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Objective: To evaluate surgical and oncologic outcomes of patients treated by robot-assisted surgery for endometrial cancer within the Belgium Gynaecological Oncology Group (BGOG)., Study Design: We performed a retrospective analysis of women with clinically Stage I endometrial cancer who underwent surgical treatment from 2007 to 2018 in five institutions of the BGOG group., Results: A total of 598 consecutive women were identified. The rate of conversion to laparotomy was low (0.8%). The mean postoperative Complication Common Comprehensive Index (CCI) score was 3.4. The rate of perioperative complications did not differ between age groups, however the disease-free survival was significantly lower in patients over 75 years compared to patients under 65 years of age (p=0.008). Per-operative complications, conversion to laparotomy rate, post-operative hospital stay, CCI score and disease-free survival were not impacted by increasing BMI., Conclusion: Robot-assisted surgery for the surgical treatment of patients suffering from early-stage endometrial cancer is associated with favourable surgical and oncologic outcomes, particularly for unfavourable groups such as elderly and obese women, thus permitting a low morbidity minimally-invasive surgical approach for the majority of patients in expert centres., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Objective: The aim of this study was to evaluate the feasibility and safety of laparoscopically assisted vaginal hysterectomy (with and without pelvic lymphadenectomy) in the staging and treatment of stage I endometrioid endometrial cancer., Materials and Methods: A prospective series of consecutive patients with primary operable endometrial cancer referred to Odense University Hospital between 01.01.2006 and 31.03.2007. All patients were evaluated and a laparoscopic treatment was planned when considered appropriate., Results: 72 consecutive patients with primary operable endometrial cancer were included in the study. 35 patients (48%) were successfully treated with a laparoscopically assisted vaginal hysterectomy. 12 (34%) of them were also treated with a pelvic lymphadenectomy. The median number of lymph nodes removed was 15 (range 10-32). The median operating time was 80 minutes (60-180) without lymphadenectomy and 140 (105-200) minutes with lymphadenectomy. No intraoperative or serious postoperative complications were registered. 26 (74%) out of 35 patients treated by laparoscopy were discharged on the first or second postoperative day., Conclusion: We conclude that laparoscopically assisted vaginal hysterectomy is a safe and effective alternative to laparotomy in the staging and treatment of stage I endometrioid endometrial cancer.

Background and Aims: Preoperative prediction of metastases to the regional lymph nodes in women with endometrioid endometrial cancer is a challenge. According to the Danish Gynaecological Cancer Society guidelines, a pelvic lymphadenectomy is warranted in all poorly differentiated tumors and all stage Ic disease. We have evaluated the accuracy of preoperative tumor grade and intraoperative gross examination of myometrial invasion, in predicting the need for a pelvic lymphadenectomy., Methods: Preoperative tumor grade and intraoperative gross examination of myometrial invasion were prospectively registered in 72 women with stage I endometrioid endometrial cancer, operated between 1 September 2004 and 18 April 2006. The pre- and intraoperative findings were compared with the final pathology report., Results: The preoperative prediction of grade (well, moderate or poorly differentiated) was correct in 96% (69/72) of the patients. Gross examination of myometrial invasion correctly differentiated between stage Ia, Ib, and Ic disease in 89% (64/72) of the patients. The combination of preoperative tumor grade and intraoperative gross examination of myometrial invasion, led to wrong clinical decisions in 11% (8/72) of the patients. Three 'unnecessary' lymphadenectomies were performed, and 5 patients were primary operated upon without 'warranted' lymphadenectomy., Conclusions: Our data suggest that preoperative tumor grade and intraoperative gross examination of the uterus provide useful information for pre-and intraoperative planning of pelvic lymphadenectomy. However, wrong decisions were made in 11% of the patients, and more reliable evaluation methods are needed.