Tomohito Tanaka1, Suguru Yamashita2, Haruo Kuroboshi2, Junya Kamibayashi3, Atsushi Sugiura3, Kaori Yoriki4, Taisuke Mori4, Kazuharu Tanaka5, Aiko Nagashima5, Michihide Maeda6, Shoji Kamiura6, Yukako Mizuno7, Noriko Ohtake7, Tomoyuki Ichimura8, Taiki Kikuchi8, Yuri Nobuta9, Tsukuru Amano9, Noriomi Matsumura10, Hidekatsu Nakai10, Eiji Kobayashi11, Yuji Kamei11, Masayo Ukita12, Junzo Hamanishi12, Junya Hirayama13, Yasushi Mabuchi13, Seiko Kato14, Hiroyuki Fujita14, Atsuko Kiyota15, Shinsuke Koyama15, Yosuke Fukui16, Mai Kimura16, Ryosuke Takahashi17, Yoshito Terai17, Madoka Suruga18, Masaru Kawanishi18, Kazuhiro Nishioka19, Masahide Ohmichi20. 1. Department of Obstetrics and Gynecology, Educational Foundation of Osaka Medical and Pharmaceutical University, 2-7, Daigakumachi, Takatsuki, Osaka, 569-8686, Japan. tomohito.tanaka@ompu.ac.jp. 2. Department of Obstetrics and Gynecology, North Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan. 3. Department of Obstetrics and Gynecology, Nara Prefecture General Medical Center, Nara, Japan. 4. Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan. 5. Department of Obstetrics and Gynecology, Izumiotsu Municipal Hospital, Izumiotsu, Japan. 6. Department of Gynecology, Osaka International Cancer Institute, Osaka, Japan. 7. Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital, Kobe, Japan. 8. Department of Obstetrics and Gynecology, Osaka City University, Osaka, Japan. 9. Department of Obstetrics and Gynecology, Shiga University of Medical Science, Ōtsu, Japan. 10. Department of Obstetrics and Gynecology, Kindai University, Higashiosaka, Japan. 11. Department of Obstetrics and Gynecology, Osaka University, Osaka, Japan. 12. Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan. 13. Department of Obstetrics and Gynecology, Wakayama Medical University, Wakayama, Japan. 14. Department of Obstetrics and Gynecology, Kyoto Second Red Cross Hospital, Kyoto, Japan. 15. Department of Obstetrics and Gynecology, Osaka Police Hospital, Osaka, Japan. 16. Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan. 17. Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan. 18. Department of Obstetrics and Gynecology, Osaka City General Hospital, Osaka, Japan. 19. Department of Obstetrics and Gynecology, Kindai University Nara Hospital, Ikoma, Japan. 20. Department of Obstetrics and Gynecology, Educational Foundation of Osaka Medical and Pharmaceutical University, 2-7, Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
Abstract
BACKGROUND: The goal of this study is to assess the oncologic outcomes of elderly patients who underwent hysterectomy for endometrial cancer across three variables: hysterectomy approach, lymph node resection, and adjuvant therapy. METHODS: Hospital records of patients aged ≥ 70 years who underwent hysterectomy for endometrial cancer were obtained from 19 institutions. Patients were categorized into three risk groups: low, intermediate, and high. In each group, disease-free survival and overall survival were compared according to hysterectomy approach, lymph node resection, and adjuvant therapy using Kaplan-Meier method. Cox regression analysis with a 95% confidence interval was performed to estimate relative risk (RR) of death. RESULTS: A total of 1246 patients were included. In the low-risk group, the adjusted RR for death for minimally invasive surgery (MIS) versus laparotomy and lymph node resection versus no lymph node resection were 0.64 (0.24-1.72) and 0.52 (0.24-1.12), respectively. In the intermediate-risk group, the adjusted RR for death for MIS versus laparotomy, lymph node resection versus no lymph node resection, and adjuvant therapy versus no adjuvant therapy were 0.80 (0.36-1.77), 0.60 (0.37-0.98), and 0.89 (0.55-1.46), respectively. In the high-risk group, the adjusted RRs for death for lymph node resection versus no lymph node resection and adjuvant therapy versus no adjuvant therapy were 0.56 (0.37-0.86) and 0.60 (0.38-0.96), respectively. CONCLUSIONS: MIS is not inferior to laparotomy in uterine-confined diseases. Lymph node resection improved the outcome for all disease stages and histological types. In contrast, adjuvant therapy improved the outcomes only in high-risk patients.
BACKGROUND: The goal of this study is to assess the oncologic outcomes of elderly patients who underwent hysterectomy for endometrial cancer across three variables: hysterectomy approach, lymph node resection, and adjuvant therapy. METHODS: Hospital records of patients aged ≥ 70 years who underwent hysterectomy for endometrial cancer were obtained from 19 institutions. Patients were categorized into three risk groups: low, intermediate, and high. In each group, disease-free survival and overall survival were compared according to hysterectomy approach, lymph node resection, and adjuvant therapy using Kaplan-Meier method. Cox regression analysis with a 95% confidence interval was performed to estimate relative risk (RR) of death. RESULTS: A total of 1246 patients were included. In the low-risk group, the adjusted RR for death for minimally invasive surgery (MIS) versus laparotomy and lymph node resection versus no lymph node resection were 0.64 (0.24-1.72) and 0.52 (0.24-1.12), respectively. In the intermediate-risk group, the adjusted RR for death for MIS versus laparotomy, lymph node resection versus no lymph node resection, and adjuvant therapy versus no adjuvant therapy were 0.80 (0.36-1.77), 0.60 (0.37-0.98), and 0.89 (0.55-1.46), respectively. In the high-risk group, the adjusted RRs for death for lymph node resection versus no lymph node resection and adjuvant therapy versus no adjuvant therapy were 0.56 (0.37-0.86) and 0.60 (0.38-0.96), respectively. CONCLUSIONS: MIS is not inferior to laparotomy in uterine-confined diseases. Lymph node resection improved the outcome for all disease stages and histological types. In contrast, adjuvant therapy improved the outcomes only in high-risk patients.
Authors: Gun Min Kim; Joong Bae Ahn; Sun Young Rha; Han Sang Kim; Beodeul Kang; Min Whan Kim; Soo Yeon Choi; Jae Kyung Roh; Hyun Cheol Chung; Nam Kyu Kim; Sang Joon Shin Journal: Asia Pac J Clin Oncol Date: 2012-12-21 Impact factor: 2.601
Authors: Joan L Walker; Marion R Piedmonte; Nick M Spirtos; Scott M Eisenkop; John B Schlaerth; Robert S Mannel; Richard Barakat; Michael L Pearl; Sudarshan K Sharma Journal: J Clin Oncol Date: 2012-01-30 Impact factor: 44.544
Authors: Leslie H Clark; Amanda L Jackson; Paola A Gehrig; Victoria Bae-Jump; Linda Van Le; Emily M Ko Journal: Int J Gynecol Cancer Date: 2016-02 Impact factor: 3.437
Authors: A Rousselin; S Bendifallah; K Nyangoh Timoh; L Ouldamer; G Canlorbe; E Raimond; N Hudry; C Coutant; O Graesslin; C Touboul; P Collinet; A Bricou; C Huchon; E Daraï; M Ballester; J Levêque; V Lavoue Journal: Eur J Surg Oncol Date: 2017-08-09 Impact factor: 4.424
Authors: Joan L Walker; Marion R Piedmonte; Nick M Spirtos; Scott M Eisenkop; John B Schlaerth; Robert S Mannel; Gregory Spiegel; Richard Barakat; Michael L Pearl; Sudarshan K Sharma Journal: J Clin Oncol Date: 2009-10-05 Impact factor: 44.544