IMR Press / EJGO / Volume 35 / Issue 1 / DOI: 10.12892/ejgo23202014

European Journal of Gynaecological Oncology (EJGO) is published by IMR Press from Volume 40 Issue 1 (2019). Previous articles were published by another publisher on a subscription basis, and they are hosted by IMR Press on as a courtesy and upon agreement with S.O.G.

Original Research
The prognostic significance of lymphovascular space invasion in laparoscopic versus abdominal hysterectomy for endometrioid endometrial cancer
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1 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology
1 Washington University School of Medicine and Siteman Cancer Center, St. Louis, MO
2 Department of Pathology and Immunology, Washington University School of Medicine and Siteman Cancer Center, St. Louis, MO
3 Division of Biostatistics, Washington University School of Medicine and Siteman Cancer Center, St. Louis, MO (USA)
Eur. J. Gynaecol. Oncol. 2014, 35(1), 7–10;
Published: 10 February 2014

Introduction: Recent reports have suggested that uterine manipulators can induce lymphovascular space involvement (LVSI) by endometrial cancer in laparoscopic hysterectomy specimens. The prognostic significance of this phenomenon known as “vascular pseudo invasion” remains elusive. Materials and Methods: The authors conducted a retrospective, single institution study of patients who underwent initial surgery for grade 1 and grade 2 endometrioid endometrial cancers with LVSI. Cases were stratified by surgical approach (laparoscopy vs laparotomy). Clinicopathologic and procedure characteristics as well as outcome data were analyzed. Univariate and multivariate analyses were performed. Disease-free survival (DFS) was analyzed using the Kaplan-Meier product limit method. Results: A total of 104 cases (20 laparoscopic, 84 laparotomy) were analyzed. Mean age (65 vs 64 years, respectively), stage distribution, mean number of lymph nodes sampled (18 vs 21, respectively) and use of adjuvant therapy was similar for both groups (p > 0.05). Mean body mass index (BMI) was 30 vs 35 kg/m2, respectively (p = 0.002). Mean follow up was 24 months (range 0.1–102). Univariate analysis demonstrated that LVSI in the laparoscopic setting was associated with worse DFS (p = 0.002). After adjusting for grade the risk of recurrence remained higher for laparoscopic cases (HR: 15.7, 95% CI 1.7–140.0, p = 0.014). Conclusions: Adjusted risk of recurrence associated with LVSI is higher in cases approached laparoscopically arguing against the concept of “vascular pseudo invasion” associated with the use of uterine manipulators and balloons. LVSI should be regarded as a serious risk factor and taken into account for triage to adjuvant therapies, even in laparoscopically treated early-stage endometrial cancer.
Endometrial cancer
Lymphovascular space invasion
Pseudo invasion
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