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Minerva Medica 2020 Nov 18

DOI: 10.23736/S0026-4806.20.07073-1

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Ultra-minimally invasive approaches for endometrial cancer treatment: review of literature

Mariaclelia LA RUSSA , Nikolaos BURBOS, Chrysoula G. LIAKOU

Department of Gynaecological Oncology, Norfolk and Norwich University Hospital, Norwich, UK


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INTRODUCTION: We conducted a systematic review to evaluate the outcomes and role of ultra-minimally invasive surgical approaches for treatment of women diagnosed with endometrial cancer. Although, there is no agreed definition of the term “ultraminimal”, we considered the hysteroscopic surgery, single-port surgery, mini/microlaparoscopy and percutaneous laparoscopy as surgical approaches that would best fit this description.
EVIDENCE ACQUISITION: The current systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We performed a literature search using MEDLINE (PubMed), EMBASE and Cochrane Library databases for English-language studies published before August 1, 2020. We used the following keywords including “endometrial cancer”, “endometrial malignancy”, “fertilitysparing or preserving”, “hysteroscopy”, “hysteroscopic resection”, “dilatation and curettage”, “ultraminimally invasive surgery”, “progestin therapy”, “hormone therapy”, “single port”, “single-site”, minilaparoscopy”, “microlaparoscopy”, “percutaneous” and “3 mm laparoscopy”.
EVIDENCE SYNTHESIS: Hysteroscopic surgery. A total of 21 studies, reporting on 229 patients were included. 219 (95.6%) of the patients were premenopausal. Among premenopausal women, complete disease response was reported in 186 (84.9%) patients. The complete response rate was 77.1% in patients who underwent focal or extensive endometrial resection, 90.9% in patients who had the two-step approach and 88.9% in the group of patients treated with the three-step technique. Among 98 women who wished and attempted to conceive, 65 (66.3%) women became pregnant. Recurrent disease was diagnosed in 26 of 219 (11.9%) patients. No surgical complications were reported. In 10 postmenopausal patients that underwent hysteroscopic resection, no recurrences were detected after 5 years of follow up. Single-port laparoscopic surgery. We identified 11 studies that reported on the use single-port laparoscopic surgery and included a total of 447 patients. The rate of intraoperative and postoperative complications was 2.6% and 5.2%, respectively. The majority of the studies did not report on the duration of follow up or oncological outcomes. Single-port robotic-assisted laparoscopic surgery. Ten studies, including 296 patients, investigated the role of single-port robotic-assisted laparoscopy. The overall rate of intraoperative and postoperative complications was 1.0% and 7.1%, respectively. Mini/microlaparoscopy. Two studies, including 38 patients, reported on the role of minilaparoscopy. None of these cases required conversion to laparotomy. Data on overall survival in the cohort of patients that underwent minilaparoscopy were not reported. Percutaneous laparoscopic surgery. We found only one publication reporting on the use of percutaneous laparoscopy. This prospective study included 30 patients. No complication was reported, and with a median follow up time of 14 months (range 12-36) no recurrences were diagnosed.
CONCLUSIONS: In conclusion, several ultraminimally invasive surgical techniques have been developed and implemented in selected patients with endometrial cancer. The results of this review support the feasibility and perioperative safety of these approaches, while long-term outcomes are not adequately studied. However, further work is required in standardisation of the techniques, in determining the learning curve of the operator and establishing their oncological safety.


KEY WORDS: Endometrial cancer; Ultraminimally invasive; Hysteroscopic resection; Minilaparoscopy

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