Eugenia Mantovani

Conservative hysteroscopic treatment of endometrial intraepithelial neoplasia and endometrial cancer in patients with high surgical risk with mechanical hysteroscopic tissue removal systems: A retrospective cohort study

Abstract Objective To compare surgical and oncologic outcomes between conventional resectoscopic surgery and mechanical hysteroscopic tissue removal (mHTR) systems in high‐risk patients not suitable for standard surgery undergoing conservative treatment for multifocal endometrial atypical hyperplasia/endometrial intraepithelial neoplasia (EAH/EIN) or early‐stage low‐grade endometrioid endometrial cancer (EEC). Methods We conducted a single‐center, retrospective cohort study at the Department of Gynecology and Physiopathology of Human Reproduction, S. Orsola‐Malpighi Hospital, University of Bologna, Italy. A total of 31 high‐surgical‐risk patients with EAH/EIN or early‐stage low‐grade EEC were included: 18 underwent conventional resectoscopic endo‐myometrial resection, while 13 were treated with mHTR systems. All patients received a levonorgestrel‐releasing intrauterine device (LNG‐IUD) postoperatively. After treatment, patients underwent an 18‐month follow up with endometrial biopsies every 6 months. Results The mHTR group had significantly shorter operative times (mean 12.3 ± 7.7 min) compared with the resectoscopic surgery group (mean 40.6 ± 11.8 min, P  < 0.001). Additionally, the incidence of intrauterine adhesions was lower in the mHTR group ( P  < 0.001). There were no significant differences between the two groups in terms of disease presence at 6, 12, or 18 months. Conclusions Hysteroscopic endo‐myometrial resection, with resectoscopic technique or with mHTR systems, combined with LNG‐IUD may represent a safe alternative for patients at high surgical risk with EAH/EIN or early‐stage low‐grade EEC. Moreover, mHTR demonstrated advantages such as shorter operative times and fewer adhesions. A large multicenter prospective study is needed to confirm our study findings.