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The use of hysteroscopic endometrectomy in the conservative treatment of early endometrial cancer and atypical hyperplasia in fertile women

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

To illustrate the effectiveness of hysteroscopic endometrial resection in conservative treatment of early endometrial cancer/atypical hyperplasia in women of reproductive age.

Methods

Review of outcomes of women of reproductive age who underwent fertility sparing treatment (hysteroscopic superficial endometrectomy followed by progestin therapy) in early endometrial cancer.

Results

Eight women with Stage I endometrial cancer and three with atypical endometrial hyperplasia underwent hysteroscopic superficial endometrial resection, followed by 1-year treatment with oral megestrol acetate. One patient had a synchronous endometrioid ovarian carcinoma. One patient with Grade 2 carcinoma opted for conservative treatment and had hysterectomy 3 months later for persisting disease. Ten patients showed no evidence of residual disease during a 12-month follow-up period with regular hysteroscopy. Five patients had seven pregnancies without assisted reproductive technology. One patient got pregnant after one attempt of in-vitro fertilization and oocyte donation. Pregnancy rate was 54.5%; two patients had two successful pregnancies and deliveries. Average time to pregnancy was 16 months from the end of treatment. All babies were delivered vaginally.

Conclusion

Total superficial endometrial resection followed by progestin can be considered in patients with early endometrial cancer/atypical hyperplasia who still want to conceive. It does not seem to impair fertility nor pregnancy outcomes in women of reproductive age.

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Acknowledgements

The authors are thankful to all patients who participated in the study.

Funding

None.

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Authors and Affiliations

  1. Faculty of Medicine, Saint Joseph University, Beirut, Lebanon

    David Atallah, Nadine El Kassis, Joelle Safi, Hady El Hachem, Georges Chahine & Malak Moubarak

  2. Department of Obstetrics and Gynecology, Hôtel-Dieu de France University Hospital, Museum, P.O. Box: 116-5137, Beirut, Lebanon

    David Atallah, Nadine El Kassis, Joelle Safi, Hady El Hachem & Malak Moubarak

  3. Department of Oncology, Hôtel-Dieu de France University Hospital, Beirut, Lebanon

    Georges Chahine

Authors
  1. David Atallah
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  2. Nadine El Kassis
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  3. Joelle Safi
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  4. Hady El Hachem
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  5. Georges Chahine
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  6. Malak Moubarak
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Contributions

DA: study conception, data collection and analysis, patients’ treatment, surgery and follow-up, and drafting of the paper. NK: data collection and analysis, patients’ treatment, drafting of the paper. JS: patients’ treatment, drafting of the paper. HEH: patients’ treatment, drafting of the paper. GC: patients’ treatment, drafting of the paper. MM: study conception, data collection and analysis, patients’ treatment, drafting of the paper. All authors reviewed and approved the final version of the paper.

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Correspondence to David Atallah.

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Atallah, D., El Kassis, N., Safi, J. et al. The use of hysteroscopic endometrectomy in the conservative treatment of early endometrial cancer and atypical hyperplasia in fertile women. Arch Gynecol Obstet 304, 1299–1305 (2021). https://doi.org/10.1007/s00404-021-06048-0

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  • DOI: https://doi.org/10.1007/s00404-021-06048-0

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