Surgical Staging Of Endometrial Cancer Research Articles

Factors Impacting Use of Robotic Surgery for Treatment of Endometrial Cancer in the United States.

This study was designed to examine the impact of patient socioeconomic, clinical, and hospital characteristics on the utilization of robotics in the surgical staging of endometrial cancer. Patients surgically treated for endometrial cancer at facilities that offered robotic and open approaches were identified from the National Inpatient Sample Database from 2008 to 2012. The groups were compared for socioeconomic, clinical, and hospital differences. Medical comorbidity scores were calculated using the Charlson comorbidity index. T tests and χ (2) were used to compare groups. Multivariable analyses were used to determine factors that were independently associated with a robotic approach. A total of 18,284 patients were included (robotic, n=7169; laparotomy, n=11,115). Significant differences were noted in all patient clinical and socioeconomic characteristics and all hospital characteristics. Multivariable analyses identified factors that independently predicted patients undergoing robotic surgery. These patients were older [adjusted odds ratio (aOR) 1.008; 95% confidence interval (CI) 1.004-1.011], white (aOR 1.38; 95% CI 1.27-1.50), and privately insured (aOR 1.16; 95% CI 1.07-1.26). Clinically, these women were more likely to be obese (aOR 1.20; 95% CI 1.11-1.30) and to be undergoing an elective case (aOR 1.25; 95% CI 1.11-1.40). Hospitals were more likely to be under private control (aOR 1.55, 95% CI 1.39-1.71) but less likely to be located in the south (aOR 0.87; 0.81-0.93), quantified as large or medium (aOR 0.57; 95%CI 0.50-0.67), or teaching hospitals (aOR 0.68; 95% CI 0.63-0.74). Socioeconomic status and hospital characteristics are factors that independently predict robotic utilization in the United States. These racial, socioeconomic, and geographic disparities warrant further study regarding the utilization of this important technology.

Sentinel Lymph Node Mapping in Endometrial Cancer: An Update.

: Lymph node removal for staging, as part of the initial surgical management of patients with endometrial carcinoma, remains a controversial topic in gynecologic oncology. There is currently wide variability among clinical practices, with surgical approaches ranging from no nodal evaluation to comprehensive pelvic and aortic lymphadenectomy. Lymphatic mapping has emerged as an increasingly popular option over the past few years, with several attractive features in its concept, innovative surgical approach, and encouraging preliminary results. At this time, however, several different techniques have been described and used for lymphatic mapping in endometrial cancer, incorporating a variety of mapping agents and injection sites. Although recently published results are encouraging, they are limited to single-institution series or multi-institutional collaborations undertaken without the aegis of a prospective randomized controlled trial. However, the surgical staging of endometrial cancer with lymphadenectomy was historically established based not on randomized trial data but on prospective clinicopathologic studies. Another evolving field in endometrial cancer staging is the interpretation of pathologic ultrastaging of sentinel lymph nodes (SLNs), which can identify low-volume metastases for which the clinical significance and the ideal management remain uncertain. This is particularly an issue with extremely low-volume nodal metastasis and isolated tumor cells. Furthermore, it has become apparent that applying a predefined SLN algorithm can decrease false-negative rates. The Memorial Sloan Kettering Cancer Center SLN algorithm can be used as a checklist to ensure standardization of care and to reduce the chance of missing nodal disease. Prospective trials are under way at many institutions to help establish the definitive role of SLN mapping for staging of endometrial cancer. The objective of this study was to provide an update on the latest clinical data related to lymphatic mapping for the staging and management of endometrial cancer and its role in clinical practice. Lymphatic mapping is an increasingly popular option in the surgical treatment of endometrial cancer. The aim of using this tool is to target the lymph nodes that are the most likely to be involved with metastatic cancer cells (sentinel lymph nodes) and thereby limit the extent of surgery needed and decrease surgical complications and long-term side effects associated with extensive lymph node removal. By examining a limited number of sentinel lymph nodes, a more detailed examination of the node can be done (ultrastaging). This allows for the detection of a small number of cancer cells (low-volume metastasis) that can be missed with standard techniques.

Predictive Factor of Conversion to Laparotomy in Minimally Invasive Surgical Staging for Endometrial Cancer.

The aim of the study was to identify risk factors associated with laparotomy conversion during total laparoscopic hysterectomy for endometrial cancer. This is a retrospective study examining endometrial cancer cases that underwent hysterectomy-based surgical staging initiated via conventional laparoscopic approach. Factors related to patient, tumor, and surgeon were examined to establish risk of laparotomy conversion using a multivariate logistic regression model. There were 251 cases identified including 30 cases (12.0%) of laparotomy conversion. The most common indication for laparotomy conversion was a large uterus (27.0%), followed by extensive adhesions (24.3%) and surgical complications (18.9%). Outcomes of cases resulting in laparotomy conversion include longer surgical time (333 vs 224 minutes, P < 0.001), larger blood loss (350 vs 100 mL, P < 0.001), longer hospital stay (4 vs 2 days, P < 0.001), and increased risk of hospital readmission (10% vs 1.4%, P = 0.024). In multivariate analysis, morbid obesity (odds ratio [OR], 4.51; P = 0.011), suboptimal pelvic examination or enlarged uterus during preoperative evaluation (OR, 3.55; P = 0.034), para-aortic lymphadenectomy (OR, 10.5; P = 0.001), uterine size 250 g or greater (OR, 3.49; P = 0.026), and extrauterine disease (OR, 4.68; P = 0.012) remained the independent predictors for laparotomy conversion. The following numbers of risk factors were significantly correlated with laparotomy-conversion rate: none, 1.1%; single risk factor, 5.3% (OR, 5.00; P = 0.15); double risk factors, 21.7% (OR, 24.9; P = 0.002); and triple or more risk factors, 50% (OR, 90.0; P < 0.001). Ultrasonographic 3-dimensional volumes of 496 cm in preoperative uterine size correlate with actual uterine weight of 250 g (Y = 61.5 + 0.38X, P < 0.001). Laparotomy conversion significantly impacts outcomes of patients with endometrial cancer. In this setting, our predictive model for laparotomy conversion will be useful to guide the surgical management of endometrial cancer.

A Prospective, Comparative Study for the Evaluation of Postoperative Pain and Quality of Recovery in Patients Undergoing Robotic Versus Open Hysterectomy for Staging of Endometrial Cancer

Study ObjectiveTo measure and compare postoperative pain and patient satisfaction in patients undergoing either robotic or open laparotomy for surgical staging of endometrial cancer. DesignProspective, comparative study (Canadian Task Force classification II). SettingUniversity hospital. PatientsA total of 142 patients undergoing either robotic or open laparotomy for surgical staging of endometrial cancer. InterventionsPatients scheduled for surgical staging of endometrial cancer at a single institution were identified. The patients underwent either robotic or open hysterectomy for staging of endometrial cancer. The choice of operative approach (robotic vs laparotomy) was made by the faculty physician before enrollment. Patients participated in the study for up to 48 hours for pain assessments and up to 10 ± 3 days postoperatively for quality of recovery assessments. Measurements and Main ResultsThe following measurements were performed: postoperative pain with the visual analog scale (VAS), 24-hour opioid consumption, and quality of recovery using the Quality of Recovery Questionnaire (QoR-40). The study was terminated owing to futility, given the lack of open procedures at our institution. Despite that lack of statistically significant difference between VAS scores at rest and with leg extension, there was a significant decrease in 24-hour opioid consumption in the robotic group. In addition, the QoR-40 showed an increased perception of recovery in patients within the robotic group compared with the laparotomy group. ConclusionPatients with endometrial cancer who underwent robotic surgery had decreased postoperative opioid consumption and improved quality of recovery compared with those who underwent surgery via laparotomy.

Herniation formation in women undergoing robotically assisted laparoscopy or laparotomy for endometrial cancer

ObjectiveTo compare the incidence of trocar site hernia in women who underwent robotically assisted laparoscopic surgery (RBT) for endometrial cancer staging with the incidence of ventral hernia formation in patients who underwent laparotomy (LAP) for the same indication. To analyze risk factors for hernia formation in women undergoing RBT for endometrial cancer. MethodsWe retrospectively identified all patients who underwent surgical staging for endometrial cancer via RBT or LAP from 2009–2012. Clinicopathologic data were analyzed. Appropriate statistical tests were used. Results738 patients were staged via RBT (n=567) or LAP (n=171). Overall median age was 61years (RBT range, 33–90; LAP range,28–86; p=0.4). Median BMI was 29.5kg/m2 (range, 17.9–66) and 30.3kg/m2 (range, 16.8–67.2), respectively (p=1.0). Eleven (1.9%) of 567 patients in the RBT cohort developed a trocar site hernia compared with 11 (6.4%) of 171 LAP patients who developed a ventral hernia (p=0.002). Median time to diagnosis was 18months (range, 3–49) and 17months (range, 7–30), respectively (p=0.7). Of the 11 RBT patients who developed a trocar site hernia, 10 (91%) were midline defects and 1 (9%) was a lateral defect of a prior inferior epigastric port site. No hernias required emergent operative intervention. Four (0.7%) of 567 RBT patients compared with 2 (1.2%) of 171 LAP patients required surgical hernia repair (p=0.4). ConclusionsTrocar site herniation after RBT staging for endometrial cancer is uncommon and less likely to occur than ventral hernia formation with LAP staging. Furthermore, surgical revision rates are low.

Perioperative Outcomes in Robotic-Assisted Versus Conventional Laparoscopic Treatment of Endometrial Cancer

Objective: To compare perioperative outcomes of robotic-assisted (RALS) versus conventional laparoscopic surgery (CLS) in endometrial cancer. Methods: This is a retrospective analysis of a prospectively maintained database of procedures performed from January 2009 to January 2014 by a single surgeon experienced in both minimally invasive techniques. One hundred and five patients underwent surgical staging of endometrial cancer via either conventional or robotic-assisted laparoscopy. Characteristics such as age, body mass index (BMI), prior abdominal surgery, number of comorbidities, stage of disease, and extent of surgery were compared. Outcomes, including estimated blood loss (EBL), operating room time (ORT), length of stay (LOS), number of lymph nodes resected, conversion rates, and intra-operative and postoperative complications were analyzed. Results: Fifty-seven patients received RALS; 48 had CLS. RALS patients had a higher mean BMI (38.1 ± 11.8 vs. 30.1 ± 7.5 kg/m2; p=0.0003) and more comorbidities. Median ORT was longer for RALS patients [277 (135-660) vs. 223.5 (120-547) minutes; p=0.0012]. RALS ORT remained significantly longer for BMI ≥ 25 to 35 groups. Only in the BMI ≥ 30 to <35 group there was no apparent difference in the ORT. Among patients with endometrioid adenocarcinoma histology, ORT was longer in the RALS group [273 (135-660) vs. 222 (120-420) minutes; p=0.0018]. There was no difference in EBL or LOS between the two surgical approaches. Conclusions: In our experience, perioperative outcomes of endometrial cancer staging are comparable between RALS and CL. Furthermore, the overall ORT is significantly longer in the RALS group. Further studies of patients stratified by BMI are needed.

Perioperative Outcomes for Laparotomy Compared to Robotic Surgical Staging of Endometrial Cancer in the Elderly: A Retrospective Cohort.

Perioperative Outcomes for Laparotomy Compared to Robotic Surgical Staging of Endometrial Cancer in the Elderly: A Retrospective Cohort.

Novel technique for the complete staging of endometrial cancer by single-port laparoscopy

ObjectiveOur aim was to evaluate the feasibility of a novel technique using single-port laparoscopy for the complete surgical staging of endometrial cancer. MethodsTotal hysterectomy, bilateral salpingo-oophorectomy, pelvic lymphadenectomy and para-aortic lymphadenectomy was performed using a single-port device in two steps: first, a retroperitoneal para-aortic dissection was conducted, followed by a transperitoneal pelvic lymphadenectomy and a total hysterectomy. Conventional laparoscopic instruments were used in all cases. Perioperative details were collected. ResultsFour consecutive patients with endometrial cancer underwent single-port laparoscopic staging procedure. All cases were high-risk endometrial cancers (two FIGO stage IA and two IB). Histologic types included three adenocarcinomas and one carcinosarcoma. The median operating time was 280min (ranged 240–320min), and the median length of stay was 3.5days (ranged 3–6days). No complications or conversion to conventional multiport laparoscopy were reported. ConclusionsSingle-port laparoscopic surgical staging for endometrial cancer is a feasible procedure, even when the procedure included a para-aortic lymph node dissection.

Postoperative rehabilitation following surgical staging of endometrial cancer: A hidden cost savings of robotic surgery?

Postoperative rehabilitation following surgical staging of endometrial cancer: A hidden cost savings of robotic surgery?

Comparative outcomes in older and younger women undergoing laparotomy or robotic surgical staging for endometrial cancer

Older patients are at increased risk of perioperative morbidity and mortality. There are limited data on the safety of a robotic approach in the staging for endometrial cancer. We compared outcomes in women undergoing laparotomy or robotic surgical staging for endometrial cancer. Using the Healthcare Cost and Utilization Project National Inpatient Sample database from 2008 through 2010, we abstracted records for patients who had surgery for endometrial cancer with either a robotic approach or laparotomy. Patients were categorized by age (<65 vs ≥65 years and 5-year increments). Medical comorbidity scores were calculated using the Charlson Comorbidity Index. Outcomes included intraoperative/perioperative/medical complications, death, length of stay (LOS), and discharge disposition. Student t and χ(2) tests were used to compare groups and approach. Multiple analysis of variance models were used to compare differences between robotics and laparotomy and age groups. We identified 16,980 patients who had surgery for endometrial cancer with either a robotic approach (age ≥65 years, n = 1228; age <65 years, n = 1574) or laparotomy (age ≥65 years, n = 5914; age <65 years, n = 8264). Older patients had a higher Charlson Comorbidity Index score at the time of surgery (2.6 vs 2.5, P < .001). In laparotomy cases, intraoperative complication rates were similar (4.1% vs 3.7%, P = .17). Older patients had higher rates of perioperative surgical (20.5% vs 15.4%, P < .001) and medical (23.3% vs 15.5%, P < .001) complications, longer LOS (5.1 vs 4.2 days, P < .001), and lower rates of discharge to home (71.2% vs 90.1%, P < .001). In robotic cases, rates of intraoperative complications were similar (5.9% vs 6.8%, P = .32). Older patients had higher rates of perioperative surgical (8.3% vs 5.2%, P = .001) and medical (12.3% vs 6.7%, P = .001) complications, longer LOS (2.00 vs 1.67 days, P < .001), and lower rates of discharge to home (88.8% vs 96.8%, P < .001). With both approaches, as age increased, perioperative surgical and medical complications also increased in a linear fashion. In a subanalysis of older patients (n = 7142), there were lower rates of perioperative surgical (8.3% vs 20.5%, P < .001) and medical (12.3% vs 23.3%, P < .001) complications, death (0.0% vs 0.8%, P < .001), shorter LOS (2.00 vs 5.13 days, P < .001) and higher rate of discharge to home (88.8% vs 71.2%, P < .001) in robotic compared to laparotomy cases. Although the risks of surgery increase with age, in patients age ≥65 years, a robotic approach for endometrial cancer appears to be safe given current selection criteria utilized in the United States.

Relative Morbidity and Mortality of Panniculectomy-Combined Surgical Staging in Endometrial Cancer.

To examine intraoperative and postoperative complication rates for surgical staging combined with panniculectomy for endometrial cancer. A prospectively collected institutional surgical database was used to identify patients with endometrial cancer who underwent hysterectomy-based surgical staging between December 2008 and August 2014 (n = 551). The cases were grouped into surgical staging with panniculectomy (panniculectomy group, n = 11 [2.0%]), laparotomy without panniculectomy (laparotomy group, n = 208 [37.7%]), and laparoscopy (minimally invasive surgery group, n = 332 [60.3%]). Major complication and surgical wound complication rates within 30 days from surgery were compared. The panniculectomy group had a significantly higher body mass index compared with other approaches (panniculectomy group, laparotomy group, and minimally invasive surgery group: 60.4, 35.7, and 34.1; P < 0.001) and had a high stage I disease rate (90.9%, 61.5%, and 88.3%; P < 0.001). Mean pannus weight was 5733 g (4.4% of body weight). Intraoperative major complication rates were statistically nonsignificant across the groups (0%, 7.2%, and 4.2%; P = 0.23); however, the panniculectomy group had a significantly higher postoperative major complication rate compared with other approaches (36.4%, 16.3%, and 5.1%; P < 0.001). In multivariate analysis controlling for age, ethnicity, body habitus, medical comorbidities, and tumor factors, panniculectomy remained an independent predictor for increased risk of postoperative major complications (adjusted odds ratio, 4.37; P = 0.043). Surgical mortality rates were similar across the groups (0%, 0.5%, and 0%; P = 0.44). Among superobese patients (n = 50), intraoperative and postoperative complication rates were statistically similar across the 3 groups (all, P > 0.05). Although panniculectomy-combined surgical staging is associated with an increased risk of postoperative complications, the majority recovered uneventfully, making this approach a feasible treatment option, especially for superobese patients with endometrial cancer.

2738 Role of surgical staging in Endometrial cancer: 5 years regional cancer institute experience

2738 Role of surgical staging in Endometrial cancer: 5 years regional cancer institute experience

Abstract 4996: Expression of the estrogen receptor, progesterone receptor and PTEN in endometrial cancers from women with type II diabetes mellitus

Abstract Objectives: The anti-diabetic drug, metformin, has been found to decrease proliferation, reduce estrogen receptor (ER) expression and inhibit downstream targets of the mTOR pathway in a pre-operative window study in endometrial cancer patients. Thus, we compared the endometrial cancers between patients with Type II diabetes taking metformin versus those not on metformin, in regards to expression of ER, progesterone receptor (PR) and PTEN. Methods: Patients with Type II diabetes who underwent surgical staging for endometrial cancer at our institution were identified. These patients were divided into two cohorts based on whether or not they were on metformin. The use of insulin and other anti-diabetic agents was recorded. Using triplicate cores from surgical specimens, a tissue microarray was constructed from formalin-fixed paraffin-embedded hysterectomy specimens. ER, PR and PTEN expression was measured by immunohistochemistry in both the epithelial and stromal components of the tumors. H scores were calculated, averaged among the triplicate cores, and compared between the two groups using Mann-Whitney U test and negative binomial regression analysis. Results: Triplicate cores were obtained from 162 endometrial cancers from patients with Type II diabetes. Of the 162 patients, 102 (63%) were taking metformin and 60 (37%) were not on metformin. Median BMI for metformin users and non-users was 40 and 37, respectively (p = 0.04). There was no significant difference in tumor stage, grade or histology between the two groups. There was no association between metformin use and PR or PTEN expression. There was a trend towards higher ER expression in the non-metformin users, which was statistically significant for stromal cells (p = 0.04) but not for epithelial cells (p = 0.13). However, when adjusting for age, BMI, race, tumor grade and stage, there was no association between metformin use and ER expression. The median H score for ER did differ between tumors from patients on metformin only (median 26) versus insulin only (median 91), but this was not statistically significant. Conclusions: Expression of ER, PR and PTEN in endometrial cancers did not differ amongst patients with Type II diabetes regardless of whether their diabetes treatment regimen involved metformin or insulin. Further studies are underway to compare the endometrial cancers of metformin users versus non-users in regards to other insulin and mTOR signaling targets. Citation Format: Dario R. Roque, Arthur M. Dizon, Brooke Rambally, Siobhan O'Connor, Paola A. Gehrig, Sheri A. Denslow, Victoria L. Bae-Jump. Expression of the estrogen receptor, progesterone receptor and PTEN in endometrial cancers from women with type II diabetes mellitus. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4996. doi:10.1158/1538-7445.AM2015-4996

Adjuvant radiotherapy in Stage II endometrial carcinoma: Is brachytherapy alone sufficient for local control?

To evaluate recurrence patterns and overall survival in patients treated with adjuvant radiation after surgical staging for Stage II endometrial carcinoma. Secondary goals include identification of prognostic factors for recurrence and toxicity assessment. The medical records of 41 patients treated with adjuvant radiotherapy at Washington University School of Medicine after surgical staging for endometrial cancer (total abdominal hysterectomy and bilateral salpingo-oophorectomy, peritoneal cytology, lymph node dissection) were reviewed. Nineteen were treated with a combination of external beam radiotherapy and vaginal brachytherapy (VB), and 22 patients were treated with postoperative VB alone. Median followup for all patients was 41 months. Median patient age was 59 years (range, 42-87 years). All tumors were of endometrioid histology. There were 20 Grade 1 tumors, 13 Grade 2 tumors, and 8 Grade 3 tumors. For all patients, the 5-year overall survival was 69.8%, and the 5-year recurrence-free survival was 89.0%. There was no statistically significant difference in overall survival (p = 0.510) or freedom from vaginal (p = 0.840), distant (p = 0.133), or any recurrence (p = 0.275) with respect to modality of treatment (external beam radiotherapy and VB vs. VB alone). There were no pelvic lymph node recurrences. In the univariate analysis, there were no risk factors influencing overall survival or recurrences. One patient experienced a toxicity requiring hospital admission. She was treated with pelvic external beam radiation plus brachytherapy. VB alone results in excellent local control for patients with Stage II endometrial cancer after surgical staging. Long-term toxicities are rare and more common in the group of patients who were treated with pelvic external beam plus brachytherapy.

Contributing factors for menopausal symptoms after surgical staging for endometrial cancer

Contributing factors for menopausal symptoms after surgical staging for endometrial cancer

Comparison of myometrial invasion and tumor free distance from uterine serosa in endometrial cancer.

We aimed to investigate whether the tumor free distance (the distance between the uterine serosa and the tumor at its deepest point) is useful in surgical staging and in predicting prognosis. Data from patients who underwent complete surgical staging for endometrial cancer between January 2006 and June 2011 were reviewed retrospectively. All demographic findings, surgical stages, histological type and grade, myometrial invasion, lymphovascular space invasion as well as abdominal cytology, cervical, adnexal, and omental involvement, and lymph node metastasis were recorded. The relations between myometrial invasion and tumor free distance from uterine serosa with prognostic factors were investigated. Seventy patients were included in the study. Sixty-four (91.5%) had endometrioid type cancers and forty-four (62.9%) were grade 1. The deepest myometrial invasion was less than 1/2 in 42 patients (60%). In 18 patients (25.8%) lymphovascular invasion was noted. Eight (11.4%) were found to have cervical involvement, five (7.1%) had adnexal involvement and in 4 cases (5.7%) the peritoneal washings included malignant cells. Four patients had pelvic and one para-aortic node metastasis. We recognized that an invasion of more than 1/2 was correlated significantly with lymphovascular space involvement, histological grade, positive abdominal washing cytology, nodal and cervical involvement, but not with adnexal involvement. Tumor-free myometrial thickness was negative and statistically significant correlated with surgical stage, histological grade, lymphovascular space involvement, positive abdominal washing cytology, cervical and adnexal involvement. The importance of tumor- free myometrial thickness in determinating the lymphovascular space invasion was found to be highest in terms of sensitivity and specificity when crossing the ROC curve at 11 millimeters. Depth of myometrial invasion is more valuable for predicting lymph node metastasis than tumor-free myometrial thickness. The tumor-free myometrial thickness provides a better prediction for adnexal involvement.

Robotic surgery in supermorbidly obese patients with endometrial cancer

Morbid obesity is a known risk factor for the development of endometrial cancer. Several studies have demonstrated the overall feasibility of robotic-assisted surgical staging for endometrial cancer as well as the benefits of robotics compared with laparotomy. However, there have been few reports that have evaluated robotic surgery for endometrial cancer in the supermorbidly obese population (body mass index [BMI], ≥50 kg/m(2)). We sought to evaluate safety, feasibility, and outcomes for supermorbidly obese patients who undergo robotic surgery for endometrial cancer, compared with patients with lower body mass indices. We performed a retrospective chart review of 168 patients with suspected early-stage endometrial adenocarcinoma who underwent robotic surgery for the management of their disease. Analysis of variance and univariate logistic regression were used to compare patient characteristics and surgical variables across all body weights. Cox proportional hazard regression was used to determine the impact of body weight on recurrence-free and overall survival. The mean BMI of our cohort was 40.9 kg/m(2). Median follow up was 31 months. Fifty-six patients, 30% of which had grade 2 or 3 tumors, were supermorbidly obese with a BMI of ≥50 kg/m(2) (mean, 56.3 kg/m(2)). A comparison between the supermorbidly obese and lower-weight patients demonstrated no differences in terms of length of hospital stay, blood loss, complication rates, numbers of pelvic and paraaortic lymph nodes retrieved, or recurrence and survival. There was a correlation between BMI and conversion to an open procedure, in which the odds of conversion increased with increasing BMI (P = .02). Offering robotic surgery to supermorbidly obese patients with endometrial cancer is a safe and feasible surgical management option. When compared with patients with a lower BMI, the supermorbidly obese patient had a similar outcome, length of hospital stay, blood loss, complications, and numbers of lymph nodes retrieved.

Is Peritoneal Cytology a Prognostic Factor in Endometrial Cancer?

The International Federation of Gynecology and Obstetrics (FIGO) changed the surgical staging criteria for endometrial cancer in 2009, namely combining FIGO 1988 Stage IA and IB in FIGO 2009 Stage IA, eliminating cervical glandular involvement from Stage II, and removing peritoneal cytology as criteria from Stage IIIA (3). This review of the literature sheds light on the continued debate among authorities on the utility of peritoneal cytology in surgical staging of endometrial cancer. At the time FIGO removed peritoneal cytology from the staging criteria in 2009, there was little to no evidence to support its removal. In fact, FIGO continues to recommend obtaining peritoneal cytology, which is in contradiction to their staging criteria. While a few small studies support the idea that peritoneal cytology does not preclude a worse prognosis, a number of large scale studies with at least 300 patients demonstrate a clear association between survival and the presence of malignant peritoneal cytology (11 - 12, 15 - 19). In one of the largest studies, investigators reviewed 14,704 from the SEER’s database, demonstrating that malignant peritoneal cytology is associated with decreased survival across Stage I/II disease even when controlled for histology, grade, and other risk factors. Malignant peritoneal cytology should be considered when counseling patients on the risk of recurrence and overall survival of endometrial cancer. However, the role of adjuvant treatment in this setting remains unclear.

Swelling among women who need education about leg lymphedema: a descriptive study of lymphedema in women undergoing surgery for endometrial cancer.

In addition to hysterectomy and bilateral salpingo-oophorectomy, comprehensive surgical staging for endometrial cancer includes pelvic and para-aortic lymphadenectomy. Clarifying and addressing the morbidity from these surgical procedures is imperative. The goal of this study was to assess the prevalence of lower extremity swelling after surgery for endometrial cancer. We performed a descriptive, cross-sectional survey study of women who underwent surgery for endometrial cancer at our institution from 2006 to 2008. Survey information included symptoms, management, and education regarding lymphedema. Demographic information such as race and education was collected in addition to clinical data such as body mass index and age. Of the 482 patients identified, 440 were determined eligible and 305 (69.3%) responded to the survey with information on lower limb swelling (LLS). Of the 108 (35%) responders who reported swelling, only 68 (22%) participants reported a diagnosis of lower limb lymphedema (LLL). The most commonly experienced symptoms among those who reported LLS were tightness, pain/tenderness, and heaviness. Among those with a diagnosis of LLL, most (60%) stated it affected their daily activities and noted exacerbating factors such as prolonged standing, heat, and walking. The most common therapies used to reduce symptoms included leg elevation (96%), compression stockings (65%), diuretics (46%), massage therapy (35%), and bandaging (25%). There was no association between LLS or LLL diagnosis and body mass index, age, race, and tobacco use. Only 8% of responders reported receiving preoperative education regarding risks for LLS and a desire for more comprehensive education was frequently noted. The patient-reported incidence of LLS occurred in approximately 35% of survey participants who underwent surgery for endometrial cancer. However, only 22% reported a diagnosis of LLL. Efforts to obtain the true incidence of LLL and to develop effective educational materials and programs to improve the management of lymphedema are warranted.

Comparative Outcomes in Older and Younger Women Undergoing Laparotomy or Robotic Surgical Staging for Endometrial Cancer

Guy, Michael S. MD; Sheeder, Jeanelle MSPH, PhD; Guntupalli, Saketh R. MD; Behbakht, Kian MD Author Information