Reply to ``Surgery for endometrial cancer - Taiwanese Journal of ...

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1987;316:1105e10. [3] Lau HY, Chen MY, Ke YM, Chen JR, Chen IH, Liou WS, et al. Outcome of ovarian · preservation during surgical treatment for endometrial ...
Taiwanese Journal of Obstetrics & Gynecology 55 (2016) 153

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Reply to “Surgery for endometrial cancer”

To the Editor, We thank Li and colleagues for their comments on our article, and we understand their concern regarding the need to perform oophorectomy during surgical staging in patients with early-stage endometrial cancer. However, oophorectomy would reduce circulating estrogen level and bring forth early menopausal symptoms in young premenopausal women. Estrogen deficiency raises concerns about additional health risks, namely osteoporosis, hip fracture, and coronary heart disease [1,2]. Based on the abovementioned concept, if we could limit bilateral salpingo-oophorectomy (BSO) for young women with early-stage endometrial cancer during routine complete surgical staging, it is then possible to reduce the additional long-term health risks for young women. Complete surgical staging, including both BSO and lymphadenectomy, is currently the only reliable method for the evaluation of the lymph node status and the chance of extrauterine spreading. Nonetheless, a major shortcoming of complete surgical staging is its association with high morbidity, prolonged recovery time, and postoperative peritoneal adhesion. Our study was a retrospective study, and not a prospective study [3]. We intended to compare the survival outcomes of patients who underwent concurrent BSO with those who did not. Although our study cohort included nearly 15% of patients who had high-risk nonendometrioid cell type, the results of our retrospective study suggested no unfavorable cancer-related mortality and only one local recurrence among those with preservation of bilateral ovaries. Moreover, only eight patients with high risk factors received adjuvant therapies (6 underwent adjuvant radiotherapy, and 2 with nonendometrioid type underwent adjuvant chemotherapy). As we have emphasized in our discussion, only carefully selected early-stage patients of low-grade endometrial cancer should receive a more conservative approach than complete surgical staging, i.e., excluding BSO procedure as part of the staging surgery and preserving bilateral ovaries. Patients who desire ovarian preservation should be fully informed regarding the potential risks, and this option should be limited to patients without extrauterine

spread at preoperative (clinical and image study) and intraoperative assessments. These patients should also be carefully monitored with longer than typical follow-up duration compared with those who have undergone a BSO procedure. Nevertheless, we hope that the results of our study could contribute toward the clinical understanding of bilateral ovarian preservation among young women with early-stage endometrioid endometrial cancer. From a clinical perspective, we hope that this study can encourage clinicians to reconsider the benefits and risks of BSO when making operative decisions during staging operation. Conflicts of interest The authors declare no conflicts of interest. References [1] Lindsay R. Estrogens, bone mass, and osteoporotic fracture. Am J Med 1991;91: 10Se3S. [2] Colditz GA, Willett WC, Stampfer MJ, Rosner B, Speizer FE, Hennekens CH. Menopause and the risk of coronary heart disease in women. N Engl J Med 1987;316:1105e10. [3] Lau HY, Chen MY, Ke YM, Chen JR, Chen IH, Liou WS, et al. Outcome of ovarian preservation during surgical treatment for endometrial cancer: a Taiwanese Gynecologic Oncology Group study. Taiwan J Obstet Gynecol 2015;54:532e6.

Kung-Liahng Wang* Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and Mackay Medical College, Taipei, Taiwan Department of Nursing, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan *

Corresponding author. Mackay Memorial Hospital, Taitung Branch, No. 1, Lane 303, Changsha Street, Taitung City 95054, Taiwan. E-mail address: [email protected].

DOI of original article: http://dx.doi.org/10.1016/j.tjog.2015.12.013. http://dx.doi.org/10.1016/j.tjog.2015.12.015 1028-4559/Copyright © 2016, Taiwan Association of Obstetrics & Gynecology. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).