Does the extension of the type of hysterectomy contribute to the local control of endometrial cancer?

OBJECTIVE: To examine the necessity and sufficiency of different types of hysterectomy for the surgical treatment of endometrial cancer. METHODS: This was a multicenter collaborative study conducted by 11 institutions. Among patients with stage I-III endometrial cancer who underwent surgery as the initial treatment (only chemotherapy was provided if adjuvant therapy was needed) from 2001 to 2012, we retrospectively examined the type of hysterectomy, clinicopathological factors, recurrence rate over a maximum period of 5 years, and the site of recurrence. The local recurrence rate was examined by univariate and multivariate analyses. RESULTS: Among 1335 patients, 982 (73.6%) underwent simple hysterectomy (SH) and 353 (26.4%) underwent modified radical hysterectomy (mRH) and were observed for a mean duration of 51.8 months. No significant difference was observed in the rate of local recurrence between the SH and mRH groups (p = 0.928). In multivariate analysis, clinicopathological factors independently associated with localized recurrence included postmenopausal status [hazard ratio (HR) 5.036, 95% confidence interval (CI) 1.506-16.841, p = 0.009], with stages II (HR 3.337, 95% CI 1.701-6.547, p < 0.001) and III (HR 2.445, 95% CI 1.280-4.668, p = 0.007), vs stage I and histological type 2 (HR 1.610, 95% CI 0.938-2.762, p = 0.001). CONCLUSIONS: For endometrial cancer patients requiring surgery, the selection of a more extensive type of hysterectomy did not reduce the rate of local recurrence. Therefore, there is little significance in performing mRH in such cases.

Circumvallate placenta: associated clinical manifestations and complications-a retrospective study.

Aims. To analyze the pregnancy outcomes of circumvallate placenta retrospectively and to predict circumvallate placenta during pregnancy based on its clinical features. Methods. The pregnancy outcomes of 92 women with circumvallate placenta who delivered live singletons at a tertiary care center between January 2000 and September 2012 were compared with those of 9057 controls. Results. Women with circumvallate placenta were associated with higher incidences of preterm delivery (64.1%), placental abruption (10.9%), emergency cesarean section (45.6%), small-for-gestational age (36.9%), neonatal death (8.9%), neonatal intensive care unit admission (55.4%), and chronic lung disease (33.9%). When vaginal bleeding during the second trimester and premature chemical rupture of membranes (PCROM) were both used as predictive factors for circumvallate placenta, the sensitivity was 28.8% and specificity was 99.9%. Conclusion. With circumvallate placenta, pregnancy outcomes were poor and had characteristic clinical manifestations. In women with both vaginal bleeding and PCROM during pregnancy, circumvallate placenta should be strongly suspected.