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

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.

Comparison of Laparoscopic and Open Surgery for Patients With Borderline Ovarian Tumors

2018 ◽  
Vol 28 (9) ◽  
pp. 1657-1663 ◽  
Author(s):  
Hee-Jung Jung ◽  
Jeong-Yeol Park ◽  
Dae-Yeon Kim ◽  
Dae-Shik Suh ◽  
Jong-Hyeok Kim ◽  
...  
Keyword(s):  
Overall Survival ◽  
Laparoscopic Surgery ◽  
Surgical Outcomes ◽  
Open Surgery ◽  
Disease Free Survival ◽  
Free Survival ◽  
Borderline Ovarian Tumors ◽  
Surgery Group ◽  
Significant Difference ◽  
Disease Free

ObjectivesThe aim of this study was to compare surgical and oncologic outcomes of open and laparoscopic surgery in patients with borderline ovarian tumors (BOTs).Materials and MethodsThis study included patients with BOTs who underwent open (n = 433) or laparoscopic (n = 210) surgery between 1990 and 2015. Surgical outcomes, perioperative morbidity, and disease-free survival and overall survival were compared.ResultsThere was no significant difference in age, histologic type of tumor, and laterality of tumor. However, body mass index was slightly higher for the open surgery group (P = 0.046). The open surgery group had a higher serum cancer antigen 125 level (P < 0.001), larger tumor size (P < 0.001), more frequent radical surgery (P = 0.001), higher stage (P = 0.034), and higher incidence of invasive implants (P = 0.035). The operative time (P < 0.001), time interval to return of bowel movement (P < 0.001), and length of postoperative hospital stay (P < 0.001) were significantly shorter and estimated blood loss was significantly less (P < 0.001) in the laparoscopic group. Perioperative complications were documented in 5 (2.4%) patients in the laparoscopic surgery group and 17 (3.9%) in the open surgery group (P = 0.064). Twenty-three (5.3%) patients in the open surgery group and 9 (4.3%) in the laparoscopic surgery group had recurrence (P = 0.902) at a median follow-up of 57 months. The 10-year disease-free survival was 96% and 97% for the open and laparoscopic groups, respectively (P = 0.851), with no significant difference between the groups after adjusting for independent factors (odds ratio, 1.0; 95% confidence interval, 0.4–2.4; P = 0.999). The 10-year overall survival was 99% for both groups, respectively (P = 0.441).ConclusionsLaparoscopic surgery and open surgery showed similar survival outcomes in BOTs. The surgical outcomes of laparoscopic surgery were more favorable.

scholarly journals FIGO 2018 stage IB endocervical adenocarcinomas: an international study of outcomes informed by prognostic biomarkers

2020 ◽  
pp. ijgc-2020-001893
Author(s):  
Simona Stolnicu ◽  
Monica Boros ◽  
Lien Hoang ◽  
Noorah Almadani ◽  
Louise de Brot ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Lymphovascular Invasion ◽  
Figo Stage ◽  
Prognostic Biomarkers ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Stage Ib ◽  
Gynecology And Obstetrics ◽  
Hpv Status

ObjectivePrognostic factors for endocervical adernocarcinomas are well known, but little is known about prognostic biomarkers influencing outcome for the newly defined International Federation of Gynecology and Obstetrics (FIGO) 2018 IB sub-stages. The aim of this study was to identify prognostic biomarkers influencing recurrence-free and overall survival for FIGO 2018 stage IB cervical adenocarcinoma sub-types. We sought to identify these factors using a large international multi-institutional series of cases.MethodsStage IB endocervical adenocarcinomas were retrospectively collected from nine international institutions; full slide sets (n=464) were used to assign prognostic biomarkers. Inclusion criteria were the following: FIGO stage IB endocervical adenocarcinomas with follow-up in which all paraffin blocks/glass slides were available for review and/or additional studies and the patient was surgically treated from 1985 to 2019. The types of specimens included in the study were conizations, trachelectomies, and simple/radical hysterectomies with or without lymph node samples. We excluded in situ carcinomas, squamous cell carcinomas, adenosquamous carcinomas, tumors with a neuroendocrine component, carcinosarcomas, and any tumor showing clinical, macroscopic, or microscopic features suggesting a lower uterine segment, uterine corpus, or an adnexal primary origin. Tumors treated with neoadjuvant chemotherapy and/or radiation therapy were also excluded, as well as biopsies and loop electrosurgical excision procedures.ResultsOf 464 cases, 225 (48%) were stage IB1, 177 (38%) were stage IB2, and 62 (13%) were stage IB3. Five-year and 10-year recurrence-free survivals were statistically different among stage IB sub-types (p=0.005). Silva pattern of invasion was significant for recurrence-free survival at 5 and 10 years (p=0.04); overall survival and recurrence-free survival were higher in human papillomavirus (HPV)-associated cases (p=0.007 and p=0.001, respectively) and in cases without lymphovascular invasion (p=0.004 and p=0.00001, respectively). Factors that significantly influenced recurrence-free survival were HPV-independent status (p=0.05; HR 2.31; 95% CI 1.02 to 5.46), presence of lymphovascular invasion (p=0.011; HR 3.50; 95% CI 1.33 to 9.19), and presence of lymph node metastasis (p=0.016; HR 2.66; 95% CI 1.20 to 5.90).ConclusionHPV status and the presence of lymphovascular invasion are prognosticators in stage IB endocervical adenocarcinoma sub-types. These parameters should be included in future sub-staging modifications of FIGO stage IB endocervical adenocarcinomas and in treatment strategies.

Robotic Resection of Duodenal Gastrointestinal Stromal Tumour: Preliminary Experience from a Single Centre

2021 ◽  
Author(s):  
Zhipeng Zhou ◽  
Xianglong Tan ◽  
Zhiming Zhao ◽  
Yuanxing Gao ◽  
Yuyao Song ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Open Surgery ◽  
Tumour Size ◽  
Postoperative Recurrence ◽  
Recurrence Free Survival ◽  
Gastrointestinal Stromal Tumours ◽  
Free Survival ◽  
Surgery Group ◽  
Significant Difference ◽  
Robotic Resection

Abstract Background: The experience of minimally invasive surgery in the treatment of duodenal gastrointestinal stromal tumours (DGISTs) is accumulating, but there is no consensus on the choice of surgical method. The purpose of this study is to summarize the technique and feasibility of robotic resection of DGIST.Methods: The demographics and perioperative outcomes of a consecutive series of patients who underwent robotic resection and open resection of DGIST between May 1, 2010 and May 1, 2020 were retrospectively analysed. Patients were divided into an open surgery group and a robotic surgery group. Pancreaticoduodenectomy (PD) or limited resection was performed based on the location of the tumour and the distance between the tumour and duodenal papilla. Age, sex, tumour location, tumour size, operation time (OT), estimated blood loss (EBL), postoperative hospital stay (PHS), tumour mitosis, postoperative risk classification, postoperative recurrence and recurrence-free survival were compared between the two groups.Results: Among the 28 patients, there were 19 males and 9 females aged 51.3± 13.1 years. Limited resection was performed in 17 patients, and PD was performed in 11 patients. Eleven patients underwent open surgery, and 17 patients underwent robotic surgery. Two patients in the robotic surgery group underwent conversion to open surgery. All the tumours were R0 resected, and there was no significant difference in age, sex, tumour size, operation mode, PHS, tumour mitosis, incidence of postoperative complications, risk classification, postoperative targeted drug therapy or postoperative recurrence between the two groups (p>0.05). OT and EBL in the robotic group were significantly different from those in the open surgery group (p<0.05). All the patients survived during the follow-up period, and 4 patients had recurrence and metastasis. No significant difference in recurrence-free survival was noted between the open surgery group and the robotic surgery group (p>0.05).Conclusions: Robotic resection is safe and feasible for patients with duodenal gastrointestinal stromal tumours, and its therapeutic effect is equivalent to open surgery.

scholarly journals Stage IB Endometrioid Type Endometrial Cancer: The Role of Lymphadenectomy and Adjuvant Radiation Therapy

2018 ◽  
Vol 24 (3) ◽  
pp. 156
Author(s):  
Osman Turkmen ◽  
Tolga Tasci ◽  
Derman Basaran ◽  
Gunsu Comert Kimyon ◽  
Alper Karalök ◽  
...  
Keyword(s):  
Overall Survival ◽  
Endometrial Cancer ◽  
Adjuvant Radiotherapy ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Adjuvant Radiation ◽  
Free Survival ◽  
Stage Ib ◽  
Gynecology And Obstetrics ◽  
Disease Free

<p><strong>Objective:</strong> Both performances of lymphadenectomy and benefit of adding adjuvant radiotherapy are controversial for patients with International Federation of Gynecology and Obstetrics stage IB endometrioid type endometrial cancer. We aimed to identify the role of lymphadenectomy and adjuvant radiation therapy as well as clinicopathological prognostic factors for this group of patients.<br /><strong></strong></p><p><strong>Study Design:</strong> Records of all patients (n=132) with stage IB endometrioid endometrial cancer who were referred to or treated in our institution between Jan 1992 and Dec 2013 were retrospectively reviewed. Cox Proportional Hazard Regression Analysis was used to determine the effects of lymphadenectomy and adjuvant radiation as well as other clinicopathological factors on disease free survival and overall survival.</p><p><strong>Results:</strong> Mean age was 59.9 years (range, 45-82). Lymphadenectomy didn't perform in 36 (27.3%) patients and 23 (17.4%) patients did not have any kind of adjuvant treatment. Mean lymph node count was 18.8 (range, 3-67). Federation of Gynecology and Obstetrics grade, lymphovascular space invasion, lymphadenectomy, receiving adjuvant treatment and type of received adjuvant therapy were not associated with disease free survival and overall survival for the entire cohort. In a subgroup of patients with grade1&amp;2 tumor, 5-year disease free survival rates were 80% and 50% (p=0.4), respectively and overall survival rates were 94.8% and 93.8% (p=0.2), respectively for patients who had or didn't have adjuvant radiotherapy. While performance of lymphadenectomy was not significantly associated with disease free survival in this subgroup (p=0.56), this association was statistically significant for overall survival (97.9% vs. 86.4%, p=0.04) <br /><strong></strong></p><p><strong>Conclusion:</strong> Benefit of adjuvant radiotherapy in regard to prevention of recurrence needs to be confirmed by further studies. Lymphadenectomy had a survival benefit for patients with myometrial invasion greater than a half of myometrial thickness.</p>

scholarly journals Nomogram for Predicting Recurrence-Free Survival in Chinese Women with Endometrial Cancer after Initial Therapy: External Validation

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Yuan Cheng ◽  
Yangyang Dong ◽  
Wenjuan Tian ◽  
Hua Zhang ◽  
Xiaoping Li ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Chinese Women ◽  
External Validation ◽  
Figo Stage ◽  
Peritoneal Cytology ◽  
Tumor Diameter ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Training Cohort ◽  
Gynecology And Obstetrics

This study aimed at developing an available recurrence-free survival (RFS) model of endometrial cancer (EC) for accurate and individualized prognosis assessment. A training cohort of 520 women with EC who underwent initial surgical treatment and an external validation cohort of 445 eligible EC patients from 2006 to 2016 were analyzed retrospectively. Multivariable Cox proportional hazards regression models were used to develop nomograms for predicting recurrence. The concordance index (C-index) and the area under the receiver operating characteristic curve (AUC) were calculated to determine the discrimination of RFS prognostic scoring systems. Calibration plots were generated to examine the performance characteristics of the predictive nomograms. Regression analysis revealed that an advanced International Federation of Gynecology and Obstetrics (FIGO) stage, histological grade 3, primary tumor diameter ≥2 cm, and positive peritoneal cytology were independent prognostic factors for RFS in EC in the training set. The nomograms estimated RFS according to these four variables, with a C-index of 0.860, which was superior to that of FIGO stage (2009 criteria), at 0.809 (P=0.034), in the training cohort. Encouragingly, consistent results were observed in the validation set, with a C-index of 0.875 for the nomogram and a C-index of 0.833 for the FIGO staging (P=0.0137). Furthermore, the calibrations of the nomograms predicting 3- and 5-year RFS strongly corresponded to the actual survival outcome. In conclusion, this study developed an available nomogram with effective external validation and relatively appreciable discrimination and conformity for the accurate assessment of 3- and 5-year RFS in Chinese women with EC.

scholarly journals Survival and prognostic factors of lymphadenectomy in endometrial cancer: a Tunisian single center experience

2018 ◽  
Vol 5 (11) ◽  
pp. 3658
Author(s):  
Ines Ben Safta ◽  
Olfa Jaidane ◽  
Houyem Mansouri ◽  
Raoudha Doghri ◽  
Selma Gadria ◽  
...  
Keyword(s):  
Overall Survival ◽  
Endometrial Cancer ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Retrospective Study ◽  
Lymph Node Ratio ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Node Ratio ◽  
The Impact

Background: Endometrial cancer (EC) is the most common pelvic gynecological cancer. The purpose of the present study is to identify histoprognostic risk factors for lymph node involvement, evaluate the impact of lymphadenectomy on relapse and overall survival and assess prognostic factors influencing the survival rates in endometrial cancer.Methods: This was a retrospective study of 249 cases of endometrial cancer, over a period of 16 years (2000-2015). We analyzed the clinical, pathological features and outcome of our patients. Curves of overall and recurrence-free survival were performed.Results: In our cohort, stage IA was found in 46.6% of cases, stage IB in 14.5%, stage II in 13.7%, stage IIIA in 3.6%, stage IIIB in 2%, stage IIIC1 in 8.8%, stage IIIC2 in 4.4% and stage IV in 6.4%. The histologic type (p=0.02, OR=2.702, CI [1.169; 6.25]), myometrial invasion (p<0.001, OR=4.524, CI [1.960; 10.416]), lymphovascular space invasion (p=0.047, OR=2.267; CI [1.013; 5.076]) were the only independent factors of lymph node invasion in multivariate analysis. 5-years overall and recurrence free survival was 76.3% and 81.5%, respectively. Overall survival at 5 years was 64.6% with a lymph node ratio of less than 10%, 22.2% with a lymph node ratio between 10 and 50%, and zero with a lymph node ration greater than 50% (p=0.016). By studying the number of lymph nodes removed during lymphadenectomy, survival trend to be improved when the lymph node count increased.Conclusions: The lymphadenectomy has an incontestable diagnostic and prognostic value. Present retrospective study showed the therapeutic interest of lymph node dissection in endometrial cancers.

scholarly journals Laparoscopic Versus Open Abdominal Radical Hysterectomy for Patients with Endometrial Cancer Involving Cervix

2020 ◽  
Author(s):  
Ming Wang ◽  
Ziyi Zhao ◽  
Xiaohong Xu ◽  
Jinwei Miao ◽  
Weimin Kong ◽  
...  
Keyword(s):  
Overall Survival ◽  
Endometrial Cancer ◽  
Radical Hysterectomy ◽  
Open Surgery ◽  
Disease Free Survival ◽  
Laparoscopic Approach ◽  
Hazard Ratio ◽  
Free Survival ◽  
Significant Difference ◽  
Disease Free

Abstract BACKGROUND: Data on the survival outcome between laparoscopic and open abdominal radical hysterectomy is limited in patients with endometrial cancer involving cervix.METHODS: We performed a retrospective 1:1 matched observational study in patients who had their cervix involved by endometrial cancer during the 2010–2018 period in Beijing Obstetrics and Gynecology Hospital in China. All enrolled patients underwent cancer-directed radical hysterectomy through laparoscopic approach or open abdominal surgery and followed until 3 years after the surgery. The primary outcome was the rates of disease-free survival and overall survival.RESULTS: A total of 142 patients were included in the study, 54 patients received laparoscopic surgery and 54 of the remaining 88 patients who received open surgery were selected as control. Overall, the median follow-up duration was 54.22 ± 31.14 months (95%CI: 48.71–59.89 months). There was no difference on the baseline information between two groups, including ages, rates of histologic subtypes, rates of deep myometrial invasion, rates of lymph-node involvement, and postoperative stage. There was no significant difference between the three-year disease-free rates between two groups (3-year rate, 94.3% vs. 92.2%; hazard ratio, 1.36; 95% CI, 0.40 to 4.61). The 3-years rate of overall survival in patients of the laparoscopic group was comparable to patients in the open surgery group (3-year rate, 89.87% vs. 92.14%; hazard ratio for death from any cause, 1.87; 95% CI, 0.60 to5.86).CONCLUSIONS: This study revealed that laparoscopic approach surgery was not associated with shorter disease-free survival and overall survival than open abdominal radical hysterectomy in patients with endometrial cancer involving cervix.

Prognostic Significance of Lymphovascular Space Invasion in the Absence of Lymph Node Metastases in Early-Stage Endometrial Cancer

2018 ◽  
Vol 28 (5) ◽  
pp. 890-894 ◽  
Author(s):  
Ellen Cusano ◽  
Victoria Myers ◽  
Rajiv Samant ◽  
Talia Sudai ◽  
Allison Keller ◽  
...  
Keyword(s):  
Overall Survival ◽  
Endometrial Cancer ◽  
Prognostic Factor ◽  
Early Stage ◽  
Prognostic Significance ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Node Negative ◽  
Early Stage Endometrial Cancer ◽  
Lymphovascular Space Invasion

ObjectiveLymphovascular space invasion (LVSI) has been defined as a significant adverse prognostic factor in early-stage endometrial cancer, primarily because of its high association with nodal metastases. This study aimed to determine if LVSI provides any prognostic significance in pathologic node-negative surgically staged (T1N0) endometrial cancer patients.Methods/MaterialsThis retrospective cohort study included all patients with pathologic stage T1N0 endometrial carcinoma treated at The Ottawa Hospital Cancer Centre from 1998 to 2007. Patient demographics, pathologic findings, treatment, and outcome data were collected. Univariate and multivariate cox regression modeling was used to assess significance and adjust for demographic and histopathologic covariates. Kaplan-Meier curves were used to estimate the 5-year overall and recurrence-free survival.ResultsOur study included 400 pathologic stage T1N0 patients who received an initial total hysterectomy and bilateral salpingo-oophorectomy with lymphadenectomy. The median age at diagnosis was 62 years, and the median follow-up was 66 months. Fifty-four patients (13.5%) had a positive LVSI status, and 346 (86.5%) had a negative LVSI status. The 5-year overall survival was 97.3% in patients without LVSI and 90.9% in those with LVSI (P < 0.001). The 5-year recurrence-free survival was 95.2% in patients without LVSI and 85.9% in those with LVSI (P = 0.006). Univariate analysis identified grade, stage, and LVSI as the covariates significantly associated with time to recurrence, and identified age, grade, stage, and LVSI to be significantly associated with overall survival. There were no significant covariates for recurrence-free survival by multivariate analysis, and only age and LVSI were significant for overall survival.ConclusionsLymphovascular space invasion is an overall poor prognostic factor in T1N0 endometrial cancer. After adjusting for other factors, LVSI remains an independent risk factor for worse overall survival. Therefore, estimation of overall survival in patients with early-stage, node-negative endometrial cancer should take into account LVSI status.

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