC, yet for high-grade EC, data are still limited. In a recently published study, it was shown that LH and laparoscopic lymph node dissection were equally safe when compared to open procedures in high-grade EC [ 26 ]. Although numbers are relatively small, these data illustrate the shift of the indication towards the laparoscopic approach in high-grade EC treatment.…”

Section: Discussionmentioning

confidence: 99%

Implementation of laparoscopic hysterectomy for endometrial cancer over the past decade

et al. 2018

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BackgroundLaparoscopic hysterectomy (LH) for the treatment of early-stage endometrial carcinoma/cancer (EC) has demonstrated to be safe in several randomized controlled trials. Yet, data on implementation of LH in clinical practice are limited. In the present study, implementation of LH for EC was evaluated in a large oncology network in the Netherlands.ResultsRetrospectively, a total of 556 EC patients with FIGO stage I-II were registered in the selected years. The proportion of LH gradually increased from 11% in 2006 to 85% in 2015. LH was more often performed in patients with low-grade EC and was not related to the studied patient characteristics. The introduction of TLH was frequently preceded by LAVH. Patients treated in teaching hospitals were more likely to undergo a LH compared to patients in non-teaching hospitals. The conversion rate was 7.7%, and the overall complication rates between LH and AH were comparable, but less postoperative complications in LH.ConclusionsImplementation of laparoscopic hysterectomy for early-stage EC increased from 11 to 85% in 10 years. Implementation of TLH was often preceded by LAVH and was faster in teaching hospitals.

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“…The endoscopic route also appears safe in high-risk endometrial cancer. 36 This approach can be accompanied by a laparoscopic lymphadenectomy, if surgical staging is to be undertaken. Robotic surgery for morbidly obese patients represents a valuable option for experienced surgeons.…”

Section: Surgical Staging Procedures For Endometrial Cancermentioning

confidence: 99%

Cancer of the corpus uteri

Amant

Mirza

Koskas³

et al. 2018

Intl J Gynecology & Obste

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Endometrial cancer is the most common gynecological malignancy in high‐income countries. Although the overall prognosis is relatively good, high‐grade endometrial cancers have a tendency to recur. Recurrence needs to be prevented since the prognosis for recurrent endometrial cancer is dismal. Treatment tailored to tumor biology is the optimal strategy to balance treatment efficacy against toxicity. Standard treatment consists of hysterectomy and bilateral salpingo‐oophorectomy. Lymphadenectomy (with ongoing studies of sentinel node biopsy) enables identification of lymph node positive patients who need adjuvant treatment, including radiotherapy and chemotherapy. Adjuvant radiotherapy is used for Stage I–II patients with high‐risk factors and Stage III lymph node negative patients. In advanced disease, a combination of surgery to no residual disease and chemotherapy results in the best outcome. Surgery for recurrent disease is only advocated in patients with a good performance status with a relatively long disease‐free interval.

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Long-term oncological safety of minimally invasive surgery in high-risk endometrial cancer

Cited by 38 publications

References 19 publications

Comparison of minimally invasive versus open surgery in the treatment of endometrial carcinosarcoma

Comparison of minimally invasive versus open surgery in the treatment of endometrial carcinosarcoma

Implementation of laparoscopic hysterectomy for endometrial cancer over the past decade

Cancer of the corpus uteri

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