Electrosurgical bi- and monopolar endometrial destruction in the prevention of recurrent tamoxifen associated endometrial pathology in postmenopause
Aim. To compare surgical treatments for tamoxifen associated endometrial pathology in patients in late postmenopause. Material and methods. The study comprised 136 postmenopausal women with breast cancer, who were taking tamoxifen, had concurrent endometrial pathology confirmed by ultrasound examination, and/or complained of genital bleeding. Patients were divided into three groups: 54 patients underwent monopolar endometrial ablation (group I), 32 patients received bipolar endometrial ablation (group II), and 50 patients had hysteroscopy, diagnostic fractional curettage, and polypectomy without endometrial ablation (group III). The results of the study were evaluated within 12 months after surgery. Results. The incidence of recurrent endometrial pathology in group I and group II was 1.8% and 0%, respectively. In the non-ablative group, the recurrence rate during the first year was 60%. Conclusion. In breast cancer patients receiving adjuvant tamoxifen therapy, endometrial ablation significantly reduces the incidence of recurrent tamoxifen-associated endometrial pathology. Our study findings suggest that the effectiveness of mono- and bipolar ablation is significantly higher than hysteroscopy, diagnostic fractional curettage and polypectomy (98.2, 100 and 40%, respectively).Sarkisov S.E., Mamikonyan I.O., Pavlovich S.V., Barsegyan G.O., Karamyshev V.K., Boiko M.A., Demidov A.V., Ulankina O.G., Kuprashvili M.I.
Keywords
breast cancer
tamoxifen
endometrial pathology
hysteroscopy
mono- and bipolar endometrial ablation
References
1. Ярыгин В.Н., Мелентьев А.С., ред. Введение в клиническую гериатрию. Руководство по геронтологии и гериатрии. М.: ГЭОТАР-Медиа; 2010. т. 2. 784с. [Yarygin VN, Melentiev AS, ed. Introduction to clinical geriatrics. Guide to gerontology and geriatrics. Moscow: GEOTAR-Media; 2010. t. 2. 784p. (in Russian)]
2. Матвейчик Т.В., Вальчук Э.Э. Проблемы первичной медицинской помощи пациентам пожилого и старческого возраста. Вопросы организации и информатизации здравоохранения. 2011; 4: 24-31. [Matveychik T.V., Valchuk E.E. Problems of primary medical care for elderly and senile patients. Voprosyi organizatsii i informatizatsii zdravoohraneniya. 2011; 4: 24-31. (in Russian)]
3. Мельникова Н.С. Патологические процессы в эндометрии у пациенток пожилого и старческого возраста: клинико-морфологические особенности: автореф. дисс. … канд. мед. наук. М.; 2015. 23c. [Melnikova N.S. Pathological processes in the endometrium in patients of elderly and senile age: clinical and morphological features: author’s abstract. diss. ... cand. med. sciences. Moscow; 2015. 23p. (in Russian)]
4. Бохман Я.В. Руководство по онкогинекологии. М.: Книга по Требованию; 2012. 464с. [Bohman Ya.V. Guide to oncogynecology. Moscow: The book on demand; 2012. 464p. (in Russian)]
5. Киселев В.И., Сидорова И.С., Унанян А.Л., Муйжнек Е.Л. Гиперпластические процессы органов женской репродуктивной системы: теория и практика. М.: Медпрактика-М; 2010. 467с. [Kiselev V.I., Sidorova I.S., Unanyan A.L., Muyzhnek E.L. Hyperplastic processes of the organs of the female reproductive system: theory and practice. Moscow: Medpraktika-M; 2010. 467p. (in Russian)]
6. Jones M.E., van Leeuwen F.E., Hoogendoorn W.E., Mourits M.J., Hollema H., van Boven H. et al. Endometrial cancer survival after breast cancer in relation to tamoxifen treatment: pooled results from three countries. Breast Cancer Res. 2012; 14(3): R91.
7. Runowicz C.D., Costantino J.P., Wickerham D.L., Cecchini R.S., Cronin W.M., Ford L.G. et al. Gynecologic conditions in participants in the NSABP breast cancer prevention study of tamoxifen and raloxifene (STAR). Am. J. Obstet. Gynecol. 2011; 205(6): 535. e1-5.
8. Negoiţă M., Terinte C., Mihailovici M.S. Tamoxifen and endometrial pathology. Rev. Med. Chir. Soc. Med. Nat. Iasi. 2010; 114(4): 1114-7.
9. Крапивин Б.В., Давыдов А.А., Дадаев Р.С., Латышев А.В., Орлов Д.А., Передков П.А. К вопросу о понятии „осложнение эндохирургической операции”. Эндоскопическая хирургия. 2001; 6: 3-9. [Krapivin B.V., Davyidov A.A., Dadaev R.S., Latyishev A.V., Orlov D.A., Peredkov P.A. On the issue of the concept of “complication of endosurgical operation”. Endoskopicheskaya hirurgiya. 2001; 6: 3-9. (in Russian)]
10. Казарян Л.C. Ближайшие и отдаленные результаты гистерорезектоскопии с оценкой качества жизни у больных подслизистой миомой матки и гиперпластическими процессами в эндометрии : автореф. дисс. … канд. мед. наук. М.; 2002. 21с. [Ghasaryan L.C. The immediate and long-term results of hysteroresectoscopy with an assessment of the quality of life in patients with submucous myoma of the uterus and hyperplastic processes in the endometrium: author’s abstract. diss. ... cand. med. sciences. Moscow; 2002. 21p. (in Russian)]
11. Обоскалова Т.А., Нефф Е.И., Глухов Е.Ю., Плотко Е.Э., Абакумова Е.И. Оценка эффективности метода термической баллонной абляции для лечения гиперпластических процессов эндометрия. Акушерство и гинекология. 2009; 4: 37-40. [Oboskalova T.A., Neff E.I., Gluhov E.Yu., Plotko E.E., Abakumova E.I. Otsenka effektivnosti metoda termicheskoy ballonnoy ablyatsii dlya lecheniya giperplasticheskih protsessov endometriya. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2009; 4: 37-40. (in Russian)]
12. Пашков В.М., Бахтияров К.Р. Оценка качества жизни женщин после гистерорезектоскопических операций. Вопросы гинекологии, акушерства и перинатологии. 2002; 1(1): 31-4. [Pashkov V.M., Bahtiyarov K.R. Evaluation of the quality of life of women after hysteroresectoscopic surgeries. Voprosyi ginekologii, akusherstva i perinatologii. 2002; 1(1): 31-4. (in Russian)]
13. Kucera E., Holub Z., Svobodova G. Laparoscopic oophorectomy either with or without hysterectomy for early breast cancer. Eur. J. Gynaecol. Oncol. 2007; 28(4): 294-6.
14. Edris F., Vilos G.A., Al-Mubarak A., Ettler H.C., Hollett-Caines J., Abu-Rafea B. Resectoscopic surgery may be an alternative to hysterectomy in high-risk women with atypical endometrial hyperplasia. J. Minim. Invasive Gynecol. 2007; 14(1): 68-73.
15. De Franciscis P., Grauso F., Cobellis L., Messalli E.M., Cucinella G., Perino A. et al. Outcomes of monopolar versus bipolar endometrial ablation on uterine bleeding and psychophysical wellbeing. Minerva Ginecol. 2017; 69(4): 328-35.
16. Адамян Л.В., Ткаченко Э.Р. Принципы гистерорезектоскопической хирургии (гистерорезектоскопии). В кн.: Кулаков В.И., Адамян Л.В., ред. Эндоскопия в диагностике, лечении и мониторинге женских болезней. М.: ПАНТОРИ; 2000: 484-500. [Adamyan L.V., Tkachenko E.R. Printsipyi gisterorezektoskopicheskoy hirurgii (gisterorezektoskopii). In: Kulakov V.I., Adamyan L.V., ed. Endoscopy in the diagnosis, treatment and monitoring of female diseases. Moscow: PANTORI; 2000: 484-500. (in Russian)]
17. Давыдов А.И., Стрижаков А.Н. Оперативная гистероскопия. М.: Династия; 2015. 196с. [Davyidov A.I., Strizhakov A.N. Operative hysteroscopy. Moscow: Dinastiya; 2015. 196p. (in Russian)]
18. Попов А.А., Баринова И.В., Чечнева М.А., Чаусова Н.А. Малоинвазивные методы лечения женщин с гиперпластическими процессами в эндометрии. Российский вестник акушера-гинеколога. 2007; 4: 50-3. [Popov A.A., Barinova I.V., Chechneva M.A., Chausova N.A. Minimally invasive methods of treatment of women with hyperplastic processes in the endometrium. Rossiyskiy vestnik akushera-ginekologa. 2007; 4: 50-3. (in Russian)]
19. Попов А.А., Мананникова Т.Н., Чечнева М.А., Чаусова Н.А., Кирюшкина О.Г. Аблация эндометрия по технологии Thermachoice в лечении гиперпластических процессов эндометрия. В кн.: Тезисы XVI Международной конференции РАРЧ «Вспомогательные репродуктивные технологии сегодня и завтра». Ростов-на-Дону 7-9 сентября 2017 года. Ростов-на-Дону; 2007: 133-4. [Popov A.A., Manannikova T.N., Chechneva M.A., Chausova N.A., Kiryushkina O.G. Ablation of the endometrium with Thermachoice technology in the treatment of endometrial hyperplastic processes. In: Theses of the XVI International Conference of the ARC “Auxiliary reproductive technologies today and tomorrow”. Rostov-on-Don on September 7-9, 2017. Rostov-on-Don; 2007: 133-4. (in Russian)]
20. Уланкина О.Г., Саркисов С.Э., Хужокова И.Н. Гистерорезектоскопическая деструкция эндометрия в лечении больных с гиперпластическими процессами в эндометрии в перименопаузальном периоде. Российский вестник акушера-гинеколога. 2009; 2: 69-72. [Ulankina O.G., Sarkisov S.E., Huzhokova I.N. Hysteroresectoscopic destruction of the endometrium in the treatment of patients with hyperplastic processes in the endometrium in the perimenopausal period. Rossiyskiy vestnik akushera-ginekologa. 2009; 2: 69-72. (in Russian)]
21. Berg A., Sandvik L., Langebrekke A., Istre O. A randomized trial comparing monopolar electrodes using glycine 1.5% with two different typesof bipolar electrodes (TCRis, Versapoint) using saline, in hysteroscopic surgery. Fertil. Steril. 2009; 91(4): 1273-8.
22. Бреусенко В.Г., Савельева Г.М., Голова Ю.А., Мишиева О.И. Лечение гиперпластических процессов эндометрия в периоде постменопаузы. Акушерство и гинекология. 2009; 4: 19-23. [Breusenko V.G., Saveleva G.M., Golova Yu.A., Mishieva O.I. Treatment of endometrial hyperplastic processes in the postmenopausal period. Akusherstvo i ginekologiya/Obstetrics and gynecology. 2009; (4): 19-23. (in Russian)]
23. Мельникова Н.С. Патологические процессы в эндометрии у пациенток пожилого и старческого возраста: клинико-морфологические особенности: автореф. дисс. … канд. мед. наук. М.; 2015. 23c. [Melnikova N.S. Pathological processes in the endometrium in patients of elderly and senile age: clinical and morphological features: author’s abstract. diss. ... cand. med. sciences. Moscow; 2015. 23p. (in Russian)]
24. Goldenberg M., Nezhat C., Seidman D.S. A randomized prospective study of the use of endometrial ablation for prevention of recurrent endometrial polyps in breast cancer patients receiving tamoxifen. Prim. Care Update Ob Gyns. 1998; 5(4): 160.
25. Gao W., Zhang L., Li W., Li J., Wang W., Zhao W., Feng L. Three-year follow-up results of polypectomy with endometrial ablation in the management of endometrial polyps associated with tamoxifen in Chinese women. Eur. J. Obstet. Gynecol. Reprod. Biol. 2012; 161(1): 62-5.
Received 08.09.2017
Accepted 22.09.2017
About the Authors
Sarkisov Sergey Eduardovich , MD, professor, head of the innovative department of minimally invasive technologies in gynecology, National Medical Research Centerof Obstetrics, Gynecology, and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia
Mamikonyan Irina Oganesovna, Junior Researcher of National Medical Research Center of Obstetrics, Gynecology, and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: irinamamikonyan@gmail.com
Pavlovich Stanislav Vladislavovich, Ph.D., Associate Professor, Scientific Secretary of National Medical Research Center of Obstetrics, Gynecology,
and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4
Barsegyan Gagik Omarovich, Junior Researcher of National Medical Research Center of Obstetrics, Gynecology, and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: 2390990@rambler.ru
Karamyshev Vyacheslav Konstantinovich, Candidate of Medical Science, acting. head. Innovative department of minimally invasive technologies in gynecology, National Medical Research Center of Obstetrics, Gynecology, and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4
Boyko Marina Alexandrovna, obstetrician-gynecologist, LLC “Medical Center”.
119021, Russia, Moscow, Timura Frunze str. 15/1. E-mail: bma555@bk.ru
Demidov Anton Vladimirovich, Junior Researcher of National Medical Research Center of Obstetrics, Gynecology, and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: demydow@ya.ru
Ulankina Olga Gennadievna, Ph.D., scientific employee of the innovative department of minimally invasive technologies in gynecology,
National Medical Research Center of Obstetrics, Gynecology, and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: olgaulankina@yandex.ru
Kuprashvili Maya Ilinichna, Ph.D., scientific employee of the innovative department of minimally invasive technologies in gynecology,
National Medical Research Center of Obstetrics, Gynecology, and Perinatology named after Academician V.I. Kulakov, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: ki-maya@mail.ru
For citations: Sarkisov S.E., Mamikonyan I.O., Pavlovich S.V., Barsegyan G.O.,
Karamyshev V.K., Boiko M.A., Demidov A.V., Ulankina O.G., Kuprashvili M.I.
Electrosurgical bi- and monopolar endometrial destruction in the prevention
of recurrent tamoxifen associated endometrial pathology in postmenopause.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2018; (5): 78-84. (in Russian)
https://dx.doi.org/10.18565/aig.2018.5.78-84
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