April 9th, 2020

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Lower Uterine Segment Involvement Is a Prognostic Factor for Recurrence in Endometrial Cancer: A Study of Patient Cohort Treated with Open and Minimally Invasive Surgery
Authors:  Eav K. Lim, D.O., Okechukwu Ibeanu, M.D., M.P.H., Tani Malhotra, M.D., Derek Liang, D.O., and Mark A. Miller, D.O.
  OBJECTIVE: To determine whether lower uterine seg­ ment involvement is associated with an increased risk of recurrence in endometrial cancer.

STUDY DESIGN: Case­ controlled retrospective re­view of patients with endo­metrioid adenocarcinoma of the endometrium. Recurrence rates in patients with lower uterine segment involvement (LUSI) were compared to those without LUSI. Patients were stratified to disease stage, recurrence, mode of surgery, and history of ce­sarean delivery. Pearson’s χ2 test was used to compare populations, and multivariate analysis was performed using a logistic regression model.

RESULTS: Complete medical records were available for 469 patients. Of those, 230 patients had lower uterine segment involvement and 239 patients did not. A total of 221 underwent laparotomies as compared to 248 who underwent minimally invasive approach. Twenty­ three patients in stage I and 27 with advanced stage had recurrence. In 91 patients with advanced stage, 69 had LUSI (p<0.001). Laparotomy patients had more association with LUSI as compared to laparoscopy/ robotic (p=0.049). However, patients with LUSI under­ going laparoscopy robotics had higher recurrence (p=0.026). There was no cor­ relation between history of cesarean delivery and risk for development of LUSI (p=0.731).

CONCLUSION: Lower uterine segment involve­ment is associated with risk of recurrence in patients with stage IA endometrioid adenocarcinoma of the endo­metrium and laparoscopic/ robotic approach.
Keywords:  cesarean section, endometrial cancer, gynecologic surgical procedures, hysterectomy, laparoscopy, neoplasm recurrence, robotic surgical procedures, uterine cancer
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