Top

Published in:

01-03-2017 | Review Article

Fertility sparing surgery for stage IA type I and G2 endometrial cancer in reproductive-aged patients: evidence-based approach and future perspectives

Authors: Salvatore Giovanni Vitale, Diego Rossetti, Alessandro Tropea, Antonio Biondi, Antonio Simone Laganà

Published in: Updates in Surgery | Issue 1/2017

Abstract

Fertility-sparing surgery (FSS) in reproductive-age patients affected by endometrial cancer (EC) gained growing attention in the last decade, although the first reports were already published in 1990–2000s. Nevertheless, only few patients undergoing FSS for stage I, type I EC had been reported in each case series, without a robust multicenter study. In the available literature there are even fewer reported cases of conservative treatment of Stage IA and G2 EC. Considering these important gaps in our current knowledge, the purpose of this review was to summarize the available evidence about conservative treatments for stage IA type I and G2 EC, to improve the pretreatment counseling for reproductive-age patients. According to our overview, women who have low-risk disease (G1 or G2, endometrioid histotype confined to the endometrium) are candidates for progestin therapy. In addition, FSS could be considered a valid option for reproductive-aged patients with stage IA type I and G2 EC. Nevertheless, we solicit new trials to clarify the medium- and long-term outcomes in this kind of patients.

Vitale SG, Valenti G, La Rosa VL, Laganà AS (2016) Comment on “Laparoscopic myomectomy of a symptomatic uterine leiomyoma in a 15-year-old adolescent”. J Pediatr Adolesc Gynecol. doi:10.1016/j.jpag.2016.11.013 PubMed

Vitale SG, Gasbarro N, Lagana AS et al (2016) Safe introduction of ancillary trocars in gynecological surgery: the “yellow island” anatomical landmark. Ann Ital Chir 87:608–611PubMed

Giacobbe V, Rossetti D, Vitale SG et al (2016) Otorrhagia and nosebleed as first signs of intravascular absorption syndrome during hysteroscopy: from bench to bedside. Kathmandu Univ Med J 14:87–89

Laganà AS, Vitale SG, Palmara V et al (2016) Transvaginal specimen removal in minimally invasive surgery: feasibility and possible complications during the incision of the posterior vaginal wall. World J Urol. doi:10.1007/s00345-016-1955-7

Butticè S, Sener TE, Lucan VC et al (2016) Hybrid transvaginal NOTES nephrectomy: postoperative sexual outcomes. A three-center matched study. Urology 99:131–135. doi:10.1016/j.urology.2016.09.023 CrossRefPubMed

Laganà AS, Vitale SG, Trovato MA et al (2016) Full-thickness excision versus shaving by laparoscopy for intestinal deep infiltrating endometriosis: rationale and potential treatment options. Biomed Res Int 2016:3617179. doi:10.1155/2016/3617179 CrossRefPubMedPubMedCentral

Lagana AS, Vitale SG, De Dominici R et al (2016) Fertility outcome after laparoscopic salpingostomy or salpingectomy for tubal ectopic pregnancy A 12-years retrospective cohort study. Ann Ital Chir 87:461–465PubMed

Laganà AS, Sapia F, Butticè S et al (2016) Comment on “efficacy and safety of skeletonized mesh implants for advanced pelvic organ prolapse: 12 month follow up”. World J Urol 34:1499–1500. doi:10.1007/s00345-016-1858-7 CrossRefPubMed

Laganà AS, Sofo V, Salmeri FM et al (2016) Oxidative stress during ovarian torsion in pediatric and adolescent patients: changing the perspective of the disease. Int J Fertil Steril 9:416–423PubMed

10.

Vitale SG, Laganà AS, Rapisarda AM (2016) Letter to the editor: comment on “Simultaneous treatment of anterior vaginal wall prolapse and stress urinary incontinence by using transobturator four arms polypropylene mesh”. Investig Clin Urol 57:150–151. doi:10.4111/icu.2016.57.2.150 CrossRefPubMedPubMedCentral

11.

Vitale SG, Laganà AS, Gulino FA et al (2016) Prosthetic surgery versus native tissue repair of cystocele: literature review. Updates Surg 68:325–329. doi:10.1007/s13304-015-0343-y CrossRefPubMed

12.

Laganà AS, Santoro G, Triolo O et al (2015) Hashimoto thyroiditis onset after laparoscopic removal of struma ovarii: an overview to unravel a rare and intriguing finding. Clin Exp Obstet Gynecol 42:673–678PubMed

13.

Ciancimino L, Laganà AS, Imbesi G et al (2015) Evaluation of maternal-fetal outcomes after emergency vaginal cerclage performed with Shirodkar–McDonald combined modified technique. J Clin Med Res 7:319–323. doi:10.14740/jocmr2108w CrossRefPubMedPubMedCentral

14.

Laganà AS, Colonese F, Colonese E et al (2015) Cytogenetic analysis of epithelial ovarian cancer’s stem cells: an overview on new diagnostic and therapeutic perspectives. Eur J Gynaecol Oncol 36:495–505PubMed

15.

Bellia A, Vitale SG, Laganà AS et al (2016) Feasibility and surgical outcomes of conventional and robot-assisted laparoscopy for early-stage ovarian cancer: a retrospective, multicenter analysis. Arch Gynecol Obstet 294:615–622. doi:10.1007/s00404-016-4087-9 CrossRefPubMed

16.

Vitale SG, Marilli I, Lodato M et al (2013) The role of cytoreductive surgery in advanced-stage ovarian cancer: a systematic review. Updates Surg 65:265–270. doi:10.1007/s13304-013-0213-4 CrossRefPubMed

17.

Rossetti D, Vitale SG, Gulino FA et al (2016) Laparoendoscopic single-site surgery for the assessment of peritoneal carcinomatosis resectability in patients with advanced ovarian cancer. Eur J Gynaecol Oncol 37:671–673. doi:10.12892/ejgo3234.2016

18.

Vitale SG, Valenti G, Gulino FA et al (2016) Surgical treatment of high stage endometrial cancer: current perspectives. Updates Surg 68:149–154. doi:10.1007/s13304-015-0340-1 CrossRefPubMed

19.

Rossetti D, Bogani G, Carnelli M et al (2014) Efficacy of IVF following conservative management of endometrial cancer. Gynecol Endocrinol 30:280–281. doi:10.3109/09513590.2014.892065 CrossRefPubMed

20.

Rossetti D, Vitale SG, Gulino FA et al (2016) Concomitant chemoradiation treatment in selected Stage I endometrioid endometrial cancers. Eur J Gynaecol Oncol 37:657–661. doi:10.12892/ejgo3125.2016

21.

Bentivegna E, Gouy S, Maulard A et al (2016) Oncological outcomes after fertility-sparing surgery for cervical cancer: a systematic review. Lancet Oncol 17:e240–e253. doi:10.1016/S1470-2045(16)30032-8 CrossRefPubMed

22.

de Hullu JA, van der Avoort IA, Oonk MH, van der Zee AG (2006) Management of vulvar cancers. Eur J Surg Oncol 32:825–831. doi:10.1016/j.ejso.2006.03.035 CrossRefPubMed

23.

Vitale SG, Valenti G, Biondi A et al (2015) Recent trends in surgical and reconstructive management of vulvar cancer: review of literature. Updates Surg 67:367–371. doi:10.1007/s13304-015-0303-6 CrossRefPubMed

24.

Laganà AS, La Rosa V, Petrosino B, Vitale SG (2017) Comment on “Risk of developing major depression and anxiety disorders among women with endometriosis: a longitudinal follow-up study”. J Affect Disord 208:672–673. doi:10.1016/j.jad.2016.07.016 CrossRefPubMed

25.

Vitale SG, La Rosa VL, Rapisarda AM, Laganà AS (2017) Comment on: “Impact of endometriosis on quality of life and mental health: pelvic pain makes the difference”. J Psychosom Obstet Gynecol 38:81–82. doi:10.1080/0167482X.2016.1244183 CrossRef

26.

Vitale SG, La Rosa VL, Rapisarda AM, Laganà AS (2016) Impact of endometriosis on quality of life and psychological well-being. J Psychosom Obstet Gynecol. doi:10.1080/0167482X.2016.1244185

27.

Laganà AS, La Rosa VL, Rapisarda AM, Vitale S (2017) Comment on: “Needs and priorities of women with endometrial and cervical cancer”. J Psychosom Obstet Gynecol 38:85–86. doi:10.1080/0167482X.2016.1244186 CrossRef

28.

Vitale SG, La Rosa VL, Rapisarda AM, Laganà AS (2017) Comment on: “Anxiety and depression in patients with advanced ovarian cancer: a prospective study”. J Psychosom Obstet Gynecol 38:83–84. doi:10.1080/0167482X.2016.1244182 CrossRef

29.

Vitale SG, La Rosa VL, Rapisarda AM, Laganà AS (2017) Psychology of infertility and assisted reproductive treatment: the Italian situation. J Psychosom Obstet Gynecol 38:1–3. doi:10.1080/0167482X.2016.1244184 CrossRef

30.

Vitale SG, Petrosino B, La Rosa VL, Laganà AS (2016) Comment on “Differences in psychophysical well-being and signs of depression in couples undergoing their first consultation for assisted reproduction technology (ART): an Italian pilot study”. Eur J Obstet Gynecol Reprod Biol. doi:10.1016/j.ejogrb.2016.10.029 PubMed

31.

Laganà AS, La Rosa VL, Rapisarda AM, Vitale SG (2017) Comment on: “Effect on sexual function of patients and patients’ spouses after midurethal sling procedure for stress urinary incontinence: a prospective single center study”. Low Urin Tract Symptoms 9:62. doi:10.1111/luts.12164 CrossRefPubMed

32.

Vitale SG, Petrosino B, La Rosa VL et al (2016) A systematic review of the association between psychiatric disturbances and endometriosis. J Obstet Gynaecol Canada 38:1079–1080. doi:10.1016/j.jogc.2016.09.008 CrossRef

33.

Muscatello MR, Lorusso S, Bruno A et al (2016) Anger in women treated with assisted reproductive technology (ART): effects on mother and newborn. J Matern Fetal Neonatal Med 29:813–817. doi:10.3109/14767058.2015.1019459 CrossRefPubMed

34.

Laganà AS, Condemi I, Retto G et al (2015) Analysis of psychopathological comorbidity behind the common symptoms and signs of endometriosis. Eur J Obstet Gynecol Reprod Biol 194:30–33. doi:10.1016/j.ejogrb.2015.08.015 CrossRefPubMed

35.

Randall TC, Kurman RJ (1997) Progestin treatment of atypical hyperplasia and well-differentiated carcinoma of the endometrium in women under age 40. Obstet Gynecol 90:434–440CrossRefPubMed

36.

Koskas M, Azria E, Walker F et al (2012) Progestin treatment of atypical hyperplasia and well-differentiated adenocarcinoma of the endometrium to preserve fertility. Anticancer Res 32:1037–1043PubMed

37.

Rodolakis A, Biliatis I, Morice P et al (2015) European society of gynecological oncology task force for fertility preservation: clinical recommendations for fertility-sparing management in young endometrial cancer patients. Int J Gynecol Cancer 25:1258–1265. doi:10.1097/IGC.0000000000000493 CrossRefPubMed

38.

Kaku T, Yoshikawa H, Tsuda H et al (2001) Conservative therapy for adenocarcinoma and atypical endometrial hyperplasia of the endometrium in young women: central pathologic review and treatment outcome. Cancer Lett 167:39–48CrossRefPubMed

39.

Falcone F, Laurelli G, Losito S et al (2017) Fertility preserving treatment with hysteroscopic resection followed by progestin therapy in young women with early endometrial cancer. J Gynecol Oncol 28:e2. doi:10.3802/jgo.2017.28.e2 CrossRefPubMed

40.

Gallos ID, Yap J, Rajkhowa M, et al (2012) Regression, relapse, and live birth rates with fertility-sparing therapy for endometrial cancer and atypical complex endometrial hyperplasia: a systematic review and metaanalysis. Am J Obstet Gynecol 207:266.e1–266.e12. doi:10.1016/j.ajog.2012.08.011

41.

Duska LR, Garrett A, Rueda BR et al (2001) Endometrial cancer in women 40 years old or younger. Gynecol Oncol 83:388–393. doi:10.1006/gyno.2001.6434 CrossRefPubMed

42.

Leitao MM, Kehoe S, Barakat RR et al (2008) Accuracy of preoperative endometrial sampling diagnosis of FIGO grade 1 endometrial adenocarcinoma. Gynecol Oncol 111:244–248. doi:10.1016/j.ygyno.2008.07.033 CrossRefPubMed

43.

Daniel AG, Peters WA (1988) Accuracy of office and operating room curettage in the grading of endometrial carcinoma. Obstet Gynecol 71:612–614PubMed

44.

Ushijima K, Yahata H, Yoshikawa H et al (2007) Multicenter phase II study of fertility-sparing treatment with medroxyprogesterone acetate for endometrial carcinoma and atypical hyperplasia in young women. J Clin Oncol 25:2798–2803. doi:10.1200/JCO.2006.08.8344 CrossRefPubMed

45.

Eltabbakh GH, Shamonki J, Mount SL (2005) Surgical stage, final grade, and survival of women with endometrial carcinoma whose preoperative endometrial biopsy shows well-differentiated tumors. Gynecol Oncol 99:309–312. doi:10.1016/j.ygyno.2005.06.010 CrossRefPubMed

46.

Kinkel K, Kaji Y, Yu KK et al (1999) Radiologic staging in patients with endometrial cancer: a meta-analysis. Radiology 212:711–718. doi:10.1148/radiology.212.3.r99au29711 CrossRefPubMed

47.

Dhar KK, NeedhiRajan T, Koslowski M, Woolas RP (2005) Is levonorgestrel intrauterine system effective for treatment of early endometrial cancer? Report of four cases and review of the literature. Gynecol Oncol 97:924–927. doi:10.1016/j.ygyno.2004.10.031 CrossRefPubMed

48.

Wang Q, Guo Q, Gao S et al (2015) Fertility-conservation combined therapy with hysteroscopic resection and oral progesterone for local early stage endometrial carcinoma in young women. Int J Clin Exp Med 8:13804–13810PubMedPubMedCentral

49.

Vetvicka V, Laganà AS, Salmeri FM et al (2016) Regulation of apoptotic pathways during endometriosis: from the molecular basis to the future perspectives. Arch Gynecol Obstet 294:897–904. doi:10.1007/s00404-016-4195-6 CrossRefPubMed

50.

Laganà AS, Salmeri FM, Triolo O et al (2016) Comments on “rhTNFR: Fc suppresses the development of endometriosis in a mouse model by downregulating cell proliferation and invasiveness”. Reprod Sci. doi:10.1177/1933719116653838 PubMed

51.

Maniglio P, Ricciardi E, Laganà AS et al (2016) Epigenetic modifications of primordial reproductive tract: a common etiologic pathway for Mayer-Rokitansky-Kuster-Hauser Syndrome and endometriosis? Med Hypotheses 90:4–5. doi:10.1016/j.mehy.2016.02.015 CrossRefPubMed

52.

Laganà AS, Triolo O, Salmeri FM et al (2016) Natural Killer T cell subsets in eutopic and ectopic endometrium: a fresh look to a busy corner. Arch Gynecol Obstet 293:941–949. doi:10.1007/s00404-015-4004-7 CrossRefPubMed

53.

Sofo V, Götte M, Laganà AS et al (2015) Correlation between dioxin and endometriosis: an epigenetic route to unravel the pathogenesis of the disease. Arch Gynecol Obstet 292:973–986. doi:10.1007/s00404-015-3739-5 CrossRefPubMed

54.

Salmeri FM, Laganà AS, Sofo V et al (2015) Behavior of tumor necrosis factor-α and tumor necrosis factor receptor 1/tumor necrosis factor receptor 2 system in mononuclear cells recovered from peritoneal fluid of women with endometriosis at different stages. Reprod Sci 22:165–172. doi:10.1177/1933719114536472 CrossRefPubMedPubMedCentral

55.

Sturlese E, Salmeri FM, Retto G et al (2011) Dysregulation of the Fas/FasL system in mononuclear cells recovered from peritoneal fluid of women with endometriosis. J Reprod Immunol 92:74–81. doi:10.1016/j.jri.2011.08.005 CrossRefPubMed

56.

Laganà AS, Giacobbe V, Triolo O et al (2016) Dienogest as preoperative treatment of submucous myomas for hysteroscopic surgery: a prospective, randomized study. Gynecol Endocrinol 32:408–411. doi:10.3109/09513590.2015.1128409 CrossRefPubMed

57.

Laganà AS, Palmara V, Granese R et al (2014) Desogestrel versus danazol as preoperative treatment for hysteroscopic surgery: a prospective, randomized evaluation. Gynecol Endocrinol 30:794–797. doi:10.3109/09513590.2014.929658 CrossRefPubMed

58.

Laganà AS, Vitale SG, Muscia V et al (2016) Endometrial preparation with Dienogest before hysteroscopic surgery: a systematic review. Arch Gynecol Obstet. doi:10.1007/s00404-016-4244-1

59.

Gunderson CC, Fader AN, Carson KA, Bristow RE (2012) Oncologic and Reproductive outcomes with progestin therapy in women with endometrial hyperplasia and grade 1 Adenocarcinoma: a systematic review. Gynecol Oncol 125:477–482. doi:10.1016/j.ygyno.2012.01.003 CrossRefPubMed

60.

Montz FJ, Bristow RE, Bovicelli A et al (2002) Intrauterine progesterone treatment of early endometrial cancer. Am J Obstet Gynecol 186:651–657CrossRefPubMed

61.

Thigpen JT, Brady MF, Alvarez RD et al (1999) Oral medroxyprogesterone acetate in the treatment of advanced or recurrent endometrial carcinoma: a dose-response study by the Gynecologic Oncology Group. J Clin Oncol 17:1736–1744. doi:10.1200/jco.1999.17.6.1736 CrossRefPubMed

62.

Eftekhar Z, Izadi-Mood N, Yarandi F et al (2009) Efficacy of megestrol acetate (megace) in the treatment of patients with early endometrial adenocarcinoma: our experiences with 21 patients. Int J Gynecol Cancer 19:249–252. doi:10.1111/IGC.0b013e31819c5372 CrossRefPubMed

63.

Kalogera E, Dowdy SC, Bakkum-Gamez JN (2014) Preserving fertility in young patients with endometrial cancer: current perspectives. Int J Womens Health 6:691–701. doi:10.2147/IJWH.S47232 PubMedPubMedCentral

64.

Park JY, Kim DY, Kim JH et al (2013) Long-term oncologic outcomes after fertility-sparing management using oral progestin for young women with endometrial cancer (KGOG 2002). Eur J Cancer 49:868–874. doi:10.1016/j.ejca.2012.09.017 CrossRefPubMed

65.

Park JY, Lee SH, Seong SJ et al (2013) Progestin re-treatment in patients with recurrent endometrial adenocarcinoma after successful fertility-sparing management using progestin. Gynecol Oncol 129:7–11. doi:10.1016/j.ygyno.2012.12.037 CrossRefPubMed

66.

AlHilli MM, Mariani A, Bakkum-Gamez JN et al (2014) Risk-scoring models for individualized prediction of overall survival in low-grade and high-grade endometrial cancer. Gynecol Oncol 133:485–493. doi:10.1016/j.ygyno.2014.03.567 CrossRefPubMedPubMedCentral

67.

De Angelis C, Carnevale A, Santoro G et al (2013) Hysteroscopic findings in women with menorrhagia. J Minim Invasive Gynecol 20:209–214. doi:10.1016/j.jmig.2012.10.009 CrossRefPubMed

68.

Ianieri MM, Staniscia T, Pontrelli G et al (2016) A new hysteroscopic risk scoring system for diagnosing endometrial hyperplasia and adenocarcinoma. J Minim Invasive Gynecol 23:712–718. doi:10.1016/j.jmig.2016.02.017 CrossRefPubMed

69.

Han AR, Kwon Y-S, Kim DY et al (2009) Pregnancy outcomes using assisted reproductive technology after fertility-preserving therapy in patients with endometrial adenocarcinoma or atypical complex hyperplasia. Int J Gynecol Cancer 19:147–151. doi:10.1111/IGC.0b013e31819960ba CrossRefPubMed

70.

Kim SM, Shin SJ, Bae JG et al (2016) Endometrial adenocarcinoma in a 13-year-old girl. Obstet Gynecol Sci 59:152–156. doi:10.5468/ogs.2016.59.2.152 CrossRefPubMedPubMedCentral

Title: Fertility sparing surgery for stage IA type I and G2 endometrial cancer in reproductive-aged patients: evidence-based approach and future perspectives
Authors: Salvatore Giovanni Vitale
Diego Rossetti
Alessandro Tropea
Antonio Biondi
Antonio Simone Laganà
Publication date: 01-03-2017
Publisher: Springer Milan
Published in: Updates in Surgery / Issue 1/2017
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI: https://doi.org/10.1007/s13304-017-0419-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Fertility sparing surgery for stage IA type I and G2 endometrial cancer in reproductive-aged patients: evidence-based approach and future perspectives

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2017

Composite mesh and gluteal fasciocutaneous rotation flap for perineal hernia repair after abdominoperineal resection: a novel technique

Sleeve gastrectomy leads to easy management of hormone replacement therapy and good weight loss in patients treated for craniopharyngioma

All that glitters are not gold! Reactive lymphoid hyperplasia mimicking colorectal liver metastases: description of a case and literature review

Risk factors for postoperative complications in robotic general surgery

Phrenic nerve stimulation during neck dissection for advanced thyroid cancer involving level IV: is it worth doing it?

A systematic review of clinical effectiveness of wound edge protector devices in reducing surgical site infections in patients undergoing abdominal surgery