Feasibility and efficacy of surgical staging for endometrial cancer by using Pfannenstiel incision

Objective: The purpose of this study was to evaluate short-term oncological and perioperative outcomes of using Pfannenstiel incision for the surgical staging of endometrial carcinoma. Methods: This was a retrospective cohort study. All patients with endometrial carcinoma referred to the Department of Surgical Oncology, South Egypt Cancer Institute, for surgical staging between January 1, 2014, and July 1, 2016, were enrolled. The patients were grouped according to the type of surgical incision either through Pfannenstiel incision or midline incision, and the groups were compared. Demographic, clinical, operative, and short-term oncological features were analyzed. Results: A total number of 117 patients were recruited, of which 45 patients had Pfannenstiel incision, and 72 patients had midline incision. The clinical and pathological features of patients in both groups were similar. The operative outcomes showed no significant difference between the groups (p > 0.1). Postoperatively, the Pfannenstiel incision group had a statistically significant lower rate of complications compared to the midline incision group (15.5% vs. 38.9%, p = 0.02). The short-term oncological outcomes in the form of total procured lymph nodes or para-aortic lymph nodes were not statistically different (p > 0.1). Conclusion: Pfannenstiel incision can be safely performed for the surgical staging of endometrial cancer with acceptable oncological outcomes compared to the midline incision.

Download Full-text

Comparison of Minimally Invasive Surgery versus Laparotomy for Surgical Staging of Endometrial Carcinoma: A Retrospective Study

Birat Journal of Health Sciences ◽

10.3126/bjhs.v5i1.29613 ◽

2020 ◽

Vol 5 (1) ◽

pp. 916-920

Author(s):

Mona Priyadarshini ◽

Rani Akhil Bhat

Keyword(s):

Endometrial Cancer ◽

Minimally Invasive Surgery ◽

Blood Loss ◽

Minimally Invasive ◽

Hospital Stay ◽

Endometrial Carcinoma ◽

Invasive Surgery ◽

Surgical Staging ◽

Duration Of Hospital Stay ◽

Significant Difference

Introduction: Endometrial carcinoma is one of the commonest gynaecological cancer in developed countries as well as developing countries. The mainstay of initial treatment of endometrial carcinoma is surgical staging which may be performed by either the conventional abdominal approach or by minimally invasive route i.e. laparoscopic or robotic. Objectives: The purpose of this study was to compare and evaluate the surgical staging, safety and clinical benefits of minimally invasive surgeries versus. laparotomy in patients with endometrial cancer. Methodology: We retrospectively analyzed 105 patients with endometrial cancer over a period of five years and compared the outcome of total hysterectomy with pelvic and para-aortic lymphadenectomy by abdominal, laparoscopic approach or robotic-assisted surgery. Comparison was done with respect to operative time, blood loss, number of lymph nodes retrieved, length of hospital stay, intraoperative and postoperative complications. The data were analyzed using paired “t”- test / Wilcoxon signed rank test ,χ2 - test, Pearson correlation coefficient “r” whenever found suitable. P value of less than 0.05 was considered as statistically significant. Result: There was no statistically significant difference seen in the baseline characteristics like age and BMI between the two groups. The laparotomies were done in a shorter time than the minimally invasive approach (p<0.001). The amount of blood loss (p=0.002), and the duration of hospital stay (p<0.001) was significantly less in the minimally invasive surgery group than the laparotomies. Not much difference in the lymph node retrieval was observed between the two arms (p=0.614). The number of complications were almost similar in both the groups. Conclusion: Minimally invasive surgery for surgical staging of endometrial carcinoma is feasible and effective than laparotomy. The amount of blood loss and duration of hospital stay is seen much lesser with MIS than laparotomy.

Download Full-text

52 SHORT-TERM OUTCOMES OF RAMIE VERSUS TLE FOR LOCALLY ADVANCED ESOPHAGEAL CANCER AFTER NEOADJUVANT CHEMORADIOTHERAPY: A PROPENSITY SCORE-MATCHED ANALYSIS

Diseases of the Esophagus ◽

10.1093/dote/doaa087.06 ◽

2020 ◽

Vol 33 (Supplement_1) ◽

Author(s):

X Guo ◽

H Jiang ◽

B Li ◽

Y Sun ◽

R Hua ◽

...

Keyword(s):

Esophageal Cancer ◽

Lymph Nodes ◽

Operative Time ◽

Locally Advanced ◽

Neoadjuvant Chemoradiotherapy ◽

Perioperative Outcomes ◽

Advanced Esophageal Cancer ◽

Short Term ◽

Significant Difference ◽

Locally Advanced Esophageal Cancer

Abstract This study aimed to compare the short-term outcomes of esophagectomy (RAMIE) versus thoracolaparoscopic esophagectomy (TLE) for patients undergoing neoadjuvant chemoradiotherapy (nCRT) for locally advanced esophageal cancer in a propensity matched cohort. Methods Data for consecutive patients receiving nCRT plus RAMIE or TLE were collected prospectively from February 2016 to December 2019. Baseline characteristics and perioperative outcomes of the RAMIE and TLE groups were retrospectively compared. Results After propensity matching, 48 pairs were identified. The conversion rate to open thoracotomy was comparable in RAMIE and TLE (4.2% vs 6.3%, P = 1). Median operative time in RAMIE was significantly shorter than TLE (237 vs 271 min, P < 0.001). Compared with TLE group, the median number of dissected lymph nodes was higher in RAMIE group at the left recurrent laryngeal nerve (RLN) area [2 (1–3) vs 1 (0–2), P = 0.014], total RLN area [4.5 (2.0–7.0) vs 2.5 (1.0–5.0), P = 0.008], and thoracic area [10.5(7.0–16.0) vs 8.5(5.0–14.5), P = 0.049]. There was no significant difference in pneumonia, leakage, and vocal cord paralysis. Conclusion Compared to traditional TLE, RAMIE can achieve more lymph nodes yield at the RLN region and shorter operative time for the patients undergoing nCRT with comparable postoperative outcomes.

Download Full-text

Endometrial Carcinoma staging Issues Laparotomy versus Laparoscopic Approach which is More Feasible and Safer?

International Journal of Women’s Health Care ◽

10.33140/ijwhc.04.02.01 ◽

2019 ◽

Vol 4 (2) ◽

Keyword(s):

Endometrial Cancer ◽

Endometrial Carcinoma ◽

Uterine Cancer ◽

Surgical Staging ◽

Peritoneal Cytology ◽

Tumor Type ◽

Statistical Significant Difference ◽

Conversion Rates ◽

Hospitalization Period ◽

Significant Difference

Background: Surgical staging of endometrial cancer is considered one of the main pathways for managing those categories of cases. Uterine cancers are considered a challenging surgical scenario in many situations due to anatomical changes in tissue planes and metastatic disease besides the presence of obesity in many cases requiring management. Aim: To compare laparoscopy versus laparotomy for complete uterine cancer surgical staging. Methodology: Cases having clinical stage I to IIA endometrial carcinoma have been randomly allocated to laparoscopy or open laparotomy including hysterectomy, salpingo - oophorectomy, pelvic cytology, pelvic and para-aortic lymphadenectomy. The chief research study outcomes were the 6-week morbidity, mortality issues, hospitalization period and conversion rates from laparoscopy to laparotomy. Results: There was no statistical significant difference as regards the Surgical stage, tumor type, types and numbers of nodes of the studied research groups in which there was no statistical significant difference as regards surgical staging, tumor type observed, peritoneal cytology, type of nodes, no nodes, Para aortic nodes only, pelvic nodes only, both pelvic and para - aortic nodes, any pelvic node, no. of nodes median (IQR) values = 0.996, 0.998, 0.929, 0.607, 0.928, 0.669, 0.541, 0.562, 0.680, 0.934 consecutively. Conclusions and recommendations: The current research elucidates the privilege of laparoscopic surgical staging for early stage endometrial cancer, however future research studies are required to be performed in multi centric fashion and to put in consideration variability’s in BMI, coexisting medical morbidities e.g. DM, hypertension besides the racial and ethnic differences

Download Full-text

Cytokeratin staining of resected lymph nodes may improve the sensitivity of surgical staging for endometrial cancer☆

Gynecologic Oncology ◽

10.1016/j.ygyno.2003.08.026 ◽

2003 ◽

Vol 91 (3) ◽

pp. 518-525 ◽

Cited By ~ 35

Author(s):

Jesus Gonzalez Bosquet ◽

Gary L Keeney ◽

Andrea Mariani ◽

Maurice J Webb ◽

William A Cliby

Keyword(s):

Endometrial Cancer ◽

Lymph Nodes ◽

Surgical Staging

Download Full-text

Merkel cell carcinoma in pelvic lymph nodes after surgical staging for endometrial cancer: A case report and review of the literature

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2012.03.027 ◽

2012 ◽

Vol 3 (7) ◽

pp. 340-342 ◽

Cited By ~ 2

Author(s):

Nikolaos Thomakos ◽

Dimitrios Zacharakis ◽

Nikolaos Akrivos ◽

Flora Zagouri ◽

Maria Simou ◽

...

Keyword(s):

Endometrial Cancer ◽

Case Report ◽

Lymph Nodes ◽

Cell Carcinoma ◽

Merkel Cell Carcinoma ◽

Surgical Staging ◽

Merkel Cell ◽

Review Of The Literature ◽

Pelvic Lymph Nodes

Download Full-text

Evolving trends in the surgical staging of endometrial cancer patients in Germany: Analysis of a nationwide registry with special emphasis on perioperative outcomes

10.21203/rs.3.rs-791632/v1 ◽

2021 ◽

Author(s):

Katrin Roth ◽

Klaus Kaier ◽

Peter Stachon ◽

Constantin von zur Mühlen ◽

Florin-Andrei Taran ◽

...

Keyword(s):

Endometrial Carcinoma ◽

Prolonged Mechanical Ventilation ◽

Laparoscopic Approach ◽

International Classification Of Diseases ◽

Surgical Staging ◽

Perioperative Outcomes ◽

Robotic Assisted ◽

Classification Of Diseases ◽

Prolonged Hospital ◽

Robotic Assisted Laparoscopy

Abstract Purpose The present study compared the use and outcomes of open surgical staging, laparoscopic surgical staging and robotic-assisted surgical staging in all patients suffering from endometrial carcinoma undergoing surgery in Germany between 2007 and 2018. Methods All patients with the diagnosis of endometrial carcinoma undergoing open surgical staging, laparoscopic surgical staging and robotic-assisted surgical staging were identified by international classification of diseases (ICD) or specific operational codes (OPS) within the database of the German federal bureau of statistics. Results Between 2007 and 2018, a total of 85,204 patients underwent surgery for endometrial carcinoma. Since 2013 laparoscopy was the leading approach in the surgical staging. The use of robotic-assisted laparoscopy increased steadily since 2011 with a share of 3% in 2018. Open surgical staging was associated with a higher risk of in-hospital mortality than laparoscopic surgical staging (1.3% vs. 0.2%, p < 0.001), of prolonged mechanical ventilation (1.3% vs. 0.2%, p < 0.001), and of prolonged hospital stay (13.7 ± 10.2 vs. 7.2 ± 5.3, p < 0.001). 0.04% patients undergoing laparoscopy were converted to laparotomy. The perioperative outcomes of surgical staging by laparotomy compared with robotic-assisted were comparable. None of the robotic-assisted treated patients died or was converted into laparotomy. Costs were highest in the open laparotomy staging group, followed by robotic assisted. Conventional laparoscopic approach caused lowest costs (8286 ± 7533€ vs. 7083 ± 3893€ vs. 6047 ± 3509€). Conclusion The present analysis shows that conventional laparoscopy is the standard therapy of endometrial carcinoma with excellent in-hospital outcomes in clinical practice. Robotic-assisted laparoscopy is an emerging technology with convincing results similar to

Download Full-text

Impact of retrieved lymph nodes count on short-term complications in patients with gastric cancer: a retrospective study

10.21203/rs.3.rs-17793/v1 ◽

2020 ◽

Author(s):

Feng Sun ◽

Song Liu ◽

Peng Song ◽

Chen Zhang ◽

Zhijian Liu ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Postoperative Complications ◽

Lymph Node Metastasis ◽

Lymph Nodes ◽

Operation Time ◽

Short Term ◽

Node Metastasis ◽

Significant Difference ◽

Univariate Analyses

Abstract Background: It is well established that retrieved lymph nodes (RLNs) count were positively correlated with better overall survival in gastric cancer (GC). But little is known about the relationship between RLNs count and short-term complications after radical surgery. Methods: A total of 1487 consecutive GC patients between January 2016 and December 2018 at Nanjing Drum Tower Hospital were retrospectively analyzed. Univariate analyses were performed to elucidate the association between RLNs count and postoperative complications. We further identified clinical factors that might affect the RLNs count.Results: Among all of the patients, postoperative complications occurred in 435 (29.3%) patients. The mean RLNs count was 25.1 and 864 (58.1%) patients were diagnosed with lymph node metastasis. Univariate analyses showed no significant difference between RLNs count and postoperative complications (both overall and stratified by CDC grade). We further explored that preoperative serum albumin, type of resection, operation time, tumor invasion, lymph node metastasis, and pTNM stage were associated with RLNs count. Conclusions: The current study demonstrated that RLNs count was not associated with postoperative short-term complications following gastrectomy of GC, which provided a rationale for the determination of a proper RLNs count of curative gastrectomy.

Download Full-text

Impact of Retrieved Lymph Nodes Count on Short-Term Complications in Patients with Gastric Cancer

10.21203/rs.3.rs-34560/v1 ◽

2020 ◽

Author(s):

Feng Sun ◽

Song Liu ◽

Peng Song ◽

Chen Zhang ◽

Zhijian Liu ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Postoperative Complications ◽

Lymph Node Metastasis ◽

Lymph Nodes ◽

Operation Time ◽

Short Term ◽

Node Metastasis ◽

Significant Difference ◽

Univariate Analyses

Download Full-text

Which surgical procedure for patients with atypical endometrial hyperplasia?

International Journal of Gynecological Cancer ◽

10.1136/ijgc-00009577-200501000-00019 ◽

2005 ◽

Vol 15 (1) ◽

pp. 127-131 ◽

Cited By ~ 4

Author(s):

B. S. Karamursel ◽

S. Guven ◽

G. Tulunay ◽

T. Kucukali ◽

A. Ayhan

Keyword(s):

Endometrial Carcinoma ◽

Endometrial Hyperplasia ◽

Menopausal Status ◽

Endometrial Biopsy ◽

Surgical Staging ◽

Lymph Node Status ◽

Atypical Endometrial Hyperplasia ◽

Group I ◽

Significant Difference ◽

Group Ii

ObjectiveTo determine the occult coexistence of endometrial carcinoma in patients with atypical endometrial hyperplasia and to compare histological prognostic factors according to lymph node status in occult endometrial carcinoma.Materials and MethodsTwo hundred and four patients from two referral centers (during the period 1990–2003) who were operated on within 1 month of endometrial biopsy for symptomatic endometrial hyperplasia without receiving any medical treatment were included retrospectively. Patients having preoperative endometrial biopsy results of concomitant endometrial hyperplasia and carcinoma were excluded from the study. Fifty-six patients having atypia in preoperative biopsy (group I) were compared with 148 patients without atypia (group II). Chi-square and Mann–Whitney U-tests were used for statistical analyses.ResultsNo significant difference was observed between the two groups according to age or menopausal status. Patients in group II had significantly higher parity than patients in group I. In group I, 62.5% of the patients had endometrial carcinoma, 21.4% had endometrial hyperplasia, and 16.1% had normal endometrium in hysterectomy specimens. In group II, the percentages were 5.4, 38.5, and 56.1%, respectively. Complete surgical staging was performed in 20 patients. Four patients had metastatic lymph nodes. All of them had grade 2 tumors with lymphovascular space involvement. Three of them had nonendometrioid tumors.ConclusionCareful intraoperative and preoperative evaluation of the endometrium must be the sine qua non for patients with atypical endometrial hyperplasia. It is reasonable to do frozen section at the time of hysterectomy for atypical endometrial hyperplasia, and if grade 2/3 of nonendometriod cancer with lymphovascular space involvement is found, complete surgical staging should be performed.

Download Full-text

Remnant pancreatic volume to predict short-term and long-term outcomes in patients with resected pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15713 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15713-e15713

Author(s):

Ryoichi Miyamoto ◽

Yukio Oshiro ◽

Nobuhiro Ohkohchi

Keyword(s):

Pancreatic Cancer ◽

Multivariate Analysis ◽

Prognostic Factors ◽

Cancer Patients ◽

Perioperative Outcomes ◽

Long Term Outcomes ◽

Short Term ◽

Significant Difference ◽

Pancreatic Volume

e15713 Background: Remnant pancreatic volume (RPV) is a well-known marker for short-term outcomes in patients with resectable pancreatic cancer. However, in terms of the long-term outcomes, the significance of the RPV remains unclear. Here, we addressed whether the RPV is a predictor of long-term outcomes in pancreatic cancer patients by comparing various cancer-, patient-, and surgery-related prognostic factors and systemic inflammatory response markers in a retrospective cohort. Methods: The RPV was measured on the 3D image, revealing the actual pancreatic parenchymal remnant volume. Ninety-one patients who underwent pancreaticoduodenectomy (PD) were retrospectively enrolled. We divided the cohort into high- and low-RPV groups based on a cut-off value ( > 35.5 cm3, n = 66 and ≤ 35.5 cm3, n = 25, respectively). The patient characteristics, perioperative outcomes and median survival times (MSTs) were respectively compared between the two groups. Using multivariate analysis, the RPV and other well-known prognostic factors were independently assessed. Results: A significant difference in the RPV value was observed with respect to the incidence of postoperative pancreatic fistula (high, 18 [55%] vs. low, 9 [16%], p < 0.001). The MSTs (days) were significantly different between the two groups (high, 823 vs. low, 482, p = 0.001). Multivariate analysis identified the RPV (≤ 31.5 cm3) (hazard ratio [HR], 2.015; p = 0.011), lymph node metastasis (HR, 8.415; p = 0.002), adjuvant chemotherapy (HR, 5.352; p < 0.001), presence of stage III/IV disease (HR, 2.352; p = 0.029), and pathological fibrosis (HR, 1.771; p = 0.031) as independent prognostic factors. Conclusions: The present study suggests that the RPV is an additional useful predictor of both long-term and short-term outcomes in pancreatic cancer patients after PD.

Download Full-text