Obstet Gynecol Sci.  2022 Nov;65(6):522-530. 10.5468/ogs.22236.

Laparoscopic systemic restaging surgery for women with unexpected uterine malignancy

• Kim EB
• Hong HM
• Lee WM
• Choi JS
• Bae JB
• Jung US
• Eom JM
• Keum J

• KMID: 2535960
• DOI: http://doi.org/10.5468/ogs.22236

Abstract

Objective
We investigated the feasibility of laparoscopic restaging surgery in patients with unexpected uterine cancer.
Methods
This retrospective study included eight patients who underwent laparoscopic restaging surgery for Iran University uterine cancer after a prior hysterectomy or myomectomy.
Results
The median age of the patients and their body mass index were 55 years (range, 44-78) and 23.8 kg/m2 (range, 20.75- 31.89), respectively. The median interval between the prior hysterectomy and the restaging surgery was 21 days (range, 10-35). The median operating time and time for the return of bowel activity were 325 minutes (range, 200-475) and 35 hours (range, 18-50), respectively. The median numbers of harvested pelvic and para-aortic lymph nodes were 17.5 (range, 14-29) and 20.5 (range, 7-36), respectively. In seven of the eight patients, uterine extraction was performed with vaginal or electronic morcellation. The final International Federation of Gynecology and Obstetrics stage was IA in all patients. Intraoperative and postoperative complications did not occur in any of the patients, except for the need for transfusion. Patient 4 had synchronous primary cancer (stage IA) of the endometrium and left ovary. Two of the eight patients with clear cell carcinoma received chemotherapy, and none received radiotherapy. All patients survived without disease recurrence.
Conclusion
Restaging surgery might be necessary for highly selective patients with unexpected uterine malignancies. This would be an alternative surgical modality for complete staging and planning tailored adjuvant treatments. However, lymphadenectomy might not be performed in patients with early uterine cancer.

Keyword

Laparoscopy; Cancer staging; Uterine cancer

Reference

References

1. Jung KW, Park S, Kong HJ, Won YJ, Boo YK, Shin HR, et al. Cancer statistics in Korea: incidence, mortality and survival in 2006–2007. J Korean Med Sci. 2010; 25:1113–21.

2. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012; 62:10–29.

3. Shepherd JH. Revised FIGO staging for gynaecological cancer. Br J Obstet Gynaecol. 1989; 96:889–92.

4. Creasman WT, DeGeest K, DiSaia PJ, Zaino RJ. Significance of true surgical pathologic staging: a Gynecologic Oncology Group Study. Am J Obstet Gynecol. 1999; 181:31–4.

5. Creasman W. Revised FIGO staging for carcinoma of the endometrium. Int J Gynaecol Obstet. 2009; 105:109.

6. American College of Obstetricians and Gynecologists. ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65, August 2005: management of endometrial cancer. Obstet Gynecol. 2005; 106:413–25.

7. Theben JU, Schellong AR, Altgassen C, Kelling K, Schneider S, Große-Drieling D. Unexpected malignancies after laparoscopic-assisted supracervical hysterectomies (LASH): an analysis of 1,584 LASH cases. Arch Gynecol Obstet. 2013; 287:455–62.

8. Ouldamer L, Rossard L, Arbion F, Marret H, Body G. Risk of incidental finding of endometrial cancer at the time of hysterectomy for benign condition. J Minim Invasive Gynecol. 2014; 21:131–5.

9. Abeler VM, Røyne O, Thoresen S, Danielsen HE, Nesland JM, Kristensen GB. Uterine sarcomas in Norway. A histopathological and prognostic survey of a total population from 1970 to 2000 including 419 patients. Histopathology. 2009; 54:355–64.

10. Amant F, Floquet A, Friedlander M, Kristensen G, Mahner S, Nam EJ, et al. Gynecologic Cancer InterGroup (GCIG) consensus review for endometrial stromal sarcoma. Int J Gynecol Cancer. 2014; 24:S67–72.

11. National Comprehensive Cancer Network. NCCN practice guidelines in oncology 2015 uterine neoplasms [Internet]. Plymouth Meeting (PA): National Comprehensive Cancer Network;c2015. [cited 2014 Aug 8]. Available from: http://www.nccn.org/professionals/physician_gls/PDF/uterine.pdf .

12. Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, Signorelli M, Scambia G, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2008; 100:1707–16.

13. Sharma C, Deutsch I, Lewin SN, Burke WM, Qiao Y, Sun X, et al. Lymphadenectomy influences the utilization of adjuvant radiation treatment for endometrial cancer. Am J Obstet Gynecol. 2011; 205:562e1–9.

14. Bogani G, Cliby WA, Aletti GD. Impact of morcellation on survival outcomes of patients with unexpected uterine leiomyosarcoma: a systematic review and meta-analysis. Gynecol Oncol. 2015; 137:167–72.

15. Oduyebo T, Rauh-Hain AJ, Meserve EE, Seidman MA, Hinchcliff E, George S, et al. The value of re-exploration in patients with inadvertently morcellated uterine sarcoma. Gynecol Oncol. 2014; 132:360–5.

16. Jeong NH, Lee JM, Lee JK, Kim MK, Kim YJ, Cho CH, et al. Role of systematic lymphadenectomy and adjuvant radiation in early-stage endometrioid uterine cancer. Ann Surg Oncol. 2010; 17:2951–7.

17. Todo Y, Kato H, Kaneuchi M, Watari H, Takeda M, Sakuragi N. Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet. 2010; 375:1165–72.

18. Lee JH, Jung US, Kyung MS, Hoh JK, Choi JS. Laparoscopic systemic retroperitoneal lymphadenectomy for women with low-risk early endometrial cancer. Ann Acad Med Singapore. 2009; 38:581–6.

19. Odagiri T, Watari H, Kato T, Mitamura T, Hosaka M, Sudo S, et al. Distribution of lymph node metastasis sites in endometrial cancer undergoing systematic pelvic and para-aortic lymphadenectomy: a proposal of optimal lymphadenectomy for future clinical trials. Ann Surg Oncol. 2014; 21:2755–61.

20. Park JY, Kim EN, Kim DY, Suh DS, Kim JH, Kim YM, et al. Comparison of the validity of magnetic resonance imaging and positron emission tomography/ computed tomography in the preoperative evaluation of patients with uterine corpus cancer. Gynecol Oncol. 2008; 108:486–92.

21. Kitajima K, Murakami K, Yamasaki E, Fukasawa I, Inaba N, Kaji Y, et al. Accuracy of 18F-FDG PET/CT in detecting pelvic and paraaortic lymph node metastasis in patients with endometrial cancer. AJR Am J Roentgenol. 2008; 190:1652–8.

22. Kitajima K, Murakami K, Yamasaki E, Kaji Y, Shimoda M, Kubota K, et al. Performance of integrated FDG-PET/ contrast-enhanced CT in the diagnosis of recurrent pancreatic cancer: comparison with integrated FDG-PET/ non-contrast-enhanced CT and enhanced CT. Mol Imaging Biol. 2010; 12:452–9.

23. Sironi S, Buda A, Picchio M, Perego P, Moreni R, Pellegrino A, et al. Lymph node metastasis in patients with clinical early-stage cervical cancer: detection with integrated FDG PET/CT. Radiology. 2006; 238:272–9.

24. SGO Clinical Practice Endometrial Cancer Working Group, Burke WM, Orr J, Leitao M, Salom E, Gehrig P, et al. Endometrial cancer: a review and current management strategies: part I. Gynecol Oncol. 2014; 134:385–92.

25. Frost JA, Webster KE, Bryant A, Morrison J. Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev. 2017; 10:CD007585.

26. Fayallah EA, Hemida RA, Gamal AM, Abd Elhady E, Anwar KI, Nada NA, et al. Pretreatment study of P53 over-expression for selection of candidates for pelvic lymphadenectomy in clinical stage I endometrial carcinoma: a randomized-controlled study. Arch Gynecol Obstet. 2011; 283:617–22.

27. Song SY, Park M, Kang BH, Yang JB, Ko YB, Lee M, et al. Distribution of lymphocele following lymphadenectomy in patients with gynecological malignancies. Obstet Gynecol Sci. 2020; 63:700–8.