Study on the relationship between laparoscopic operation and pseudo vascular invasion in stage Ⅰ a endometrial carcinoma / 中华妇产科杂志

ABSTRACT

Objective To explore relations between pseudo vascular invasion (PVI) and laparoscopic operation in patients with stage Ⅰa endometrial carcinoma. Methods Details of stage Ⅰa endometrial carcinoma patients′ clinical information and pathological sections who received operation treatment between January 2008 and October 2015 were obtained from the Dalian Maternal and Child Health Hospital. There were 515 cases entrolled into this study, including 332 (64.5%) cases performed surgery by laparoscopy and 183 (35.5%) cases undergone abdominal surgery. The vascular invasion rate and the microscopic manifestations of PVI in two groups were retrospectively compared and analyzed. The follow-up period ended February 2017, the adjuvant treatment and prognosis of patients with lympho-vascular space invasion (LVSI) and PVI were analysed. Results (1) Seventy-five of 515 cases with stage Ⅰa endometrial carcinoma, there were seven-five cases found with tumor cells in lympho-vascular space, including 52 cases of LVSI and 25 cases of PVI (2 cases of both). The incidence of cancer emboli in lympho-vascular space and LVSI in laparoscopic group and laparotomy group were respectively 15.4%(51/332) vs 13.1%(24/183) and 9.6%(32/332) vs 10.9%(20/183), there were no significant differences (all P>0.05). But the rate of PVI between the two group was significantly different [6.3% (21/332) vs 2.2%(4/183), P=0.036], laparoscopic group was higher than that in laparotomy group. (2) Of 332 cases in laparoscopic group, 21 cases was found PVI, containing 8 cases showed tumor tissue with mesenchyme or papillary structures located in large thick wall vessels of the outer lateral myometrium, 13 cases showed the tumor tissue was away from the vessel wall. Among 183 cases in laparotomy group, 3 cases with PVI which the tumor tissue was away from the vessel wall, and 1 with interstitial tissue. (3) During the follow-up period, 7 of 75 cases (both LVSI and PVI) were lost, and 66 cases were relapse-free survival, 2 cases recurred at fifth months and died respectively at 7, 20 months after the operation. This 2 cases were both PVI of laparoscopic group, and the pathological type was endometrioid adenocarcinoma grade 3, and adjuvant treatment was not accepted after the operation. The relapse-free survival with LVSI was 49 months and 46 months for cases with PVI. Conclusions Laparoscopic operation could increase PVI in patients with stageⅠa endometrial carcinoma, while does not increase LVSI. It is not yet possible to demonstrate that PVI affects the prognosis of patients.