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Contemporary Incidence of Medical Inoperability in Clinical Stage I Endometrial Cancer

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Minimally invasive surgical (MIS) staging is the standard treatment approach for clinical stage I endometrial cancer. Historical rates of inoperability in endometrial cancer are approximately 10%. Given surgical and medical advancements against increasing population obesity, we aimed to describe a contemporary incidence of medical inoperability in clinical stage I endometrial cancer.

Patients and Methods

Patients diagnosed with clinical stage I endometrial cancer of any histology from April 2014 to December 2018 were included in this retrospective cohort study. The primary outcome, medical inoperability, was defined as (1) patients deemed inoperable by a gynecologic oncologist at initial consultation, (2) patients deemed inoperable during preoperative clearance, or (3) an aborted hysterectomy. Fisher’s exact or χ2, and Student’s t-test or Wilcoxon rank sum test were used, as appropriate, for data analysis. Multivariable logistic regression was also employed.

Results

Overall, 767 patients were included, of which 4.6% (35/767) were determined to be inoperable. The inoperable group had a higher body mass index (52.7 vs. 33.9, p < 0.001), and increased rates of diabetes (62.8%, 22/35 vs. 27.1%, 199/732, p < 0.001), coronary artery disease (31.4%, 11/35 vs. 7.1%, 52/732, p < 0.001), and hypertension (94.3%, 33/35 vs. 70.2%, 514/732, p < 0.001). Of those with attempted surgical staging, hysterectomy was aborted intraoperatively in 0.68% (5/737). The overall complication rate was 11.6% (86/737).

Conclusions

With maximal surgical effort and MIS, hysterectomy is possible in > 95% of patients with newly diagnosed endometrial cancer treated at a high-volume center. Complication rates were comparable to other trials evaluating the safety of MIS staging for endometrial cancer.

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Authors and Affiliations

  1. University of North Carolina, Chapel Hill, NC, USA

    Michelle Ertel MD, S. Allison Staley MD, MPH, Tam Nguyen BA, Austin Johnson MD, Austin Hopkins BA, Nerlyne Desravines MD, Johnathon Recknagel MD, Xinyi Zhang MS, Xianming Tan PhD & Leslie H. Clark MD

  2. Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA

    Michelle Ertel MD, S. Allison Staley MD, MPH, Austin Johnson MD, Nerlyne Desravines MD, Johnathon Recknagel MD & Leslie H. Clark MD

  3. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC, USA

    S. Allison Staley MD, MPH & Leslie H. Clark MD

  4. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA

    S. Allison Staley MD, MPH, Xianming Tan PhD & Leslie H. Clark MD

  5. Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA

    Xinyi Zhang MS & Xianming Tan PhD

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  1. Michelle Ertel MD
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Correspondence to Leslie H. Clark MD.

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Ertel, M., Staley, S.A., Nguyen, T. et al. Contemporary Incidence of Medical Inoperability in Clinical Stage I Endometrial Cancer. Ann Surg Oncol 28, 8987–8995 (2021). https://doi.org/10.1245/s10434-021-10313-6

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