H. Patel

National Survey of Current Follow-up Protocols for Patients Treated for Endometrial Cancer in the UK

The aim of this study was to establish a baseline of national practice for follow-up after treatment for endometrial cancer in the UK. An online cross-sectional survey was developed and distributed through the Royal College of Radiologists via an email link to the audit leads of radiotherapy centres in the UK. The survey was conducted from November 2021 to 5 January 2022. The main themes assessed in the survey were the form, frequency and duration of follow-up practices. There were a total of 43/61 (70%) complete responses. 93% of centres had a standard follow-up protocol and 7% who did not have a follow-up protocol discharged patients after the post-operative review. Five centres (13%) used molecular profiling to inform follow-up practices. Patient-initiated follow-up was mainly used in the cohort of patients who had surgery alone with no adjuvant treatment (68%, (19/28)). In the cohort who had face-to-face follow-up, the majority had pelvic examinations as part of their review and total follow-up for five years. 93% of respondents are interested in a national follow-up protocol. Our data shows that there is national variation in practise with regard to follow-up of women treated for endometrial cancer. Many of the follow-up practises are based on conventional follow-up regimens and these may fail to address the more holistic needs of cancer survivors. Recent publication of updated guidance from the British Gynaecological Cancer Society may help standardise practise and provide a more relevant approach to follow-up for women treated for endometrial cancer.

Robotic radical hysterectomy for stage 1B1 cervical cancer: A case series of survival outcomes from a leading UK cancer centre

AbstractBackgroundWe present the largest UK single institute robotic radical hysterectomy (RRH) case series for the management of cervical cancer (CC).MethodsData were collected on women who had a RRH as primary treatment for stage 1b1 CC between December 2009 and December 2018.ResultsNinty women had a robotic hysterectomy. Five‐year follow‐up data were available for 30%. The disease‐free survival at 5 years was 89.6%. Overall survival at 3 and 5 years for death from any cause was 96.1% and 91.4%, respectively. The overall 5‐year survival for death from disease only was 92.8%. Overall survival by tumour size alone showed that women with tumours less than 2 cm had a 98.3% 5‐year survival compared to 83.4% for tumour size greater than 2 cm. Irrespective of tumour size, those that had no evidence of lymphovascular space invasion had a 100% 5‐year survival.ConclusionOur preliminary data supports the oncological safety of RRH in a selective cohort of patients with stage 1b1 CC.

Awareness of and attitudes towards cervical cancer prevention among migrant Eastern European women in England

Objectives It has been hypothesized that, in England, the rise in incidence of cervical cancer and the fall in screening coverage might be attributable in part to the effect of migration of Eastern European born women. We explored the attitudes and behaviours of these women towards cervical cancer prevention strategies. Methods A mixed methods study using quantitative surveys and in-depth semi-structured qualitative interviews was conducted between April 2015 and December 2016. Results In total, 331 surveys and 46 interviews were completed. Native English women had greater knowledge that a smear test is a screening test for pre-cancerous cervical cells (90% vs. 71% p≤0.01), whereas migrant Eastern European women believed that it was conducted as part of a full gynaecological examination (46% vs. 21% p≤0.01) and that the screen interval was annual (18% vs. 4% p≤0.01). Distrust of the English healthcare system resulted in some Eastern European women returning to their country of birth for screening. Poor awareness of cervical cancer prior to migration and lack of information at registration with a general practitioner in England were associated with failure to participate in screening. Conclusions The views and attitudes expressed by the migrant Eastern European women in this study suggest that they are not fully participating in cervical screening in England. Targeted education at the point of contact with healthcare services in England is needed to increase cervical screening participation among these women.

Robotic Hysterectomy for Endometrial Cancer in Class III Obesity: 13 Years of Experience From a UK Epicentre in Guildford

ABSTRACTBackgroundSurgery in morbidly obese patients is technically challenging; however, this can be mitigated using robotic surgery. We present 13‐years’ experience of robotic hysterectomy in patients with Class‐III obesity (BMI≥ 40 kg/m) and endometrial cancer.Materials and MethodsThis retrospective cohort study included 236 women with Class‐III obesity who underwent robotic hysterectomy for endometrial cancer between 2010 and 2023. Key outcomes include, completion rates and peri‐operative events. Comparative analysis evaluated outcomes following technological upgrades, introduction of sentinel lymph‐node assessment and surgeons' learning curve. Statistical analysis used Fisher's exact test and Chi‐squared for categorical variables, and ANOVA and Kruskall‐Wallis tests for continuous variables.ResultsRobotic hysterectomy was completed in 91.5% (216/236), with conversion to laparotomy in 2.5% (6/236). Median inpatient admission was 1 day. Infection occurred in 6.9% (15/216). A statistically significant decrease in laparotomies from 11% (9/236) (2010–2015) to 0% (2020–2023) (p = 0.004) was observed.ConclusionRobotic Hysterectomy can be safely completed in majority of morbidly obese patients with endometrial cancer with minimal perioperative complications.

Endometrial Cancer: Analysing Patterns of Recurrence and Real-Life Outcome Data Using the 2020 ESGO-ESTRO-ESP Risk Stratification System

To evaluate patterns of recurrence and explore the prognostic differences between the 2018 FIGO staging system and the 2020 ESGO-ESTRO-ESP risk stratification system of endometrial cancer with an emphasis on early-stage disease. The incidence of endometrial cancer has risen by around 60% since the 90's. It is projected that by 2035 endometrial cancer will be the sixth most common cause of cancer-related death amongst females. This was a retrospective cohort study which included patients treated between 2010 and 2017. Primary endpoints were overall survival (OS) and recurrence-free survival (RFS). Kaplan-Meyer survival analysis was used to assess OS and RFS across different risk groups. Cox proportional hazards regression was used to evaluate prognostic risk factors implicated in recurrence. Different recurrence patterns across the subgroups were analysed with Pearson's chi-square test. The study included 692 patients with a recurrence rate of 14.9%. The median time to recurrence was 17.1 months (IQR:8.8-28.4). The mean OS varied between 97.2 months in the low-risk group to 63.1 months in the high-risk group (p < 0.001). Mean RFS was 96.1 in the low-risk group and 58.9 in the high-risk group (p < 0.001). RFS was predicted by the following factors; high risk group (OR=3.87; p = 0.041), LVSI (OR=2.54, p = 0.005), carcinosarcoma (OR=2.20, p = 0.021) and serous subtype (OR=1.91, p = 0.01). Logistic regression was used to evaluate risk factors for loco-regional and distant recurrence. Patients in the low-risk group were less likely to have distant recurrence (OR=0.08, p = 0.004). Similarly, negative LVSI and Grade 1 cancers were associated with decreased risk of distant recurrence (OR=0.34, p = 0.006 and OR=0.33, p = 0.007, respectively). There were no significant risk factors for loco-regional recurrence. The 2020 ESGO-ESTRO-ESP risk stratification provides accurate estimates of recurrence risk and survival. Those treated in line with current guidance have significantly better outcomes.