Factors predicting morbidity in surgically-staged high-risk endometrial cancer patients

Giorgio Bogani, Andrea Papadia, Alessandro Buda, Jvan Casarin, Violante Di Donato, Francesco Plotti, Maria Luisa Gasparri, Chiara Cimmino, Ciro Pinelli, Anna Myriam Perrone, Fabio Barra, Antonella Cromi, Giampaolo Di Martino, Innocenza Palaia, Simone Ferrero, Alice Indini, Pierandrea De Iaco, Roberto Angioli, Daniela Luvero, Ludovico MuziiFabio Ghezzi, Fabio Landoni, Michael D. Mueller, Pierluigi Benedetti Panici, Francesco Raspagliesi

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To investigate factors predicting the risk of developing 90-day postoperative complications and lymphatic-specific morbidity in patients undergoing surgical staging for high-risk endometrial cancer. Methods: This is a multi-institutional retrospective cohort study. Patients affected by apparent early-stage high-risk endometrial cancer (endometrioid FIGO grade 3 with deep myometrial invasion and non-endometrioid endometrial cancer) undergoing surgical staging between 2007 and 2019. Complications were graded according to the Clavien-Dindo classification system. Martin criteria were applied to improve quality of complications reporting. Results: Charts of 279 patients were evaluated. Lymphadenectomy, sentinel node mapping (SNM), and SNM followed by back-up lymphadenectomy were performed in 83 (29.7%), 50 (17.9%), and 146 (52.4%) patients, respectively. The former group of patients included 13 patients who had lymphadenectomy after the failure of the SNM technique. Thirteen (4.6%) patients developed severe postoperative events (grade 3 or worse). At multivariate analysis, body mass index (OR: 1.08 (95%CI: 1.01, 1.17)) and open abdominal surgery (OR: 2.27 (95%CI: 1.02, 5.32)) were the two independent factors predictive of surgery-related morbidity. Seven severe lymphatic complications occurred. The adoption of laparoscopic approach (p < 0.001, log-rank test) and SNM (p = 0.038, log-rank test) correlated with a lower risk of developing surgery-related events. Independently, open abdominal surgery was associated with an increased risk of developing lymphatic morbidity (OR: 37.4 (95%CI: 4.38, 319.5); p = 0.001). Conclusion: The adoption of the laparoscopic approach and SNM technique were associated with lower 90-day complication rates than open surgery in high-risk endometrial cancer undergoing staging surgery.

Original languageEnglish
Pages (from-to)169-174
Number of pages6
JournalEuropean Journal of Obstetrics and Gynecology and Reproductive Biology
Volume266
DOIs
Publication statusPublished - Nov 2021

Keywords

  • Endometrial cancer
  • Lymphadenectomy
  • Morbidity
  • Sentinel node mapping

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology

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