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2303 Comparison of Laparoscopy and Laparotomy in Primary Cytoreductive Surgery of Advanced Epithelial Ovarian Cancer
Abstracts / Journal of Minimally Invasive Gynecology 26 (2019) S98−S231 Virtual Poster Session 4: Oncology (1:30 PM — 1:40 PM) 1:30 PM: STATION L 2303 Comparison of Laparoscopy and Laparotomy in Primary Cytoreductive Surgery of Advanced Epithelial Ovarian Cancer Eom JM,* Choi JS, Bae J, Lee WM, Jung US, Lee H. Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Korea, Republic of (South) *Corresponding author. Study Objective: The aim of this study was to assess the surgical and oncologic outcome of laparoscopic primary cytoreductive surgery on advanced epithelial ovarian cancer in comparison with conventional laparotomy surgery. Design: Retrospective cohort study. Setting: University hospital in Korea. Patients or Participants: Patients with FIGO stage up to III ovarian cancer undergoing laparoscopic primary cytoreductive surgery from January 2011 to March 2019 were matched to controls treated with laparotomic cytoreduction during the same period. Interventions: Laparoscopic and laparotomic optimal cytoreduction. Measurements and Main Results: The surgical and long-term outcome with advanced ovarian cancer were compared. The laparoscopic group (n=30) and laparotomic group (n=24) had similar age, BMI, stages, histologic type and final stage. There were no significant differences in operating time (P = 0.08) and blood loss (P = 0.34). The laparoscopic group exhibited significantly shorter hospital stay (P = 0.002) and time to start to treat adjuvant chemotherapy (P < 0.001). No significant difference were observed either in intra-operative or in perioperative complications between the two groups (P = 0.67). No statistical difference was observed for percentage of R0 resection (99.5% vs. 97.3 %, P < 0.001). No significant differences were observed in the progression-free survival and overall survival between the two groups during the medium follow-up. Conclusion: Laparoscopic and laparotomic primary cytoreduction were similar in surgical and oncologic outcome. Laparoscopic primary cytoreduction in highly selected patients with advanced ovarian cancer was feasible and not to inferior in laparotomic surgery. Prospective randomized trials are required to evaluate the overall oncologic outcomes. Virtual Poster Session 4: Oncology (1:30 PM — 1:40 PM) 1:30 PM: STATION M 1870 Comparison of Laparoscopic Versus Open Radical Hysterectomy in Early Cervical Cancer after Completing Learning Curve and Reducing Intraperitoneal Tumor Exposure Park JY,* Kim JH. Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asian Medical Center, Seoul, Korea, Republic of (South) *Corresponding author. Study Objective: The main limitation of LACC trial is that the surgeon validation criteria for laparoscopic radical hysterectomy was not enough to include surgeons who completed learning curve for laparoscopic radical hysterectomy. So, the comparison between open and laparoscopic surgery was unfair. In addition, there was no safety measure to reduce intraperitoneal tumor exposure during laparoscopic radical hysterectomy. The aim of this study was to compare the survival outcomes between laparoscopic versus open radical hysterectomy in early cervical cancer after completing learning curve and reducing intraperitoneal tumor exposure. Design: This was a retrospective study including patients with stage IA2 − IIA2 cervical cancer who underwent laparoscopic or open radical hysterectomy. All surgeons completed the learning curve for laparoscopic radical
S225 hysterectomy. To reduce the intraperitoneal tumor exposure during laparoscopic radical hysterectomy, all broken tumor tissues were washed out before colpotomy, and colpotomy and stump repair has been performed transvaginally. The survival outcomes were compared between laparoscopic and open radical hysterectomy. Setting: University hospital. Patients or Participants: 2,222 patients with early cervical cancer Interventions: Laparoscopic and open radical hysterectomy. Measurements and Main Results: During the study period, 854 and 1368 patients underwent open and laparoscopic radical hysterectomy, respectively. The 5-year DFS and OS did not differ between laparoscopic and open radical hysterectomy. The survival outcomes did not differ between laparoscopic and open radical hysterectomy both in patients with tumor < 4 cm and with tumor > 4 cm. The use of laparscopic surgery increased gradually and has become the main surgical approach during the study period. Each year’s survival rate was not compromised despite the increased use of laparoscopic radical hysterectomy. Conclusion: The survival outcome of laparoscopic radical hysterectomy is comparable to open radical hysterectomy after completing learning curve and reducing intraperitoneal tumor exposure during surgery.
Virtual Poster Session 4: Oncology (1:30 PM — 1:40 PM) 1:30 PM: STATION N 1538 Incidence of Gynecologic Cancers in Women after Uterine Fibroid Embolization Lee EM,1,* Matthews BJ,1 Rodriguez JV,2 Perkins R,1 Morgan JR,3 O’Horo S,4 Paasche-Orlow MK2. 1Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA; 2General Internal Medicine, Boston University School of Medicine, Boston, MA; 3Infectious Diseases, Boston University School of Medicine, Boston, MA; 4Interventional Radiology, Boston University School of Medicine, Boston, MA *Corresponding author. Study Objective: To estimate the likelihood that patients who have undergone uterine fibroid embolization (UFE) for leiomyomata will go on to develop subsequent gynecologic cancer that may have been prevented with hysterectomy. Design: We identified women over 18 years old without prior diagnosis of cancer who had undergone UFE for treatment of leiomyomata in the MarketScan database between 2007 and 2016. Records were then electronically queried for any diagnostic or procedure codes (ICD9, ICD10, and CPT) related to uterine, cervical, tubal, or ovarian malignancies occurring after the UFE procedure date through the end of data available. All charts identified through electronic query had all codes manually reviewed by a minimum of three coders to confirm diagnosis of cancer, and discrepancies were resolved by consensus. Diagnosis of cancer was defined as having at least two codes for gynecological malignancy submitted at least one week apart and/or with malignancy codes linked to tissue pathology results. Descriptive statistics were generated for the final study sample. Setting: N/A Patients or Participants: Patient data was obtained from MarketScan, a database of diagnostic and treatment data for over 60 million commercially insured individuals in the US. Interventions: N/A Measurements and Main Results: Between 2007 and 2016, 20,575 women underwent UFE. Fifty-one women met criteria for exhibiting cancer after UFE (37/51, 73% uterine cancer; 13/51, 25% ovarian cancer; 1/ 51, 2% cervical cancer). One in 403 (95% CI: 1 in 354 to 1 in 469) women undergoing UFE developed a gynecologic malignancy. On average, women exhibited cancer within 2.3 years from the date of UFE with a standard deviation of §2.14 years and a range of 17 days to 7.8 years. Conclusion: A small fraction of women undergoing UFE develop subsequent gynecologic malignancies. Women choosing uterine preservation with UFE should be counseled about the risk of developing gynecologic
S225 hysterectomy. To reduce the intraperitoneal tumor exposure during laparoscopic radical hysterectomy, all broken tumor tissues were washed out before colpotomy, and colpotomy and stump repair has been performed transvaginally. The survival outcomes were compared between laparoscopic and open radical hysterectomy. Setting: University hospital. Patients or Participants: 2,222 patients with early cervical cancer Interventions: Laparoscopic and open radical hysterectomy. Measurements and Main Results: During the study period, 854 and 1368 patients underwent open and laparoscopic radical hysterectomy, respectively. The 5-year DFS and OS did not differ between laparoscopic and open radical hysterectomy. The survival outcomes did not differ between laparoscopic and open radical hysterectomy both in patients with tumor < 4 cm and with tumor > 4 cm. The use of laparscopic surgery increased gradually and has become the main surgical approach during the study period. Each year’s survival rate was not compromised despite the increased use of laparoscopic radical hysterectomy. Conclusion: The survival outcome of laparoscopic radical hysterectomy is comparable to open radical hysterectomy after completing learning curve and reducing intraperitoneal tumor exposure during surgery.
Virtual Poster Session 4: Oncology (1:30 PM — 1:40 PM) 1:30 PM: STATION N 1538 Incidence of Gynecologic Cancers in Women after Uterine Fibroid Embolization Lee EM,1,* Matthews BJ,1 Rodriguez JV,2 Perkins R,1 Morgan JR,3 O’Horo S,4 Paasche-Orlow MK2. 1Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA; 2General Internal Medicine, Boston University School of Medicine, Boston, MA; 3Infectious Diseases, Boston University School of Medicine, Boston, MA; 4Interventional Radiology, Boston University School of Medicine, Boston, MA *Corresponding author. Study Objective: To estimate the likelihood that patients who have undergone uterine fibroid embolization (UFE) for leiomyomata will go on to develop subsequent gynecologic cancer that may have been prevented with hysterectomy. Design: We identified women over 18 years old without prior diagnosis of cancer who had undergone UFE for treatment of leiomyomata in the MarketScan database between 2007 and 2016. Records were then electronically queried for any diagnostic or procedure codes (ICD9, ICD10, and CPT) related to uterine, cervical, tubal, or ovarian malignancies occurring after the UFE procedure date through the end of data available. All charts identified through electronic query had all codes manually reviewed by a minimum of three coders to confirm diagnosis of cancer, and discrepancies were resolved by consensus. Diagnosis of cancer was defined as having at least two codes for gynecological malignancy submitted at least one week apart and/or with malignancy codes linked to tissue pathology results. Descriptive statistics were generated for the final study sample. Setting: N/A Patients or Participants: Patient data was obtained from MarketScan, a database of diagnostic and treatment data for over 60 million commercially insured individuals in the US. Interventions: N/A Measurements and Main Results: Between 2007 and 2016, 20,575 women underwent UFE. Fifty-one women met criteria for exhibiting cancer after UFE (37/51, 73% uterine cancer; 13/51, 25% ovarian cancer; 1/ 51, 2% cervical cancer). One in 403 (95% CI: 1 in 354 to 1 in 469) women undergoing UFE developed a gynecologic malignancy. On average, women exhibited cancer within 2.3 years from the date of UFE with a standard deviation of §2.14 years and a range of 17 days to 7.8 years. Conclusion: A small fraction of women undergoing UFE develop subsequent gynecologic malignancies. Women choosing uterine preservation with UFE should be counseled about the risk of developing gynecologic