Modified Radical Hysterectomy Versus Extrafascial Hysterectomy in the Treatment of Stage I Endometrial Cancer: Results From the ILIADE Randomized Study

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• 作者：Mauro Signorelli (1)
  Andrea Alberto Lissoni (1)
  Gennaro Cormio (2)
  Dionyssios Katsaros (3)
  Antonio Pellegrino (1)
  Luigi Selvaggi (2)
  Fabio Ghezzi (4)
  Giovanni Scambia (5)
  Paolo Zola (6)
  Roberto Grassi (7)
  Rodolfo Milani (1)
  Raffaella Giannice (8)
  Giovanna Caspani (9)
  Costantino Mangioni (1)
  Irene Floriani (10)
  Eliana Rulli (10)
  Roldano Fossati MD (10)
  
• 刊名：Annals of Surgical Oncology
• 出版年：2009
• 出版时间：December 2009
• 年：2009
• 卷：16
• 期：12
• 页码：3431-3441
• 全文大小：311KB
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• 作者单位：Mauro Signorelli (1)
  Andrea Alberto Lissoni (1)
  Gennaro Cormio (2)
  Dionyssios Katsaros (3)
  Antonio Pellegrino (1)
  Luigi Selvaggi (2)
  Fabio Ghezzi (4)
  Giovanni Scambia (5)
  Paolo Zola (6)
  Roberto Grassi (7)
  Rodolfo Milani (1)
  Raffaella Giannice (8)
  Giovanna Caspani (9)
  Costantino Mangioni (1)
  Irene Floriani (10)
  Eliana Rulli (10)
  Roldano Fossati MD (10)
  
  1. Department of Obstetrics and Gynecology, University of Milano-Bicocca, S. Gerardo Hospital, Monza, Italy
  2. Department of Obstetrics and Gynecology, University of Bari, Bari, Italy
  3. Department of Obstetrics and Gynecology, Policlinico University of Turin, Turin, Italy
  4. Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
  5. Department of Obstetrics and Gynecology, Gemelli Hospital, Rome, Italy
  6. Department of Obstetrics and Gynecology, Mauriziano Hospital, Turin, Italy
  7. Department of Obstetrics and Gynecology, Treviglio Hospital, Treviglio, Italy
  8. Department of Gynecology, Istituto Clinico Humanitas, Milan, Italy
  9. Department of Obstetrics and Gynecology, Lecco Hospital, Lecco, Italy
  10. Department of Oncology, “Mario Negri-Institute, Milan, Italy
  

文摘

Background Five percent to 20% of stage I endometrial cancer patients undergoing total abdominal hysterectomy and bilateral salpingo-oophorectomy develop vaginal and pelvic recurrences. Adjuvant radiotherapy can improve locoregional control but not survival. This randomized trial aimed to determine whether a modified radical (Piver–Rutledge class II) hysterectomy can improve survival and locoregional control compared to the standard extrafascial (Piver–Rutledge class I) hysterectomy. Methods Eligible patients (n?=?520) with stage I endometrial cancer were randomized to class I or class II hysterectomy. Primary endpoint was overall survival. Results The median length of parametria and vagina removed were 15 and 5 vs. 20?mm and 15?mm for class I and class II hysterectomy, respectively (P?>?0.001). Operating time and blood loss were statistically significantly higher for class II hysterectomy. At a median follow-up of 70?months, 51 patients had died. Five-year disease-free and overall survival were similar between arms (87.7 and 88.9% in the class I arm and 89.7 and 92.2% in the class II arm, respectively). The unadjusted hazard ratios for recurrence was 0.91 (95% confidence interval, 0.55-.51, P?=?0.72), and the hazard ratio for death was 0.77 (95% confidence interval, 0.44-.33, P?=?0.35). Conclusions Class II hysterectomy did not improve locoregional control and survival compared to class I hysterectomy, but when an adequate vaginal cuff transection is not feasible with class I hysterectomy, a modified radical hysterectomy allows to obtain an optimal vaginal and pelvic control of disease with a minimal increase in surgical morbidity.