TY - JOUR
T1 - Factors associated with an increased risk of recurrence in patients diagnosed with high-grade endometrial cancer undergoing minimally invasive surgery
T2 - A study of the society of gynecologic oncology of Canada (GOC) community of practice (CoP)
AU - Feigenberg, Tomer
AU - Cormier, Beatrice
AU - Gotlieb, Walter Henri
AU - Jegatheeswaran, Kizanee
AU - Helpman, Limor
AU - Kim, Soyoun Rachel
AU - Lau, Susie
AU - May, Taymaa
AU - Saab, Dima
AU - Plante, Marie
AU - Renaud, Marie Claude
AU - Samouelian, Vanessa
AU - Shamiya, Sarah
AU - Vicus, Danielle
AU - Wright, Kristin
AU - Kwon, Janice S.
N1 - Publisher Copyright:
© 2021
PY - 2021/9
Y1 - 2021/9
N2 - Background: Minimally invasive surgery (MIS) is a standard surgical approach for comprehensive surgical staging in women with endometrial cancer. As rates and complexity of MIS are steadily increasing, it is important to identify potential risk factors which may be associated with this approach. This study evaluates the impact of local factors on the risk of disease recurrence. Methods: A retrospective cohort study was conducted of patients diagnosed with high grade endometrial cancer (HGEC) who underwent MIS between 2012 and 2016 at eight Canadian centers. Data was collected from medical records. The 75th percentile was calculated for estimated uterine volume and weight. All recurrences were categorized into two groups; intra-abdominal vs. extra-abdominal. To search for significant covariates associated with recurrence-free survival a Cox proportional hazard model was performed. Results: A total of 758 patients were included in the study. Intra-uterine manipulator was used in 497 (35.8%) of patients. Vaginal lacerations were documented in 9.1%. Median follow-up was 30.5 months (interquartile range 20–47). There were 157 who had disease recurrence (20.71%), including 92 (12.14%) intra-abdominal and 60 (7.92%) extra-abdominal only recurrences. In univariate analysis myometrial invasion, LVI, stage, uterine volume and weight > 75th percentile and chemotherapy were associated with increased risk of intra-abdominal recurrence. In multivariable analysis only stage, and specimen weight > 75th percentile (OR 2.207, CI 1.123–4.337) remained significant. Uterine volume, and weight were not associated with increased risk of extra-abdominal recurrences. Conclusion: For patients diagnosed with HGEC undergoing MIS, extracting a large uterus is associated with a significantly increased risk for intra-abdominal recurrence.
AB - Background: Minimally invasive surgery (MIS) is a standard surgical approach for comprehensive surgical staging in women with endometrial cancer. As rates and complexity of MIS are steadily increasing, it is important to identify potential risk factors which may be associated with this approach. This study evaluates the impact of local factors on the risk of disease recurrence. Methods: A retrospective cohort study was conducted of patients diagnosed with high grade endometrial cancer (HGEC) who underwent MIS between 2012 and 2016 at eight Canadian centers. Data was collected from medical records. The 75th percentile was calculated for estimated uterine volume and weight. All recurrences were categorized into two groups; intra-abdominal vs. extra-abdominal. To search for significant covariates associated with recurrence-free survival a Cox proportional hazard model was performed. Results: A total of 758 patients were included in the study. Intra-uterine manipulator was used in 497 (35.8%) of patients. Vaginal lacerations were documented in 9.1%. Median follow-up was 30.5 months (interquartile range 20–47). There were 157 who had disease recurrence (20.71%), including 92 (12.14%) intra-abdominal and 60 (7.92%) extra-abdominal only recurrences. In univariate analysis myometrial invasion, LVI, stage, uterine volume and weight > 75th percentile and chemotherapy were associated with increased risk of intra-abdominal recurrence. In multivariable analysis only stage, and specimen weight > 75th percentile (OR 2.207, CI 1.123–4.337) remained significant. Uterine volume, and weight were not associated with increased risk of extra-abdominal recurrences. Conclusion: For patients diagnosed with HGEC undergoing MIS, extracting a large uterus is associated with a significantly increased risk for intra-abdominal recurrence.
KW - Endometrial cancer
KW - High-grade
KW - Minimally invasive surgery
KW - Uterine manipulator
UR - http://www.scopus.com/inward/record.url?scp=85108796654&partnerID=8YFLogxK
U2 - 10.1016/j.ygyno.2021.06.013
DO - 10.1016/j.ygyno.2021.06.013
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C2 - 34183164
AN - SCOPUS:85108796654
SN - 0090-8258
VL - 162
SP - 606
EP - 612
JO - Gynecologic Oncology
JF - Gynecologic Oncology
IS - 3
ER -
