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Oncologic outcomes for patients with endometrial cancer who received minimally invasive surgery: a retrospective observational study

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Abstract

Background

Laparoscopic hysterectomy has been performed for patients with endometrial cancer as minimally invasive surgery; however, the long-term outcomes of high-risk disease compared to open surgery remain unclear.

Methods

Eight hundred and eighty-three patients with endometrial cancer who underwent laparoscopic or abdominal hysterectomy were categorized into three groups. Low-risk disease was defined as stage IA disease with endometrioid carcinoma of grade 1 or 2. Uterine-confined disease was defined as stage IA disease with high-grade tumors or stage IB and II disease. Advanced disease was defined as stage III or IV disease. The progression-free survival (PFS) and overall survival (OS) rates were compared between laparoscopic and laparotomic hysterectomy.

Results

Among 478 patients with low-risk disease, including 226 with laparoscopy and 252 with laparotomy, the prognosis was not significantly different between the groups (3-year PFS rate, 97.4% vs. 97.1%, p = 0.8; 3-year OS rate, 98.6% vs. 98.3%, p = 0.9). Among the 229 patients with uterine-confined disease, including 51 with laparoscopy and 178 with laparotomy, the prognosis was not significantly different between the groups (3-year PFS rate, 90.5% vs. 85.5%, p = 0.7; 3-year OS rate, 91.3% vs. 92.5%, p = 0.8). Among the 176 patients with advanced disease, including 24 with laparoscopy and 152 with laparotomy, laparoscopic hysterectomy had a higher PFS rate and OS rate than laparotomic hysterectomy (3-year PFS rate, 74.5% vs. 51.5%, p = 0.01; 3-year OS rate, 92.3% vs. 75.1%, p = 0.03).

Conclusions

Laparoscopic procedures are not associated with a poorer outcome than laparotomy in patients with advanced endometrial cancer or uterine-confined endometrial cancer.

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References

  1. Walker JL, Piedmonte MR, Spirtos NM et al (2009) Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: gynecologic Oncology Group Study LAP2. J Clin Oncol 27(32):5331–5336. https://doi.org/10.1200/jco.2009.22.3248

    Article  PubMed  PubMed Central  Google Scholar 

  2. Walker JL, Piedmonte MR, Spirtos NM et al (2012) Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: gynecologic Oncology Group LAP2 Study. J Clin Oncol 30(7):695–700. https://doi.org/10.1200/jco.2011.38.8645

    Article  PubMed  PubMed Central  Google Scholar 

  3. Asher R, Obermair A, Janda M et al (2018) Disease-free and survival outcomes for total laparoscopic hysterectomy compared with total abdominal hysterectomy in early-stage endometrial carcinoma: a meta-analysis. Int J Gynecol Cancer 28(3):529–538. https://doi.org/10.1097/igc.0000000000001199

    Article  PubMed  Google Scholar 

  4. Janda M, Gebski V, Davies LC et al (2017) Effect of total laparoscopic hysterectomy vs total abdominal hysterectomy on disease-free survival among women with stage i endometrial cancer: a randomized clinical trial. JAMA 317(12):1224–1233. https://doi.org/10.1001/jama.2017.2068

    Article  PubMed  Google Scholar 

  5. Terai Y, Tanaka T, Sasaki H et al (2014) Total laparoscopic modified radical hysterectomy with lymphadenectomy for endometrial cancer compared with laparotomy. J Obstet Gynaecol Res 40(2):570–575. https://doi.org/10.1111/jog.12194

    Article  PubMed  Google Scholar 

  6. Tanaka T, Terai Y, Hayashi S et al (2017) Comparison between laparoscopy and laparotomy in systematic para-aortic lymphadenectomy for patients with endometrial cancer: a retrospective multicenter study. J Gynecol Surg 33(3):105–110. https://doi.org/10.1089/gyn.2016.0101

    Article  PubMed  PubMed Central  Google Scholar 

  7. Tanaka T, Terai Y, Maeda K et al (2017) Intraperitoneal cytology after laparoscopic hysterectomy in patients with endometrial cancer: a retrospective observational study. Medicine 96(27):e7502. https://doi.org/10.1097/md.0000000000007502

    Article  PubMed  PubMed Central  Google Scholar 

  8. Tanaka T, Terai Y, Fujiwara S et al (2017) The detection of sentinel lymph nodes in laparoscopic surgery can eliminate systemic lymphadenectomy for patients with early stage endometrial cancer. Int J Clin Oncol. https://doi.org/10.1007/s10147-017-1196-9

    Article  PubMed  PubMed Central  Google Scholar 

  9. Tanaka T, Terai Y, Yamamoto K et al (2018) The diagnostic accuracy of fluorodeoxyglucose-positron emission tomography/computed tomography and sentinel node biopsy in the prediction of pelvic lymph node metastasis in patients with endometrial cancer: a retrospective observational study. Medicine 97(38):e12522. https://doi.org/10.1097/md.0000000000012522

    Article  PubMed  PubMed Central  Google Scholar 

  10. Galaal K, Bryant A, Fisher AD et al (2012) Laparoscopy versus laparotomy for the management of early stage endometrial cancer. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.cd006655.pub2

    Article  PubMed  Google Scholar 

  11. Zullo F, Falbo A, Palomba S (2012) Safety of laparoscopy vs laparotomy in the surgical staging of endometrial cancer: a systematic review and metaanalysis of randomized controlled trials. Am J Obstet Gynecol 207(2):94–100. https://doi.org/10.1016/j.ajog.2012.01.010

    Article  PubMed  Google Scholar 

  12. Vardar MA, Gulec UK, Guzel AB et al (2019) Laparoscopic surgery for low, intermediate and high-risk endometrial cancer. J Gynecol Oncol 30(2):e24. https://doi.org/10.3802/jgo.2019.30.e24

    Article  PubMed  Google Scholar 

  13. Fader AN, Seamon LG, Escobar PF et al (2012) Minimally invasive surgery versus laparotomy in women with high grade endometrial cancer: a multi-site study performed at high volume cancer centers. Gynecol Oncol 126(2):180–185. https://doi.org/10.1016/j.ygyno.2012.04.028

    Article  PubMed  Google Scholar 

  14. Vogel TJ, Knickerbocker A, Shah CA et al (2015) An analysis of current treatment practice in uterine papillary serous and clear cell carcinoma at two high volume cancer centers. J Gynecol Oncol 26(1):25–31. https://doi.org/10.3802/jgo.2015.26.1.25

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Gao H, Zhang Z (2015) Laparoscopy versus laparotomy in the treatment of high-risk endometrial cancer: a propensity score matching analysis. Medicine 94(30):e1245. https://doi.org/10.1097/md.0000000000001245

    Article  PubMed  PubMed Central  Google Scholar 

  16. Favero G, Anton C, Le X et al (2016) Oncologic safety of laparoscopy in the surgical treatment of type II endometrial cancer. Int J Gynecol Cancer 26(9):1673–1678. https://doi.org/10.1097/igc.0000000000000803

    Article  PubMed  Google Scholar 

  17. Koskas M, Jozwiak M, Fournier M et al (2016) Long-term oncological safety of minimally invasive surgery in high-risk endometrial cancer. Eur J Cancer (Oxford, England : 1990) 65:185–191. https://doi.org/10.1016/j.ejca.2016.07.001

    Article  Google Scholar 

  18. Monterossi G, Ghezzi F, Vizza E et al (2017) Minimally invasive approach in type Ii endometrial cancer: is it wise and safe? J Minim Invasive Gynecol 24(3):438–445. https://doi.org/10.1016/j.jmig.2016.12.022

    Article  PubMed  Google Scholar 

  19. Fader AN, Java J, Tenney M et al (2016) Impact of histology and surgical approach on survival among women with early-stage, high-grade uterine cancer: an NRG Oncology/Gynecologic Oncology Group ancillary analysis. Gynecol Oncol 143(3):460–465. https://doi.org/10.1016/j.ygyno.2016.10.016

    Article  PubMed  PubMed Central  Google Scholar 

  20. Shigeta S, Nagase S, Mikami M et al (2017) Assessing the effect of guideline introduction on clinical practice and outcome in patients with endometrial cancer in Japan: a project of the Japan Society of Gynecologic Oncology (JSGO) guideline evaluation committee. J Gynecolog Oncol 28(6):e76. https://doi.org/10.3802/jgo.2017.28.e76

    Article  Google Scholar 

  21. Kong A, Simera I, Collingwood M et al (2007) Adjuvant radiotherapy for stage I endometrial cancer: systematic review and meta-analysis. Ann Oncol 18(10):1595–1604. https://doi.org/10.1093/annonc/mdm066

    Article  CAS  PubMed  Google Scholar 

  22. Johnson N, Cornes P (2007) Survival and recurrent disease after postoperative radiotherapy for early endometrial cancer: systematic review and meta-analysis. BJOG Int J Obstet Gynaecol 114(11):1313–1320. https://doi.org/10.1111/j.1471-0528.2007.01332.x

    Article  CAS  Google Scholar 

  23. Randall ME, Filiaci VL, Muss H et al (2006) Randomized phase III trial of whole-abdominal irradiation versus doxorubicin and cisplatin chemotherapy in advanced endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol 24(1):36–44. https://doi.org/10.1200/jco.2004.00.7617

    Article  CAS  PubMed  Google Scholar 

  24. Susumu N, Sagae S, Udagawa Y et al (2008) Randomized phase III trial of pelvic radiotherapy versus cisplatin-based combined chemotherapy in patients with intermediate- and high-risk endometrial cancer: a Japanese Gynecologic Oncology Group study. Gynecol Oncol 108(1):226–233. https://doi.org/10.1016/j.ygyno.2007.09.029

    Article  CAS  PubMed  Google Scholar 

  25. Maggi R, Lissoni A, Spina F et al (2006) Adjuvant chemotherapy vs radiotherapy in high-risk endometrial carcinoma: results of a randomised trial. Br J Cancer 95(3):266–271. https://doi.org/10.1038/sj.bjc.6603279

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Galaal K, Al Moundhri M, Bryant A et al (2014) Adjuvant chemotherapy for advanced endometrial cancer. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.cd010681.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  27. Creutzberg CL, van Putten WL, Koper PC et al (2000) Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post operative radiation therapy in endometrial carcinoma. Lancet 355(9213):1404–1411. https://doi.org/10.1016/s0140-6736(00)02139-5

    Article  CAS  PubMed  Google Scholar 

  28. Nout RA, Smit VT, Putter H et al (2010) Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial. Lancet 375(9717):816–823. https://doi.org/10.1016/s0140-6736(09)62163-2

    Article  CAS  PubMed  Google Scholar 

  29. de Boer SM, Powell ME, Mileshkin L et al (2019) Adjuvant chemoradiotherapy versus radiotherapy alone in women with high-risk endometrial cancer (PORTEC-3): patterns of recurrence and post hoc survival analysis of a randomised phase 3 trial. Lancet Oncol 20(9):1273–1285. https://doi.org/10.1016/s1470-2045(19)30395-x

    Article  PubMed  PubMed Central  Google Scholar 

  30. Randall ME, Filiaci V, McMeekin DS et al (2019) Phase III Trial: adjuvant pelvic radiation therapy versus vaginal brachytherapy plus paclitaxel/carboplatin in high-intermediate and high-risk early stage endometrial cancer. J Clin Oncol 37(21):1810–1818. https://doi.org/10.1200/jco.18.01575

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Matei D, Filiaci V, Randall ME et al (2019) Adjuvant chemotherapy plus radiation for locally advanced endometrial cancer. N Engl J Med 380(24):2317–2326. https://doi.org/10.1056/NEJMoa1813181

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Kilgore LC, Partridge EE, Alvarez RD et al (1995) Adenocarcinoma of the endometrium: survival comparisons of patients with and without pelvic node sampling. Gynecol Oncol 56(1):29–33. https://doi.org/10.1006/gyno.1995.1005

    Article  CAS  PubMed  Google Scholar 

  33. Chuang L, Burke TW, Tornos C et al (1995) Staging laparotomy for endometrial carcinoma: assessment of retroperitoneal lymph nodes. Gynecol Oncol 58(2):189–193. https://doi.org/10.1006/gyno.1995.1208

    Article  CAS  PubMed  Google Scholar 

  34. Chan JK, Cheung MK, Huh WK et al (2006) Therapeutic role of lymph node resection in endometrioid corpus cancer: a study of 12,333 patients. Cancer 107(8):1823–1830. https://doi.org/10.1002/cncr.22185

    Article  PubMed  Google Scholar 

  35. Lutman CV, Havrilesky LJ, Cragun JM et al (2006) Pelvic lymph node count is an important prognostic variable for FIGO stage I and II endometrial carcinoma with high-risk histology. Gynecol Oncol 102(1):92–97. https://doi.org/10.1016/j.ygyno.2005.11.032

    Article  PubMed  Google Scholar 

  36. Todo Y, Kato H, Kaneuchi M et al (2010) Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet 375(9721):1165–1172. https://doi.org/10.1016/s0140-6736(09)62002-x

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan

    Tomohito Tanaka, Shoko Ueda, Shunsuke Miyamoto, Shinichi Terada, Hiromi Konishi, Yuhei Kogata, Satoe Fujiwara, Yoshimichi Tanaka & Masahide Ohmichi

  2. Translational Research Program, Osaka Medical College, Takatsuki, Japan

    Tomohito Tanaka, Kohei Taniguchi & Kazumasa Komura

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  1. Tomohito Tanaka
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Correspondence to Tomohito Tanaka.

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Tanaka, T., Ueda, S., Miyamoto, S. et al. Oncologic outcomes for patients with endometrial cancer who received minimally invasive surgery: a retrospective observational study. Int J Clin Oncol 25, 1985–1994 (2020). https://doi.org/10.1007/s10147-020-01744-4

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  • DOI: https://doi.org/10.1007/s10147-020-01744-4

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