Conservative hysteroscopic treatment of endometrial intraepithelial neoplasia and endometrial cancer in patients with high surgical risk with mechanical hysteroscopic tissue removal systems: A retrospective cohort study

Objective: To compare surgical and oncologic outcomes between conventional resectoscopic surgery and mechanical hysteroscopic tissue removal (mHTR) systems in high-risk patients not suitable for standard surgery undergoing conservative treatment for multifocal endometrial atypical hyperplasia/endometrial intraepithelial neoplasia (EAH/EIN) or early-stage low-grade endometrioid endometrial cancer (EEC). Methods: We conducted a single-center, retrospective cohort study at the Department of Gynecology and Physiopathology of Human Reproduction, S. Orsola-Malpighi Hospital, University of Bologna, Italy. A total of 31 high-surgical-risk patients with EAH/EIN or early-stage low-grade EEC were included: 18 underwent conventional resectoscopic endo-myometrial resection, while 13 were treated with mHTR systems. All patients received a levonorgestrel-releasing intrauterine device (LNG-IUD) postoperatively. After treatment, patients underwent an 18-month follow up with endometrial biopsies every 6 months. Results: The mHTR group had significantly shorter operative times (mean 12.3 ± 7.7 min) compared with the resectoscopic surgery group (mean 40.6 ± 11.8 min, P < 0.001). Additionally, the incidence of intrauterine adhesions was lower in the mHTR group (P < 0.001). There were no significant differences between the two groups in terms of disease presence at 6, 12, or 18 months. Conclusions: Hysteroscopic endo-myometrial resection, with resectoscopic technique or with mHTR systems, combined with LNG-IUD may represent a safe alternative for patients at high surgical risk with EAH/EIN or early-stage low-grade EEC. Moreover, mHTR demonstrated advantages such as shorter operative times and fewer adhesions. A large multicenter prospective study is needed to confirm our study findings.