Lavie Michael, Rattan Gilad, Englander Dana, Ram Shai, Solomon Neta, Michaan Nadav, Grisaru Dan, Laskov Ido
Department of Gynecologic Oncology, Lis Hospital for Women, Tel Aviv Medical Center, Israel.
Sackler School of Medicine, Tel Aviv University, Israel.
Gynecol Oncol Rep. 2025 Mar 25;58:101728. doi: 10.1016/j.gore.2025.101728. eCollection 2025 Apr.
Endometrial cancer, the most common gynecologic malignancy in developed nations, poses substantial treatment challenges, particularly in patients with significant comorbidities or advanced obesity.
This manuscript introduces an innovative method that employs awake hysteroscopic endometrial laser ablation (HEA) as a palliative treatment for patients with endometrial cancer who were either inoperable or medically unfit to undergo general or regional anaesthesia for conventional therapies.
A retrospective evaluation of patients diagnosed with endometrial cancer at a tertiary center from 2019 to 2024, focusing on those with symptomatic uterine bleeding, who failed previous treatment options and could not undergo surgical or standard palliative interventions due to high surgical risk.
In our study, three patients (n = 3) with severe medical conditions-high BMI and poor performance status-underwent awake HEA using a vaginoscopic approach, treating symptomatic vaginal bleeding effectively. The procedure allowed for rapid treatment, minimal recovery time, and enhanced quality of life. Histological analyses post-ablation indicated satisfactory outcomes, contributing to symptom relief and stabilization of patients' conditions.
Our findings highlight the potential of conscious HEA as a palliative management strategy in high-risk patient populations, emphasizing its role when conventional therapies fail. This study underscores the importance of personalized treatment plans and multidisciplinary approaches in managing endometrial cancer, paving the way for further research into the safety and efficacy of HEA in similar cohorts.
子宫内膜癌是发达国家最常见的妇科恶性肿瘤，带来了重大的治疗挑战，尤其是在患有严重合并症或重度肥胖的患者中。
本论文介绍了一种创新方法，即采用清醒宫腔镜子宫内膜激光消融术（HEA）作为对因无法手术或因医学原因不适于接受常规治疗的全身或区域麻醉的子宫内膜癌患者的姑息治疗方法。
对2019年至2024年在一家三级中心被诊断为子宫内膜癌的患者进行回顾性评估，重点关注有症状性子宫出血、先前治疗方案失败且因手术风险高而无法接受手术或标准姑息干预的患者。
在我们的研究中，三名患有严重疾病（高体重指数和低体能状态）的患者采用阴道镜检查方法接受了清醒HEA，有效治疗了有症状的阴道出血。该手术实现了快速治疗、最短恢复时间并提高了生活质量。消融后的组织学分析显示结果令人满意，有助于缓解症状并稳定患者病情。
我们的研究结果凸显了清醒HEA作为高危患者群体姑息治疗策略的潜力，强调了其在传统治疗失败时的作用。本研究强调了个性化治疗方案和多学科方法在子宫内膜癌管理中的重要性，为进一步研究HEA在类似患者群体中的安全性和有效性铺平了道路。
