Minimally Invasive Approach in Type II Endometrial Cancer: Is It Wise and Safe?

Giorgia Monterossi, Fabio Ghezzi, Enrico Vizza, Gian Franco Zannoni, Stefano Uccella, Giacomo Corrado, Stefano Restaino, Lorena Quagliozzi, Jvan Casarin, Giorgia Dinoi, Giovanni Scambia, Francesco Fanfani

Research output: Contribution to journalArticle

Abstract

STUDY OBJECTIVE: To compare perioperative and survival outcomes in patients with type II endometrial cancer surgically staged by a minimally invasive surgery (MIS) approach and those surgically staged by laparotomy.

DESIGN: Retrospective cohort study (Canadian Task Force classification II-2).

SETTING: Catholic University of the Sacred Heart of Rome, University of Insubria, Varese and "Regina Elena" National Cancer Institute of Rome.

PATIENTS: A total of 283 patients with type II endometrial cancer in clinical International Federation of Gynecology and Obstetrics stage I-II and pathological stage III with apparent early-stage disease detected on preoperative instrumental examination.

INTERVENTIONS: Baseline features and perioperative data were evaluated in 142 patients who underwent hysterectomy via open surgery (laparotomy [LPT] group) and 141 patients who did so via a minimally invasive approach (MIS group).

MEASUREMENTS AND MAIN RESULTS: The 2 groups were comparable in terms of baseline features and perioperative data except for operative time, which was longer in the LPT group (p < .001) and hospital stay, which was shorter in the MIS group. There were no between-group differences in pathological features, except for myometrial invasion and the rate of positive pelvic lymph nodes. Therefore, we obtained a higher number of early stages in the MIS group (p < .001). In the overall population, significant differences were observed in the recurrence rate, number, and site of relapses, with a higher recurrence rate and number in the LPT group (p < .001). Progression-free and overall survival were not significantly different in the 2 groups.

CONCLUSION: Women with type II endometrial cancer submitted to MIS for hysterectomy experienced fewer complications and similar survival outcomes compared with those who underwent open surgery. When managed by an expert surgeon, a high-risk histological subtype should not be considered a contraindication for MIS. Further prospectively randomized studies are needed to definitively evaluate the safety and feasibility of MIS in early-stage type II endometrial cancer.

Original languageEnglish
Pages (from-to)438-445
Number of pages8
JournalJournal of Minimally Invasive Gynecology
Volume24
Issue number3
DOIs
Publication statusPublished - Jan 10 2017

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Minimally Invasive Surgical Procedures
Endometrial Neoplasms
Laparotomy
Hysterectomy
Recurrence
Survival
National Cancer Institute (U.S.)
Advisory Committees
Operative Time
Gynecology
Obstetrics
Disease-Free Survival
Length of Stay
Cohort Studies
Retrospective Studies
Lymph Nodes
Safety
Population

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Endometrial Neoplasms
  • Female
  • Humans
  • Hysterectomy
  • Laparoscopy
  • Laparotomy
  • Length of Stay
  • Lymph Nodes
  • Middle Aged
  • Minimally Invasive Surgical Procedures
  • Neoplasm Recurrence, Local
  • Neoplasm Staging
  • Operative Time
  • Pelvis
  • Retrospective Studies
  • Rome
  • Comparative Study
  • Journal Article

Cite this

Minimally Invasive Approach in Type II Endometrial Cancer : Is It Wise and Safe? / Monterossi, Giorgia; Ghezzi, Fabio; Vizza, Enrico; Zannoni, Gian Franco; Uccella, Stefano; Corrado, Giacomo; Restaino, Stefano; Quagliozzi, Lorena; Casarin, Jvan; Dinoi, Giorgia; Scambia, Giovanni; Fanfani, Francesco.

In: Journal of Minimally Invasive Gynecology, Vol. 24, No. 3, 10.01.2017, p. 438-445.

Research output: Contribution to journalArticle

Monterossi, G, Ghezzi, F, Vizza, E, Zannoni, GF, Uccella, S, Corrado, G, Restaino, S, Quagliozzi, L, Casarin, J, Dinoi, G, Scambia, G & Fanfani, F 2017, 'Minimally Invasive Approach in Type II Endometrial Cancer: Is It Wise and Safe?', Journal of Minimally Invasive Gynecology, vol. 24, no. 3, pp. 438-445. https://doi.org/10.1016/j.jmig.2016.12.022
Monterossi, Giorgia ; Ghezzi, Fabio ; Vizza, Enrico ; Zannoni, Gian Franco ; Uccella, Stefano ; Corrado, Giacomo ; Restaino, Stefano ; Quagliozzi, Lorena ; Casarin, Jvan ; Dinoi, Giorgia ; Scambia, Giovanni ; Fanfani, Francesco. / Minimally Invasive Approach in Type II Endometrial Cancer : Is It Wise and Safe?. In: Journal of Minimally Invasive Gynecology. 2017 ; Vol. 24, No. 3. pp. 438-445.
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T2 - Is It Wise and Safe?

AU - Monterossi, Giorgia

AU - Ghezzi, Fabio

AU - Vizza, Enrico

AU - Zannoni, Gian Franco

AU - Uccella, Stefano

AU - Corrado, Giacomo

AU - Restaino, Stefano

AU - Quagliozzi, Lorena

AU - Casarin, Jvan

AU - Dinoi, Giorgia

AU - Scambia, Giovanni

AU - Fanfani, Francesco

N1 - Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

PY - 2017/1/10

Y1 - 2017/1/10

N2 - STUDY OBJECTIVE: To compare perioperative and survival outcomes in patients with type II endometrial cancer surgically staged by a minimally invasive surgery (MIS) approach and those surgically staged by laparotomy.DESIGN: Retrospective cohort study (Canadian Task Force classification II-2).SETTING: Catholic University of the Sacred Heart of Rome, University of Insubria, Varese and "Regina Elena" National Cancer Institute of Rome.PATIENTS: A total of 283 patients with type II endometrial cancer in clinical International Federation of Gynecology and Obstetrics stage I-II and pathological stage III with apparent early-stage disease detected on preoperative instrumental examination.INTERVENTIONS: Baseline features and perioperative data were evaluated in 142 patients who underwent hysterectomy via open surgery (laparotomy [LPT] group) and 141 patients who did so via a minimally invasive approach (MIS group).MEASUREMENTS AND MAIN RESULTS: The 2 groups were comparable in terms of baseline features and perioperative data except for operative time, which was longer in the LPT group (p < .001) and hospital stay, which was shorter in the MIS group. There were no between-group differences in pathological features, except for myometrial invasion and the rate of positive pelvic lymph nodes. Therefore, we obtained a higher number of early stages in the MIS group (p < .001). In the overall population, significant differences were observed in the recurrence rate, number, and site of relapses, with a higher recurrence rate and number in the LPT group (p < .001). Progression-free and overall survival were not significantly different in the 2 groups.CONCLUSION: Women with type II endometrial cancer submitted to MIS for hysterectomy experienced fewer complications and similar survival outcomes compared with those who underwent open surgery. When managed by an expert surgeon, a high-risk histological subtype should not be considered a contraindication for MIS. Further prospectively randomized studies are needed to definitively evaluate the safety and feasibility of MIS in early-stage type II endometrial cancer.

AB - STUDY OBJECTIVE: To compare perioperative and survival outcomes in patients with type II endometrial cancer surgically staged by a minimally invasive surgery (MIS) approach and those surgically staged by laparotomy.DESIGN: Retrospective cohort study (Canadian Task Force classification II-2).SETTING: Catholic University of the Sacred Heart of Rome, University of Insubria, Varese and "Regina Elena" National Cancer Institute of Rome.PATIENTS: A total of 283 patients with type II endometrial cancer in clinical International Federation of Gynecology and Obstetrics stage I-II and pathological stage III with apparent early-stage disease detected on preoperative instrumental examination.INTERVENTIONS: Baseline features and perioperative data were evaluated in 142 patients who underwent hysterectomy via open surgery (laparotomy [LPT] group) and 141 patients who did so via a minimally invasive approach (MIS group).MEASUREMENTS AND MAIN RESULTS: The 2 groups were comparable in terms of baseline features and perioperative data except for operative time, which was longer in the LPT group (p < .001) and hospital stay, which was shorter in the MIS group. There were no between-group differences in pathological features, except for myometrial invasion and the rate of positive pelvic lymph nodes. Therefore, we obtained a higher number of early stages in the MIS group (p < .001). In the overall population, significant differences were observed in the recurrence rate, number, and site of relapses, with a higher recurrence rate and number in the LPT group (p < .001). Progression-free and overall survival were not significantly different in the 2 groups.CONCLUSION: Women with type II endometrial cancer submitted to MIS for hysterectomy experienced fewer complications and similar survival outcomes compared with those who underwent open surgery. When managed by an expert surgeon, a high-risk histological subtype should not be considered a contraindication for MIS. Further prospectively randomized studies are needed to definitively evaluate the safety and feasibility of MIS in early-stage type II endometrial cancer.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Endometrial Neoplasms

KW - Female

KW - Humans

KW - Hysterectomy

KW - Laparoscopy

KW - Laparotomy

KW - Length of Stay

KW - Lymph Nodes

KW - Middle Aged

KW - Minimally Invasive Surgical Procedures

KW - Neoplasm Recurrence, Local

KW - Neoplasm Staging

KW - Operative Time

KW - Pelvis

KW - Retrospective Studies

KW - Rome

KW - Comparative Study

KW - Journal Article

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DO - 10.1016/j.jmig.2016.12.022

M3 - Article

C2 - 28065812

VL - 24

SP - 438

EP - 445

JO - Journal of Minimally Invasive Gynecology

JF - Journal of Minimally Invasive Gynecology

SN - 1553-4650

IS - 3

ER -