Purpose The objective was to compare laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer. Patients and Methods Patients with clinical stage I to IIA uterine cancer were randomly assigned to laparoscopy (n = 1,696) or open laparotomy (n = 920), including hysterectomy, salpingo-oophorectomy, pelvic cytology, and pelvic and para-aortic lymphadenectomy. The main study end points were 6-week morbidity and mortality, hospital length of stay, conversion from laparoscopy to laparotomy, recurrence-free survival, site of recurrence, and patient-reported quality-of-life outcomes. Results Laparoscopy was initiated in 1,682 patients and completed without conversion in 1,248 patients (74.2%). Conversion from laparoscopy to laparotomy was secondary to poor visibility in 246 patients (14.6%), metastatic cancer in 69 patients (4.1%), bleeding in 49 patients (2.9%), and other cause in 70 patients (4.2%). Laparoscopy had fewer moderate to severe postoperative adverse events than laparotomy (14...

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Laparoscopy Compared With Laparotomy for Comprehensive Surgical Staging of Uterine Cancer: Gynecologic Oncology Group Study LAP2

Purpose The primary objective was to establish noninferiority of laparoscopy compared with laparotomy for recurrence after surgical staging of uterine cancer. Patients and Methods Patients with clinical stages I to IIA disease were randomly allocated (two to one) to laparoscopy (n = 1,696) versus laparotomy (n = 920) for hysterectomy, salpingo-oophorectomy, pelvic cytology, and pelvic and para-aortic lymphadenectomy. The primary study end point was noninferiority of recurrence-free interval defined as no more than a 40% increase in the risk of recurrence with laparoscopy compared with laparotomy. Results With a median follow-up time of 59 months for 2,181 patients still alive, there were 309 recurrences (210 laparoscopy; 99 laparotomy) and 350 deaths (229 laparoscopy; 121 laparotomy). The estimated hazard ratio for laparoscopy relative to laparotomy was 1.14 (90% lower bound, 0.92; 95% upper bound, 1.46), falling short of the protocol-specified definition of noninferiority. However, the actual recurrence ...

Recurrence and Survival After Random Assignment to Laparoscopy Versus Laparotomy for Comprehensive Surgical Staging of Uterine Cancer: Gynecologic Oncology Group LAP2 Study

https://sgo.org/wp-content/uploads/2012/09/ENDOMETRIAL_PART_I.pdf

Endometrial cancer: A review and current management strategies: Part I

Purpose To assess the efficacy of fertility-sparing treatment using medroxyprogesterone acetate (MPA) for endometrial carcinoma (EC) and atypical endometrial hyperplasia (AH) in young women. Patients and Methods This multicenter prospective study was carried out at 16 institutions in Japan. Twenty-eight patients having EC at presumed stage IA and 17 patients with AH at younger than 40 years of age were enrolled. All patients were given a daily oral dose of 600 mg of MPA with low-dose aspirin. This treatment continued for 26 weeks, as long as the patients responded. Histologic change of endometrial tissue was assessed at 8 and 16 weeks of treatment. Either estrogen-progestin therapy or fertility treatment was provided for the responders after MPA therapy. The primary end point was a pathologic complete response (CR) rate. Toxicity, pregnancy rate, and progression-free interval were secondary end points. Results CR was found in 55% of EC cases and 82% of AH cases. The overall CR rate was 67%. Neither therap...

https://ascopubs.org/doi/pdf/10.1200/JCO.2006.08.8344

Multicenter Phase II Study of Fertility-Sparing Treatment With Medroxyprogesterone Acetate for Endometrial Carcinoma and Atypical Hyperplasia in Young Women

Endometrial cancer is the most common gynecologic cancer in the United States, and its incidence is rising. Although there have been significant recent advances in our understanding of endometrial cancer biology, many aspects of treatment remain mired in controversy, including the role of surgical lymph node assessment and the selection of patients for adjuvant radiation or chemotherapy. For the subset of women with microsatellite-instable, metastatic disease, anti- programmed cell death protein 1 immunotherapy (pembrolizumab) is now approved by the US Food and Drug Administration, and numerous trials are attempting to build on this early success.

https://onlinelibrary.wiley.com/doi/pdf/10.3322/caac.21561

Current recommendations and recent progress in endometrial cancer.

https://www.gynecologiconcology-online.net/article/S0090-8258(00)95843-8/pdf

Stage IVB endometrial carcinoma: the role of cytoreductive surgery and determinants of survival.

High Incidence of Positive Peritoneal Cytology in Low-Risk Endometrial Cancer Treated by Laparoscopically Assisted Vaginal Hysterectomy

Retrograde seeding of malignant cells during hysteroscopy in presumed early endometrial cancer.

Inability of Preoperative Computed Tomography Scans to Accurately Predict the Extent of Myometrial Invasion and Extracorporal Spread in Endometrial Cancer

Marc J. Zerbe

Papers

Stage IVB endometrial carcinoma: the role of cytoreductive surgery and determinants of survival.

High Incidence of Positive Peritoneal Cytology in Low-Risk Endometrial Cancer Treated by Laparoscopically Assisted Vaginal Hysterectomy

Retrograde seeding of malignant cells during hysteroscopy in presumed early endometrial cancer.

Inability of Preoperative Computed Tomography Scans to Accurately Predict the Extent of Myometrial Invasion and Extracorporal Spread in Endometrial Cancer

High Incidence of Positive Peritoneal Cytology in Low-Risk Endometrial Cancer Treated by Laparoscopically-Assisted Vaginal Hysterectomy