Implications of a two-step procedure in surgical management of patients with early-stage endometrioid endometrial cancer
Identifieur interne : 000080 ( France/Analysis ); précédent : 000079; suivant : 000081Implications of a two-step procedure in surgical management of patients with early-stage endometrioid endometrial cancer
Auteurs : Emmanuelle Arsène [France] ; Géraldine Bleu [France] ; Benjamin Merlot [France] ; Loïc Boulanger [France] ; Denis Vinatier [France] ; Olivier Kerdraon [France] ; Pierre Collinet [France]Source :
- Journal of Gynecologic Oncology [ 2005-0380 ] ; 2015.
Abstract
Since European Society for Medical Oncology (ESMO) recommendations and French guidelines, pelvic lymphadenectomy should not be systematically performed for women with early-stage endometrioid endometrial cancer (EEC) preoperatively assessed at presumed low- or intermediate-risk. The aim of our study was to evaluate the change of our surgical practices after ESMO recommendations, and to evaluate the rate and morbidity of second surgical procedure in case of understaging after the first surgery.
This retrospective single-center study included women with EEC preoperatively assessed at presumed low- or intermediate-risk who had surgery between 2006 and 2013. Two periods were defined the times before and after ESMO recommendations. Demographics characteristics, surgical management, operative morbidity, and rate of understaging were compared. The rate of second surgical procedure required for lymph node resection during the second period and its morbidity were also studied.
Sixty-one and sixty-two patients were operated for EEC preoperatively assessed at presumed low-or intermediate-risk before and after ESMO recommendations, respectively. Although immediate pelvic lymphadenectomy was performed more frequently during the first period than the second period (88.5% vs. 19.4%; p<0.001), the rate of postoperative risk-elevating or upstaging were comparable between the two periods (31.1% vs. 27.4%; p=0.71). Among the patients requiring second surgical procedure during the second period (21.0%), 30.8% did not undergo the second surgery due to their comorbidity or old age. For the patients who underwent second surgical procedure, mean operative time of the second procedure was 246.1±117.8 minutes. Third operation was required in 33.3% of them because of postoperative complications.
Since ESMO recommendations, second surgical procedure for lymph node resection is often required for women with EEC presumed at low- or intermediate-risk. This reoperation is not always performed due to age/comorbidity of the patients, and presents a significant morbidity.
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DOI: 10.3802/jgo.2015.26.2.125
PubMed: 25872893
PubMed Central: 4397228
Affiliations:
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procedure in surgical management of patients with early-stage endometrioid endometrial cancer</title><author><name sortKey="Arsene, Emmanuelle" sort="Arsene, Emmanuelle" uniqKey="Arsene E" first="Emmanuelle" last="Arsène">Emmanuelle Arsène</name><affiliation wicri:level="3"><nlm:aff id="A1">Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France.</nlm:aff><country xml:lang="fr" wicri:curation="lc">France</country><wicri:regionArea>Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille</wicri:regionArea><placeName><region type="region">Hauts-de-France</region><region type="old region">Nord-Pas-de-Calais</region><settlement type="city">Lille</settlement></placeName></affiliation></author><author><name sortKey="Bleu, Geraldine" sort="Bleu, Geraldine" uniqKey="Bleu G" first="Géraldine" last="Bleu">Géraldine Bleu</name><affiliation wicri:level="3"><nlm:aff id="A1">Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France.</nlm:aff><country xml:lang="fr" wicri:curation="lc">France</country><wicri:regionArea>Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille</wicri:regionArea><placeName><region type="region">Hauts-de-France</region><region type="old region">Nord-Pas-de-Calais</region><settlement type="city">Lille</settlement></placeName></affiliation></author><author><name sortKey="Merlot, Benjamin" sort="Merlot, Benjamin" uniqKey="Merlot B" first="Benjamin" last="Merlot">Benjamin Merlot</name><affiliation wicri:level="3"><nlm:aff id="A1">Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France.</nlm:aff><country xml:lang="fr" wicri:curation="lc">France</country><wicri:regionArea>Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille</wicri:regionArea><placeName><region type="region">Hauts-de-France</region><region type="old region">Nord-Pas-de-Calais</region><settlement type="city">Lille</settlement></placeName></affiliation></author><author><name sortKey="Boulanger, Loic" sort="Boulanger, Loic" uniqKey="Boulanger L" first="Loïc" last="Boulanger">Loïc Boulanger</name><affiliation wicri:level="3"><nlm:aff id="A1">Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France.</nlm:aff><country xml:lang="fr" wicri:curation="lc">France</country><wicri:regionArea>Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille</wicri:regionArea><placeName><region type="region">Hauts-de-France</region><region type="old region">Nord-Pas-de-Calais</region><settlement type="city">Lille</settlement></placeName></affiliation></author><author><name sortKey="Vinatier, Denis" sort="Vinatier, Denis" uniqKey="Vinatier D" first="Denis" last="Vinatier">Denis Vinatier</name><affiliation wicri:level="3"><nlm:aff id="A1">Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France.</nlm:aff><country xml:lang="fr" wicri:curation="lc">France</country><wicri:regionArea>Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille</wicri:regionArea><placeName><region type="region">Hauts-de-France</region><region type="old region">Nord-Pas-de-Calais</region><settlement type="city">Lille</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="A2">University of Lille-Nord-de-France, Lille, France.</nlm:aff><country xml:lang="fr" wicri:curation="lc">France</country><wicri:regionArea>University of Lille-Nord-de-France, Lille</wicri:regionArea><placeName><region type="region">Hauts-de-France</region><region type="old region">Nord-Pas-de-Calais</region><settlement type="city">Lille</settlement></placeName></affiliation></author><author><name sortKey="Kerdraon, Olivier" sort="Kerdraon, Olivier" uniqKey="Kerdraon O" first="Olivier" last="Kerdraon">Olivier Kerdraon</name><affiliation wicri:level="3"><nlm:aff id="A3">Department of Anatomopathology, University Hospital of Lille, Lille, France.</nlm:aff><country xml:lang="fr" wicri:curation="lc">France</country><wicri:regionArea>Department of Anatomopathology, University Hospital of Lille, Lille</wicri:regionArea><placeName><region type="region">Hauts-de-France</region><region type="old region">Nord-Pas-de-Calais</region><settlement type="city">Lille</settlement></placeName></affiliation></author><author><name sortKey="Collinet, Pierre" sort="Collinet, Pierre" uniqKey="Collinet P" first="Pierre" last="Collinet">Pierre Collinet</name><affiliation wicri:level="3"><nlm:aff id="A1">Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France.</nlm:aff><country xml:lang="fr" wicri:curation="lc">France</country><wicri:regionArea>Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille</wicri:regionArea><placeName><region type="region">Hauts-de-France</region><region type="old region">Nord-Pas-de-Calais</region><settlement type="city">Lille</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="A2">University of Lille-Nord-de-France, Lille, France.</nlm:aff><country xml:lang="fr" wicri:curation="lc">France</country><wicri:regionArea>University of Lille-Nord-de-France, Lille</wicri:regionArea><placeName><region type="region">Hauts-de-France</region><region type="old region">Nord-Pas-de-Calais</region><settlement type="city">Lille</settlement></placeName></affiliation></author></analytic><series><title level="j">Journal of Gynecologic Oncology</title><idno type="ISSN">2005-0380</idno><idno type="eISSN">2005-0399</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objective</title><p>Since European Society for Medical Oncology (ESMO) recommendations and French guidelines, pelvic lymphadenectomy should not be systematically performed for women with early-stage endometrioid endometrial cancer (EEC) preoperatively assessed at presumed low- or intermediate-risk. The aim of our study was to evaluate the change of our surgical practices after ESMO recommendations, and to evaluate the rate and morbidity of second surgical procedure in case of understaging after the first surgery.</p></sec><sec><title>Methods</title><p>This retrospective single-center study included women with EEC preoperatively assessed at presumed low- or intermediate-risk who had surgery between 2006 and 2013. Two periods were defined the times before and after ESMO recommendations. Demographics characteristics, surgical management, operative morbidity, and rate of understaging were compared. The rate of second surgical procedure required for lymph node resection during the second period and its morbidity were also studied.</p></sec><sec><title>Results</title><p>Sixty-one and sixty-two patients were operated for EEC preoperatively assessed at presumed low-or intermediate-risk before and after ESMO recommendations, respectively. Although immediate pelvic lymphadenectomy was performed more frequently during the first period than the second period (88.5% vs. 19.4%; p<0.001), the rate of postoperative risk-elevating or upstaging were comparable between the two periods (31.1% vs. 27.4%; p=0.71). Among the patients requiring second surgical procedure during the second period (21.0%), 30.8% did not undergo the second surgery due to their comorbidity or old age. For the patients who underwent second surgical procedure, mean operative time of the second procedure was 246.1±117.8 minutes. Third operation was required in 33.3% of them because of postoperative complications.</p></sec><sec><title>Conclusion</title><p>Since ESMO recommendations, second surgical procedure for lymph node resection is often required for women with EEC presumed at low- or intermediate-risk. This reoperation is not always performed due to age/comorbidity of the patients, and presents a significant morbidity.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Siegel, R" uniqKey="Siegel R">R Siegel</name></author><author><name sortKey="Naishadham, D" uniqKey="Naishadham D">D Naishadham</name></author><author><name sortKey="Jemal, A" uniqKey="Jemal A">A Jemal</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Creasman, Wt" uniqKey="Creasman W">WT Creasman</name></author><author><name sortKey="Odicino, F" uniqKey="Odicino F">F Odicino</name></author><author><name sortKey="Maisonneuve, P" uniqKey="Maisonneuve P">P Maisonneuve</name></author><author><name sortKey="Quinn, Ma" uniqKey="Quinn M">MA Quinn</name></author><author><name sortKey="Beller, U" uniqKey="Beller U">U Beller</name></author><author><name sortKey="Benedet, Jl" uniqKey="Benedet J">JL 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sortKey="Lee, Ih" uniqKey="Lee I">IH Lee</name></author><author><name sortKey="Kim, Tj" uniqKey="Kim T">TJ Kim</name></author><author><name sortKey="Lee, Kh" uniqKey="Lee K">KH Lee</name></author><author><name sortKey="Shim, Ju" uniqKey="Shim J">JU Shim</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Bendifallah, S" uniqKey="Bendifallah S">S Bendifallah</name></author><author><name sortKey="Canlorbe, G" uniqKey="Canlorbe G">G Canlorbe</name></author><author><name sortKey="Huguet, F" uniqKey="Huguet F">F Huguet</name></author><author><name sortKey="Coutant, C" uniqKey="Coutant C">C Coutant</name></author><author><name sortKey="Hudry, D" uniqKey="Hudry D">D Hudry</name></author><author><name sortKey="Graesslin, O" uniqKey="Graesslin O">O Graesslin</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>France</li></country><region><li>Hauts-de-France</li><li>Nord-Pas-de-Calais</li></region><settlement><li>Lille</li></settlement></list><tree><country name="France"><region name="Hauts-de-France"><name sortKey="Arsene, Emmanuelle" sort="Arsene, Emmanuelle" uniqKey="Arsene E" first="Emmanuelle" last="Arsène">Emmanuelle Arsène</name></region><name sortKey="Bleu, Geraldine" sort="Bleu, Geraldine" uniqKey="Bleu G" first="Géraldine" last="Bleu">Géraldine Bleu</name><name sortKey="Boulanger, Loic" sort="Boulanger, Loic" uniqKey="Boulanger L" first="Loïc" last="Boulanger">Loïc Boulanger</name><name sortKey="Collinet, Pierre" sort="Collinet, Pierre" uniqKey="Collinet P" first="Pierre" last="Collinet">Pierre Collinet</name><name sortKey="Collinet, Pierre" sort="Collinet, Pierre" uniqKey="Collinet P" first="Pierre" last="Collinet">Pierre Collinet</name><name sortKey="Kerdraon, Olivier" sort="Kerdraon, Olivier" uniqKey="Kerdraon O" first="Olivier" last="Kerdraon">Olivier Kerdraon</name><name sortKey="Merlot, Benjamin" sort="Merlot, Benjamin" uniqKey="Merlot B" first="Benjamin" last="Merlot">Benjamin Merlot</name><name sortKey="Vinatier, Denis" sort="Vinatier, Denis" uniqKey="Vinatier D" first="Denis" last="Vinatier">Denis Vinatier</name><name sortKey="Vinatier, Denis" sort="Vinatier, Denis" uniqKey="Vinatier D" first="Denis" last="Vinatier">Denis Vinatier</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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