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Uterine cancer is the most common gynecologic malignancy in the United States; however, little is understood of long-term sequelae of adjuvant radiotherapy treatment. The purpose of this study was to compare quality of life (QoL) in patients who have undergone surgery with or without adjuvant radiotherapy for uterine cancer. This is a cross-sectional cohort study that examined women treated for uterine cancer at a tertiary cancer center from 2006-2018. Participants included those who underwent hysterectomy/bilateral salpino-oophorectemy alone (BSO), with brachytherapy (BT), or with external bean radiation therapy (EBRT). A non-cancer cohort of women who underwent a hysterectomy/BSO for benign indications was also identified (NC). To compare QoL we utilized the FACT-En, a validated 27-question survey used to assess QoL in endometrial cancer patients. The survey consists of 5 well-being subscales: physical, social, emotional, functional, and an endometrial-cancer specific subscale. Responses are on a 5-point Likert scale, with a higher score indicating a better quality of life. Maximum score is 172 for the entire survey. Demographic and other treatment variables were obtained from medical records. Subscales and survey totals were compared across cohorts using ANOVA tests. 282 women completed the FACT-En survey (BSO 59, BT 70, EBRT 93, NC 65). Median time from surgery to completion of survey was 6.7 years. Women in the NC cohort were significantly younger at survey completion compared to the other cohorts (mean age 63 [std 8.2] NC, 66 [9.6] HS, 68 [8.4] BT, 67 [10.8] EBRT; p<0.001). Mean total FACT-En score for the entire cohort was 114.2 [22.1]. Overall QoL was significantly different between cohorts, with patients in the EBRT cohort reporting the lowest QoL (mean 139.4 [21.6]), followed by the NC cohort (142.1 [26.5]), BSO cohort (146.1 [20.1]), and the BT cohort reporting highest total score (150.6 [18.2], p=0.006). All subscales were significantly different (all p<0.05) across cohorts aside from social well-being subscale. In the physical domain, the EBRT cohort had the lowest average score (23.3 [5.0]), followed by the NC cohort (25.3 [4.2]), the BT cohort (25.0 [3.8]), with the BSO group reporting the highest scores (25.4 [3.9], p=0.001). The NC cohort reported the lowest scores in the endometrial symptom-specific subscale, with a mean score of 53.3 [10.5]. Among patients who had undergone cancer treatment, the EBRT cohort reported the worst average endometrial-specific QoL (53.5 [8.6]), while again the BT group reported the highest score (57.5 [6.1], p=0.007). QoL differences between treatment modalities for uterine cancer remain years after treatment. In women with endometrial cancer who require adjuvant therapy, vaginal brachytherapy does not appear to have any long-term effects of reported QOL. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To help determine whether global collaborations for prospective gynecologic surgery trials should include hospitals in developing countries, we compared surgical and oncologic outcomes of patients undergoing laparoscopic radical hysterectomy at a large comprehensive cancer center in the United States and a cancer center in Colombia. Methods: Records of the first 50 consecutive patients who underwent laparoscopic radical hysterectomy at The University of Texas MD Anderson Cancer Center in Houston (between April 2004 and July 2007) and the first 50 consecutive patients who underwent the same procedure at the Instituto de Cancerología–Clínica las Américas in Medellín (between December 2008 and October 2010) were retrospectively reviewed. Surgical and oncologic outcomes were compared between the 2 groups. Results: There was no significant difference in median patient age (US 41.9years [range 23–73] vs. Colombia 44.5years [range 24–75], P =0.09). Patients in Colombia had a lower median body mass index than patients in the US (24.4kg/m2 vs. 28.7kg/m2, P =0.002). Compared to patients treated in Colombia, patients who underwent surgery in the US had a greater median estimated blood loss (200mL vs. 79mL, P <0.001), longer median operative time (328.5min vs. 235min, P <0.001), and longer postoperative hospital stay (2days vs. 1day, P <0.001). Conclusions: Surgical and oncologic outcomes of laparoscopic radical hysterectomy were not worse at a cancer center in a developing country than at a large comprehensive cancer center in the United States. These results support consideration of developing countries for inclusion in collaborations for prospective surgical studies. [Copyright &y& Elsevier]

Abstract: Objectives. : The morbidity associated with pelvic exenteration is high; however, patients undergoing this procedure have no other curative treatment options. Excessive blood loss is a common complication of this procedure. We evaluated whether use of an electrothermal bipolar coagulator (LigaSure Atlas, ValleyLab, Boulder, Colorado, USA) during pelvic exenteration is safe and whether it reduces intraoperative blood loss, intraoperative blood transfusion requirements, and length of hospital stay. Methods. : Between September 2003 and January 2005, 12 patients underwent pelvic exenteration (total, anterior, or posterior) performed using the electrothermal bipolar coagulator. Estimated blood loss, transfusion requirements, length of hospital stay, and complications necessitating reoperation were evaluated. Results. : The mean age was 55 years (range, 30–77), the mean estimated blood loss was 1931 ml (range, 1300–1500 ml), the mean number of units of packed red blood cells transfused intraoperatively was 3.4 U (range, 2–12 U), the mean operative time was 609 min (range, 400–940 min), and the mean length of hospital stay was 19.9 days (range, 7–27). There were no intraoperative complications related to the electrothermal bipolar coagulator use. None of the patients had any complications necessitating reoperation. Conclusions. : Use of the electrothermal bipolar coagulator device during pelvic exenteration is safe and may decrease blood loss and the number of units of blood that must be transfused intraoperatively. [Copyright &y& Elsevier]

Objective: To examine the association between ovarian conservation and oncologic outcome in surgically-treated young women with early-stage, low-grade endometrial cancer., Methods: This multicenter retrospective study examined women aged <50 with stage I grade 1-2 endometrioid endometrial cancer who underwent primary surgery with hysterectomy from 2000 to 2014 (US cohort n = 1196, and Japan cohort n = 495). Recurrence patterns, survival, and the presence of a metachronous secondary malignancy were assessed based on ovarian conservation versus oophorectomy., Results: During the study period, the ovarian conservation rate significantly increased in the US cohort from 5.4% to 16.4% (P = 0.020) whereas the rate was unchanged in the Japan cohort (6.3-8.7%, P = 0.787). In the US cohort, ovarian conservation was not associated with disease-free survival (hazard ratio [HR] 0.829, 95% confidence interval [CI] 0.188-3.663, P = 0.805), overall survival (HR not estimated, P = 0.981), or metachronous secondary malignancy (HR 1.787, 95% CI 0.603-5.295, P = 0.295). In the Japan cohort, ovarian conservation was associated with decreased disease-free survival (HR 5.214, 95% CI 1.557-17.464, P = 0.007) and an increased risk of a metachronous secondary malignancy, particularly ovarian cancer (HR 7.119, 95% CI 1.349-37.554, P = 0.021), but was not associated with overall survival (HR not estimated, P = 0.987). Ovarian recurrence or metachronous secondary ovarian cancer occurred after a median time of 5.9 years, and all cases were salvaged., Conclusion: Our study suggests that adoption of ovarian conservation in young women with early-stage low-grade endometrial cancer varies by population. Ovarian conservation for young women with early-stage, low-grade endometrial cancer may be potentially associated with increased risks of ovarian recurrence or metachronous secondary ovarian cancer in certain populations; nevertheless, ovarian conservation did not negatively impact overall survival., (Copyright © 2019. Published by Elsevier Inc.)

Objective: To determine if young, normal-weight women with endometrial cancer have unique risk factors and clinical characteristics when compared with young, overweight and obese women with endometrial cancer., Methods: Between 1989 and 2003, 1531 patients were treated for endometrial cancer. 188 (12%) of these women were premenopausal and under the age of 50 at time of diagnosis. The patients were divided into three groups based on body mass index (BMI): normal weight (BMI < 25 kg/m2), overweight (BMI 25-30 kg/m2) and obese (BMI > or = 30 kg/m2). Clinical and pathologic characteristics were compared., Results: Of the 188 young endometrial cancer patients, 47 (25%) were of normal weight, 31 (17%) overweight and 106 (56%) obese. 4% of normal-weight, 12% of overweight and 0% of obese patients met criteria for Lynch syndrome/hereditary non-polyposis colorectal cancer (HNPCC). Irregular menstrual cycles were reported by 30% normal-weight, 32% of overweight and 61% of obese women (P = 0.001). 17% of normal-weight, 7% of overweight and 14% of obese women had a history of infertility (P = 0.723). Nulliparity was noted in 57% of normal-weight, 47% of overweight and 57% of obese patients (P = 0.583). Diabetes was reported in 4% of normal-weight, 13% of overweight and 35% of obese patients (P < 0.001). 28% of normal-weight, 26% of overweight and 14% of obese patients had synchronous primary tumors of the endometrium and ovary., Conclusions: As expected, a significantly higher proportion of obese and overweight women had diabetes and irregular menstrual cycles. Among the normal-weight women, a high proportion were nulliparous, had a history of infertility, irregular menstrual cycles and synchronous tumors of the endometrium and ovary when compared with the general population. This suggests that hormonal factors, and possibly polycystic ovarian syndrome (PCOS), may contribute to the development of endometrial cancer in young normal-weight women.