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A Comparison Between Laparotomy, Laparoscopy and Robotic-Assisted Radical Hysterectomy in Surgical Treatment of Early Stage Cervical Cancer
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Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
Subgroup analysis of women who underwent hysteroscopic myomectomy revealed a significantly lower amount of infused fluid for the MI group than for the PI group (1737905 mL vs. 34411952 mL, respectively; p=0.001). Infused fluid (coefficient=0.08, p\0.001) was the only significant independent factor affecting fluid deficit, with a constant of 76.1 (95% confidence interval=10.4-141.8, p=0.02). Conclusion: The MI method appears to be a safe and feasible method for delivering distending media during hysteroscopic procedures. 120
Open Communications 8 - Oncology (2:15 PM - 3:15 PM)
A Comparative Study of Clinical Characteristics and Preoperative Findings of Different Sarcoma Types Aoun J,1 Baum S,2 Buekers T,3 Schiff L,4 Eisenstein D,1 Tsafrir Z,1 Stovall D.5 1Minimally Invasive Gynecologic Surgery, Henry Ford Hospital, West Bloomfield, Michigan; 2Wayne State University, Wayne State University, Detroit, Michigan; 3Gynecology Oncology, Henry Ford Hospital, Detroit, Michigan; 4Minimally Invasive Gynecologic Surgery, University of North Carolina, Chapel Hill, North Carolina; 5Obstetrics and Gynecology, Riverside Health System, Newport News, Virginia Study Objective: To determine the clinical characteristics and preoperative findings of uterine sarcomas (US). Design: Retrospective cohort study. Setting: Academic affiliated Health System. Patients: All patients diagnosed with US between January 2004 and January 2015. Intervention: For comparison, women were divided into the following US types: leiomyosarcoma (LMS, 43%), malignant mixed m€ullerian tumor (MMMT, 42%), endometrial stromal sarcoma (ESS, 8%), and high-grade sarcomas (HGS, 7%). Measurements and Main Results: A total of 90 cases were reviewed. Almost half of the women diagnosed with LMS and ESS were premenopausal (p\ .001). Fifty-one % of women with LMS were being followed in clinic for known history of uterine fibroids as compared to only 13% in the MMMT group (p= .003). Overall, a uterine or pelvic mass was identified on imaging in 67% of cases. Of those, 85% were judged suspicious for malignancy by radiologists. The greatest dimension of the mass on imaging was significantly larger in women with LMS and HGS [14cm (7) and 13cm (9), respectively] as compared to MMMT and ESS [8cm (7) and 6cm (1), respectively, p= .025]. Only 44% of women with LMS had preoperative endometrial sampling versus 90% of MMMT, 100% of HGS and 86% of ESS (p\ .0001). Endometrial sampling identified cancer in 83% of women overall. It had a higher predictive value in diagnosing MMMT (100%) compared to the other sarcomas. Conclusion: In this retrospective analysis of US identified over 11 years in a practice group spanning urban and suburban populations, we found evidence to support that endometrial sampling and imaging can detect abnormalities leading to the diagnosis of US. In addition, we found evidence that practitioners should consider this diagnosis in pre-menopausal patients as well as those being conservatively followed for fibroids.
Setting: A solo experienced minimally invasive gynecological oncologic practice in a tertiary hospital. Patients: 115 patients underwent radical hysterectomy with bilateral pelvic lymphadenectomy (RHBPLND) for clinical stage I cervical cancer. From 1999-2008, 25 (21.7%) patients underwent open RHBPLND (ORHBPLND) and 34 (29.6%) patients underwent laparoscopic radical hysterectomy with pelvic lymphadenectomy (LRHBPLND). From 20082014, 56 (48.7%) patients underwent robotic radical hysterectomy with bilateral pelvic lymphadenectomy (RoRHBPLND). Intervention: Age, BMI, histology, grade of the tumor, status of lymph node, type of surgical treatment and survival data was retrospectively reviewed. Measurements and Main Results: During the period from 1999-2014, 115 patients underwent RHBPLND for clinical stage I cervical cancer. 70/115 (61%) were squamous histology while 45/115 (39%) were adenocarcinoma. 43/115 (37.3%) were stage 1a2, 54/115 (46.9%) stage 1B1, and 18/115 (15.8%) stage IB2. The overall 5 year survival was 88%. The 5 year PFS for robotic, laparoscopic and open surgical cohorts were 86%, 94%, and 88% respectively. There was no difference in 5 year survival for stage IA2, and IB1 for all 3 surgical procedures. Conclusion: The overall 5 year survival for Robotic radical hysterectomy with bilateral pelvic lymphadenectomy for treatment of clinical stage I cervical is 88%. There was no difference in 5 year survival between RoRHBPLND, LRHBPLND, and ORHBPLND. 122 A Comparison Between Laparotomy, Laparoscopy and Robotic-Assisted Radical Hysterectomy in Surgical Treatment of Early Stage Cervical Cancer Barletta F, Corrado G, Vizza E. Gynecology Oncology, National Cancer Institute, Rome, Italy Study Objective: To evaluate the best surgical approach between laparotomy,laparoscopy and robotic-assisted radical hysterectomy in patients with early cervical cancer (IA1,IB1). Design: A case control study. Setting: Department of Gynecology Oncology, National Cancer Institute Patients: From January 2001 to December 2014 a prospective data collection of 148 women was shared in three groups about different surgical approach. Were considered the characterisctics of patients and tumors,intraoperative parametres,early and late postoperative complications, recurrences. Measurements and Main Results: Difference statistically significant there was between abdominal and robotic group for blood loss (p=0.008) in favour of robotic group; still better results for robotic in comparison with the other two groups were on length of hospitalization; the rate of early postoperative complications is much lower in the robotic group (5%) against laparotomic (8%) and laparoscopic (13%) group.The follow up ( with median of 86 months for laparotomy,62 for laparoscopy and 35 months for robotic) did not register statistically significant differences in terms of recurrence. Conclusion: This study shows the advantages of robotic surgery in terms of blood loss and better postoperative status of the patients, optimizing the well known benefits of the minimally invasive approach.
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Comparison of Robotic Vs Laparoscopic or Open Radical Hysterectomy: Five Year Survival for Surgical Treatment for Clinic Stage I Cervical Cancer Lim PC, Kang EY. Gynecology Oncology, Center of Hope @ Renown Robotic Institute, Reno, Nevada
Early Stage Uterine Serous Carcinoma: Does Surgical Approach Impact Survival? Clark M,1 Glasgow M,2 Menderes G,3 Azodi M,3 Silasi DA.3 1 Obstetrics and Gynecology, Yale New Haven Health - Bridgeport Hospital, Bridgeport, Connecticut; 2Obstetrics and Gynecology, University of Minnesota, Minneapolis, Minnesota; 3Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
Study Objective: To determine and compare a difference in 5 year progression free survival (PFS) between robotic vs laparoscopic vs open radical hysterectomy in the treatment of clinical stage I cervical cancer. Design: A retrospective case matched cohort of robotic, laparoscopic, and open radical hysterectomy for treatment of clinical stage I cervical cancer was analyzed. Overall survival for surgical treatment for stage I cervical cancer was analyzed. The 5 year PFS for each respective surgical treatment was analyzed to determine if there was a difference between each surgical procedure.
Study Objective: The objective of this study was to evaluate the surgical and oncologic outcomes in patients with Stages I/II USC staged via minimally invasive surgical approaches compared with laparotomy. Design: A retrospective analysis of women with Stage I/II USC staged at 2 institutions between 2004 and 2013 was performed. The surgical approach
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253
Subgroup analysis of women who underwent hysteroscopic myomectomy revealed a significantly lower amount of infused fluid for the MI group than for the PI group (1737905 mL vs. 34411952 mL, respectively; p=0.001). Infused fluid (coefficient=0.08, p\0.001) was the only significant independent factor affecting fluid deficit, with a constant of 76.1 (95% confidence interval=10.4-141.8, p=0.02). Conclusion: The MI method appears to be a safe and feasible method for delivering distending media during hysteroscopic procedures. 120
Open Communications 8 - Oncology (2:15 PM - 3:15 PM)
A Comparative Study of Clinical Characteristics and Preoperative Findings of Different Sarcoma Types Aoun J,1 Baum S,2 Buekers T,3 Schiff L,4 Eisenstein D,1 Tsafrir Z,1 Stovall D.5 1Minimally Invasive Gynecologic Surgery, Henry Ford Hospital, West Bloomfield, Michigan; 2Wayne State University, Wayne State University, Detroit, Michigan; 3Gynecology Oncology, Henry Ford Hospital, Detroit, Michigan; 4Minimally Invasive Gynecologic Surgery, University of North Carolina, Chapel Hill, North Carolina; 5Obstetrics and Gynecology, Riverside Health System, Newport News, Virginia Study Objective: To determine the clinical characteristics and preoperative findings of uterine sarcomas (US). Design: Retrospective cohort study. Setting: Academic affiliated Health System. Patients: All patients diagnosed with US between January 2004 and January 2015. Intervention: For comparison, women were divided into the following US types: leiomyosarcoma (LMS, 43%), malignant mixed m€ullerian tumor (MMMT, 42%), endometrial stromal sarcoma (ESS, 8%), and high-grade sarcomas (HGS, 7%). Measurements and Main Results: A total of 90 cases were reviewed. Almost half of the women diagnosed with LMS and ESS were premenopausal (p\ .001). Fifty-one % of women with LMS were being followed in clinic for known history of uterine fibroids as compared to only 13% in the MMMT group (p= .003). Overall, a uterine or pelvic mass was identified on imaging in 67% of cases. Of those, 85% were judged suspicious for malignancy by radiologists. The greatest dimension of the mass on imaging was significantly larger in women with LMS and HGS [14cm (7) and 13cm (9), respectively] as compared to MMMT and ESS [8cm (7) and 6cm (1), respectively, p= .025]. Only 44% of women with LMS had preoperative endometrial sampling versus 90% of MMMT, 100% of HGS and 86% of ESS (p\ .0001). Endometrial sampling identified cancer in 83% of women overall. It had a higher predictive value in diagnosing MMMT (100%) compared to the other sarcomas. Conclusion: In this retrospective analysis of US identified over 11 years in a practice group spanning urban and suburban populations, we found evidence to support that endometrial sampling and imaging can detect abnormalities leading to the diagnosis of US. In addition, we found evidence that practitioners should consider this diagnosis in pre-menopausal patients as well as those being conservatively followed for fibroids.
Setting: A solo experienced minimally invasive gynecological oncologic practice in a tertiary hospital. Patients: 115 patients underwent radical hysterectomy with bilateral pelvic lymphadenectomy (RHBPLND) for clinical stage I cervical cancer. From 1999-2008, 25 (21.7%) patients underwent open RHBPLND (ORHBPLND) and 34 (29.6%) patients underwent laparoscopic radical hysterectomy with pelvic lymphadenectomy (LRHBPLND). From 20082014, 56 (48.7%) patients underwent robotic radical hysterectomy with bilateral pelvic lymphadenectomy (RoRHBPLND). Intervention: Age, BMI, histology, grade of the tumor, status of lymph node, type of surgical treatment and survival data was retrospectively reviewed. Measurements and Main Results: During the period from 1999-2014, 115 patients underwent RHBPLND for clinical stage I cervical cancer. 70/115 (61%) were squamous histology while 45/115 (39%) were adenocarcinoma. 43/115 (37.3%) were stage 1a2, 54/115 (46.9%) stage 1B1, and 18/115 (15.8%) stage IB2. The overall 5 year survival was 88%. The 5 year PFS for robotic, laparoscopic and open surgical cohorts were 86%, 94%, and 88% respectively. There was no difference in 5 year survival for stage IA2, and IB1 for all 3 surgical procedures. Conclusion: The overall 5 year survival for Robotic radical hysterectomy with bilateral pelvic lymphadenectomy for treatment of clinical stage I cervical is 88%. There was no difference in 5 year survival between RoRHBPLND, LRHBPLND, and ORHBPLND. 122 A Comparison Between Laparotomy, Laparoscopy and Robotic-Assisted Radical Hysterectomy in Surgical Treatment of Early Stage Cervical Cancer Barletta F, Corrado G, Vizza E. Gynecology Oncology, National Cancer Institute, Rome, Italy Study Objective: To evaluate the best surgical approach between laparotomy,laparoscopy and robotic-assisted radical hysterectomy in patients with early cervical cancer (IA1,IB1). Design: A case control study. Setting: Department of Gynecology Oncology, National Cancer Institute Patients: From January 2001 to December 2014 a prospective data collection of 148 women was shared in three groups about different surgical approach. Were considered the characterisctics of patients and tumors,intraoperative parametres,early and late postoperative complications, recurrences. Measurements and Main Results: Difference statistically significant there was between abdominal and robotic group for blood loss (p=0.008) in favour of robotic group; still better results for robotic in comparison with the other two groups were on length of hospitalization; the rate of early postoperative complications is much lower in the robotic group (5%) against laparotomic (8%) and laparoscopic (13%) group.The follow up ( with median of 86 months for laparotomy,62 for laparoscopy and 35 months for robotic) did not register statistically significant differences in terms of recurrence. Conclusion: This study shows the advantages of robotic surgery in terms of blood loss and better postoperative status of the patients, optimizing the well known benefits of the minimally invasive approach.
121
123
Comparison of Robotic Vs Laparoscopic or Open Radical Hysterectomy: Five Year Survival for Surgical Treatment for Clinic Stage I Cervical Cancer Lim PC, Kang EY. Gynecology Oncology, Center of Hope @ Renown Robotic Institute, Reno, Nevada
Early Stage Uterine Serous Carcinoma: Does Surgical Approach Impact Survival? Clark M,1 Glasgow M,2 Menderes G,3 Azodi M,3 Silasi DA.3 1 Obstetrics and Gynecology, Yale New Haven Health - Bridgeport Hospital, Bridgeport, Connecticut; 2Obstetrics and Gynecology, University of Minnesota, Minneapolis, Minnesota; 3Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
Study Objective: To determine and compare a difference in 5 year progression free survival (PFS) between robotic vs laparoscopic vs open radical hysterectomy in the treatment of clinical stage I cervical cancer. Design: A retrospective case matched cohort of robotic, laparoscopic, and open radical hysterectomy for treatment of clinical stage I cervical cancer was analyzed. Overall survival for surgical treatment for stage I cervical cancer was analyzed. The 5 year PFS for each respective surgical treatment was analyzed to determine if there was a difference between each surgical procedure.
Study Objective: The objective of this study was to evaluate the surgical and oncologic outcomes in patients with Stages I/II USC staged via minimally invasive surgical approaches compared with laparotomy. Design: A retrospective analysis of women with Stage I/II USC staged at 2 institutions between 2004 and 2013 was performed. The surgical approach