Federica Perelli

Clinical impact of surgical energy device (Caiman®) IN elderly patients with Endometrial Cancer (protocol ID: Cineca)

To investigate the clinical performance of the Caiman® energy device in class A radical laparoscopic hysterectomy (RLH) according to Querleu-Morrow classification, combined with bilateral salpingo-oophorectomy (BSO) and pelvic lymph node assessment in elderly patients with early-stage endometrial cancer (EC), specifically focusing on hemostatic effectiveness and safety. Single-institution, prospective observational study. Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. Forty-three women over 65 years with FIGO stage IA or IB endometrioid EC were enrolled from September 2021 to August 2023. Use of Caiman® energy device in RLH combined with BSO and pelvic lymph node assessment in elderly patients. The primary endpoint was operative time, with secondary endpoints including perioperative outcomes and postoperative complications. Results demonstrated a median surgical time of 135 min, with no significant intraoperative complications attributed to the Caiman® device. Postoperative complications were minimal, with no severe complications (Grade 4 or 5) and a median hospital stay of two days. The study highlights the advantages of the Caiman® in enhancing surgical efficiency while minimizing risks for elderly patients, suggesting its potential for improving resource allocation and patient outcomes in oncologic surgery. The findings of this study suggest the feasibility of using the Caiman® device for surgical procedures in elderly patients with early-stage endometrial cancer. Future prospective randomized trials are needed to establish its efficacy compared to traditional surgical methods.

Correlation between ultrasonographic findings and histopathological and molecular characteristics in endometrial cancer: A multicenter study

Accurate preoperative assessment of endometrial cancer is crucial for tailoring surgical and therapeutic management. Identifying correlations between ultrasonographic features and tumor histopathological and molecular profiles may help improve the accuracy of presurgical staging. This multicenter retrospective study aimed to evaluate the association between ultrasonographic features, histopathological characteristics and molecular profiles in endometrial cancer to improve preoperative assessment and risk stratification. A total of 156 women from three Italian centers underwent standardized transvaginal or transrectal ultrasound following IETA criteria prior to hysterectomy. Ultrasonographic parameters, including endometrial thickness, echogenicity, junctional zone integrity, and vascularity assessed by Doppler, were analyzed. Postoperative histopathology and molecular classification (p53, MMR, POLE, NSMP) were performed. Statistical analyses evaluated correlations among ultrasound features, pathology, and molecular data. Endometrioid histotype was detected in 88.46 % of cases, mostly low-grade and early-stage. Cases in the early stage (i.e. lesions confined to the uterine corpus) accounted for 77.27 % of all cases. Ultrasound staging was consistent with the final staging in 65.5 % of cases, with errors primarily involving the overestimation of p53-abnormal tumors and the underestimation of MMRd tumors. Increased endometrial thickness was associated with a higher stage and grade (median 20 mm for stage III, p = 0.007). An irregular junctional zone was associated with high-grade tumors (p = 0.016). Complex and multifocal vascular patterns were significantly linked to advanced stages, high grade, and molecular aggressiveness, such as p53 mutations and MMR deficiency. Tumors with scattered vessels showed a higher risk of extensive lymphovascular space invasion. Ultrasound features, particularly vascularity, junctional zone irregularity, and endometrial thickness, are significantly associated with tumor stage, grade, and molecular profiles. Incorporating detailed ultrasonographic assessment into preoperative evaluation can help identify high-risk endometrial cancers and guide personalized management strategies. Larger prospective studies are needed to validate these findings.