Comparison of laparoscopic surgery and conventional laparotomy for surgical staging of patients with presumed low-risk endometrial cancer: The current state of Japan

Abstract Background There is uncertainty surrounding the prognostic value of peritoneal cytology in low-risk endometrial cancer, especially in laparoscopic surgery. The objective of this retrospective study is to determine the prognostic significance of positive peritoneal cytology among patients with low-risk endometrial cancer and to compare it between laparoscopic surgery and conventional laparotomy. Methods From August 2008 to December 2019, all cases of pathologically confirmed stage IA grade 1 or 2 endometrial cancer were reviewed at Osaka Medical College. Statistical analyses used the Chi-square test and the Kaplan–Meier log rank. Results A total of 478 patients were identified: 438 with negative peritoneal cytology (232 who underwent laparotomy and 206 who undertook laparoscopic surgery) and 40 with positive peritoneal cytology (20 who underwent laparotomy and 20 who received laparoscopic surgery). Survival was significantly worse among patients with positive peritoneal cytology compared to patients with negative peritoneal cytology. However, there was no significant difference among patients with negative or positive peritoneal cytology between laparoscopic surgery and laparotomy. Conclusion This retrospective study suggests that, while peritoneal cytology is an independent risk factor in patients with low-risk endometrial cancer, laparoscopic surgery does not influence the survival outcome when compared to laparotomy.

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Implications of Isolated Para-Aortic Lymph Node Metastasis in Endometrial Cancer: A Large-Scale, Multicenter, and Retrospective Study

Frontiers in Medicine ◽

10.3389/fmed.2021.754890 ◽

2021 ◽

Vol 8 ◽

Author(s):

Wenting Li ◽

Jie Jiang ◽

Yu Fu ◽

Yuanming Shen ◽

Chuyao Zhang ◽

...

Keyword(s):

Endometrial Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Large Scale ◽

Low Risk ◽

Surgical Staging ◽

Node Metastasis ◽

Aortic Lymph Node ◽

Risk Patients ◽

Metastatic Sites

Objective: To systematically evaluate lymph node metastasis (LNM) patterns in patients with endometrial cancer (EC) who underwent complete surgical staging, which included systematic pelvic and para-aortic lymphadenectomy.Methods: Four thousand and one patients who underwent complete surgical staging including systematic pelvic and para-aortic lymphadenectomy for EC were enrolled from 30 centers in China from 2001 to 2019. We systematically displayed the clinical and prognostic characteristics of patients with various LNM patterns, especially the PLN-PAN+ [para-aortic lymph node (PAN) metastasis without pelvic lymph node (PLN) metastasis]. The efficacy of PAN+ (para-aortic lymph node metastasis) prediction with clinical and pathological features was evaluated.Results: Overall, 431 of the 4,001 patients (10.8%) showed definite LNM according to pathological diagnosis. The PAN+ showed the highest frequency (6.6%) among all metastatic sites. One hundred fourteen cases (26.5%) were PLN-PAN+ (PAN metastasis without PLN metastasis), 167 cases (38.7%) showed PLN+PAN-(PLN metastasis without PAN metastasis), and 150 cases (34.8%) showed metastasis to both regions (PLN+PAN+). There was also 1.9% (51/2,660) of low-risk patients who had PLN-PAN+. There are no statistical differences in relapse-free survival (RFS) and disease-specific survival (DSS) among PLN+PAN-, PLN-PAN+, and PLN+PAN+. The sensitivity of gross PLNs, gross PANs, and lymphovascular space involvement (LVSI) to predict PAN+ was 53.8 [95% confidence interval (CI): 47.6–59.9], 74.2 95% CI: 65.6–81.4), and 45.8% (95% CI: 38.7–53.2), respectively.Conclusion: Over one-fourth of EC patients with LMN metastases were PLN-PAN+. PLN-PAN+ shares approximate survival outcomes (RFS and DSS) with other LNM patterns. No effective clinical methods were achieved for predicting PAN+. Thus, PLN-PAN+ is a non-negligible LNM pattern that cannot be underestimated in EC, even in low-risk patients.

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The Role of Frozen Section in Surgical Staging of Low Risk Endometrial Cancer

PLoS ONE ◽

10.1371/journal.pone.0021912 ◽

2011 ◽

Vol 6 (9) ◽

pp. e21912 ◽

Cited By ~ 54

Author(s):

Sanjeev Kumar ◽

Sudeshna Bandyopadhyay ◽

Assaad Semaan ◽

Jay P. Shah ◽

Haider Mahdi ◽

...

Keyword(s):

Endometrial Cancer ◽

Frozen Section ◽

Low Risk ◽

Surgical Staging

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An international collaboration for comparison of two approaches to surgical staging of low-risk endometrial cancer

Gynecologic Oncology ◽

10.1016/j.ygyno.2015.01.089 ◽

2015 ◽

Vol 137 ◽

pp. 38-39

Author(s):

A.G.Z. Eriksson ◽

H. Lajer ◽

B.J. Mosgaard ◽

J.A. Ducie ◽

M.M. Leitao ◽

...

Keyword(s):

Endometrial Cancer ◽

International Collaboration ◽

Low Risk ◽

Surgical Staging

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Role of Laparoscopic Surgery in the Management of Endometrial Cancer

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2009.0038 ◽

2009 ◽

Vol 7 (5) ◽

pp. 559-567 ◽

Cited By ~ 1

Author(s):

Meaghan Tenney ◽

Joan L. Walker

Keyword(s):

Risk Factors ◽

Endometrial Cancer ◽

Laparoscopic Surgery ◽

Metastatic Disease ◽

Frozen Section ◽

Error Rates ◽

Adverse Outcomes ◽

Surgical Staging ◽

Medical Decision ◽

Metastatic Sites

Minimum surgical treatment for endometrial cancer is removal of the uterus. The operative approach to achieve that goal ranges from vaginal hysterectomy alone to laparotomy with radical hysterectomy, bilateral salpingoophorectomy, bilateral pelvic and para-aortic lymphadenectomy with possible omentectomy, and resection of all metastatic disease. Stratifying the risk factors for predicting presence of metastatic disease has error rates exceeding tolerance for many gynecologic oncologists. Most accept routine laparoscopic surgical staging with hysterectomy, pelvic and para-aortic lymphadenectomy, and removal of adnexa as standard care for patients with endometrial cancer. Modifying the extent of surgical staging for low-risk intrauterine findings or excessive risk for postoperative morbidity is also accepted. Laparoscopic surgery has become the ideal initial surgical approach for this disease, allowing for visual inspection of common metastatic sites, biopsy of abnormal areas, and cytology from peritoneal surfaces. The extent of staging can be altered depending on frozen section findings from the uterus, adnexa, and peritoneal surfaces. Intraoperative medical decision-making can be individualized, encompassing all known risk factors for metastases and balancing comorbidities and potential adverse outcomes. This article documents how laparoscopic surgery satisfies the needs of individual patients and surgeons treating this disease.

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Isolated port-site metastasis after surgical staging for low-risk endometrioid endometrial cancer: A case report

Oncology Letters ◽

10.3892/ol.2016.4595 ◽

2016 ◽

Vol 12 (1) ◽

pp. 281-284 ◽

Cited By ~ 2

Author(s):

DANIELE MAUTONE ◽

ANDREA DALL'ASTA ◽

MICHELA MONICA ◽

LETIZIA GALLI ◽

VITO ANDREA CAPOZZI ◽

...

Keyword(s):

Endometrial Cancer ◽

Case Report ◽

Port Site ◽

Low Risk ◽

Surgical Staging ◽

Port Site Metastasis ◽

Endometrioid Endometrial Cancer

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Comparison of survival outcomes between laparoscopic and open surgery in patients with low-risk endometrial cancer

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyaa116 ◽

2020 ◽

Vol 50 (11) ◽

pp. 1261-1264

Author(s):

Shinichi Togami ◽

Toshihiko Kawamura ◽

Shintaro Yanazume ◽

Masaki Kamio ◽

Hiroaki Kobayashi

Keyword(s):

Overall Survival ◽

Endometrial Cancer ◽

Laparoscopic Surgery ◽

Open Surgery ◽

Low Risk ◽

Recurrence Free Survival ◽

Free Survival ◽

Surgery Group ◽

Gynecology And Obstetrics ◽

Surgical Data

Abstract Objective To evaluate the feasibility, safety and surgical outcomes of laparoscopic surgery for the treatment of low-risk endometrial cancer. Methods Of 155 patients with low-risk endometrial cancer, who were included in this retrospective study between May 2008 and March 2017, 82 and 73 underwent laparoscopic and open surgery, respectively. Clinicopathological and surgical data, recurrence-free survival and overall survival were analyzed. Results No statistically significant differences in median age, final pathological type, International Federation of Gynecology and Obstetrics stage and lymphovascular space involvement were observed between the laparoscopic and open surgery groups. No procedure in the laparoscopic surgery group was converted to open surgery. The median follow-up period was 60 months, with oncologic recurrence identified in three cases (one lung carcinoma and two pelvic cavity carcinomas) in the laparoscopic surgery group. There was no significant between-group difference in 5-year recurrence-free survival (laparoscopic surgery group: 96.3%, open surgery group: 92.6%) and overall survival (laparoscopic surgery group: 100%, open surgery group: 95.4%). Conclusions Laparoscopic surgery is a feasible and safe treatment for endometrial cancer and should be considered as a standard treatment option for low-risk endometrial cancer.

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