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A Detailed Analysis of the Learning Curve: Da Vinci Robot-Assisted Radical Hysterectomy in Cervical Cancer
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Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253 Virtual Posters – Oncology
A Comparative Study of Preoperative Findings and Outcomes in Pre-Menopausal and Post-Menopausal Women With Leiomyosarcoma Aoun J,1 Baum S,2 Buekers T,3 Schiff L,4 Theoharis E,1 Tsafrir Z.1 1 Minimally 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 Study Objective: To determine the preoperative findings and outcomes in pre-menopausal and post-menopausal women with leiomyosarcoma. Design: Retrospective cohort study. Setting: Academic affiliated Health System. Patients: All patients diagnosed with LMS between January 2004 and January 2015. Intervention: For comparison, women were divided into two groups according to their menopausal status, premenopausal (49%) and postmenopausal (51%). Measurements and Main Results: A total of 39 women with LMS were identified, with a mean age at diagnosis of 59 12 years. Around half of them were pre-menopausal. Enlarging uterine fibroids on imaging were more commonly found in pre-menopausal women compared to postmenopausal women, 75% vs 25%, respectively (p= .001). Preoperative imaging more frequently detected a suspicious mass in post-menopausal women (100% versus 61% in pre-menopausal women, p= .0039). Overall, half of samples taken from the uterus were diagnostic for LMS. Around a third of women with LMS were diagnosed preoperatively. The most common stages at diagnosis were stage 1 (51%) and stage 4 (35%). Among patients who underwent LNs assessment, 27% had positive lymph nodes. Of the 31 women who had removal of the adnexa, 5 women had metastasis to at least one adnexa (16%). Post-menopausal women were at a 209% increased hazard of dying compared to pre-menopausal women (p= .041). Conclusion: In this retrospective analysis of LMS identified over 11 years in a practice group spanning urban and suburban populations, we found evidence to support that LMS is a perimenopausal tumor that can be diagnosed preoperatively in 33% of cases. Imaging that details mass characteristics and serial growth plays an important role in diagnosis. A dichotomy in disease state exists at diagnosis. 777 Outcomes of Endometrial Cancer Patients at Risk of Lymph Node Metastasis With Para-Aortic Lymphadenectomy Below the Level of Inferior Mesenteric Artery Lee J-Y,1 Lee TS.2 1Department of Obstetrics and Gynecology, Yonsei University, Seoul, Korea; 2Department of Obstetrics and Gynecology, SMG-SNU Boramae Medical Center, Seoul, Korea Study Objective: The aim of this study was to demonstrate the patterns of recurrence in patients who underwent surgical treatment including pelvic lymphadenectomy (PLND) with or without para-aortic lymphadenectomy (PALND) below the level of inferior mesenteric artery (IMA). Design: A retrospective chart review was carried out for 239 endometrial cancer patients with intermediate and high risk of recurrence between 2000 and 2011 from two medical centers. Setting: two medical centers. Patients: All patients underwent surgical staging including complete PLND with or without incomplete PALND (all cases below the level of inferior mesenteric artery). Rates of recurrence in the respective sites were compared according to the extent of lymphadenectomy. Intervention: PLND vs PALND (below the level of inferior mesenteric artery) Measurements and Main Results: Of the study population, 136 patients underwent PLND and 103 patients underwent PALND. The Kaplan-Meier curve and the log rank test showed no difference in progression-free survival between PLND group and PLND+PALND group (P=0.9763).
The rate of para-aortic node recurrence and isolated para-aortic recurrence was 7.5% (15/239) and 4.6% (11/239) in both groups. The rate of para-aortic recurrence was higher in PLND group than PLND+PALND group, although there was no statistically significance (8.8% vs 5.8%, P = 0.384). When pelvic nodes metastasis was found, the rate of para-aortic recurrence was higher in both groups (16.0% vs. 14.3%, P = 0.855). Conclusion: Para-aortic lymph node recurrence was frequently observed even in patients including PALND below IMA level. Surgical staging with PALND below the level of IMA followed by adjuvant therapy might not be sufficient to replace complete PALND up to the renal vein level as a treatment for occult metastatic nodes. 778 Laparoscopic Restaging Surgery in Patients With Unexpected Uterine Cancer Lee WM,1 Choi JS,1 Bae J,1 Koh AR,1 Jung US,2 Ko JH.3 1Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Republic of Korea; 2Department of Obstetrics and Gynecology, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea; 3Department of Obstetrics and Gynecology, Kangwon National University Hospital, Gangwon-Do, Republic of Korea Study Objective: We investigate the feasibility of laparoscopic restaging surgery in patients with unexpected uterine cancer. Design: Retrospective study. Setting: University teaching hospital. Patients: Eight patients who underwent laparoscopic restaging surgery due to unexpected uterine cancer after prior hysterectomy or myomectomy from January 2008 to July 2014 at Hanyang university hospital. Intervention: Laparoscopic restaging surgery including pelvic lymphadenectomy, para-aortic lymphadenectomy, washing cytology, a biopsy of any suspicious lesion and removal remained uterus, ovary and fallopian tube. Measurements and Main Results: The median age of the patients and BMI were 55 (44-78) years and 23.8 (20.75-31.89)kg/m2. The median interval between prior hysterectomy and the restaging surgery was 21 (range, 10–35) days. The median values of operating time and return of bowel activity were 365 (200-475) minutes and 35 (18-50) hours, respectively. The median number of harvested pelvic and para-aortic lymph node were 17 (14-29) and 20 (7-36), respectively. In seven of the eight patients, uterine extraction was performed with vaginal or electronic morcellation. Final FIGO stage was IA in all patients. Patient 4 had a synchronous primary cancer of endometrium and left ovary, which stage were IA each other. Of the eight subjects, two received chemotherapy, and none received radiotherapy. All patients were alive without disease recurrence until now. Conclusion: The restaging surgery is necessary for patients with unexpected uterine malignancy, and laparoscopy would be the best option for complete staging and planning appropriate adjuvant treatment. 779 A Detailed Analysis of the Learning Curve: Da Vinci Robot-Assisted Radical Hysterectomy in Cervical Cancer Cao L, Xu H, Chen Y, Pan K, Liang Z. Obstetrics & Gynecology, Southwest Hospital, Third Military Medical University, Chongqing, China Study Objective: To evaluate the learning curve of da Vinci robotic surgical system for radical hysterectomy in cervical cancer and to study the key points for surgeons to shorten the learning curve quickly. Design: Retrospective review. Setting: Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University. Patients: Clinical data of 50 cervical cancer cases, which performed da Vinci robot-assisted radical hysterectomy by the same group of surgeons between March 2010 and April 2014. The cases were divided into 3 groups (phase I, II and III) according to the sequence of the operation.
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253 Demographic data, surgical parameters and histopathology details were analyzed. Intervention: We performed da Vinci robot-assisted radical hysterectomy. The learning curve was evaluated using the cumulative summation (CUSUM) technique. Measurements and Main Results: The mean operating time (273.988.5 min) of phase I was significantly longer than phase II (222.051.4min) (p = 0.032) and phase III (218.250.6 min) (p = 0.015). Significant differences were found among the 3 groups which the number of pelvic autonomic nerve preservation and para-aortic lymph node resection, (p \ 0.005). There were no significant differences between the three groups with respect to lymph node yield and identifying positive lymph nodes, and pathologic outcome. Time to resume voiding function did differ between the three groups, (p \ 0.005). The learning period of da Vinci robotic surgical system for radical hysterectomy to reach a turning point was calculated to be 30 cases. Conclusion: An extended learning period can be required for da Vinci robotic surgical system for radical hysterectomy, during which pathologic outcome of radical hysterectomy may not be adversely affected. As for the surgeons with abundant experiences of laparoscopic surgery for cervical cancer surgery, after about 30 resections, they can overcome the learning curve and master da Vinci robotic surgical system for radical hysterectomy in cervical cancer. 780 Clinical Outcomes of Type II Endometrial Cancer in Open Versus Minimally Invasive Staging Surgery Farag S, Andikyan V, Fields J, Kanis M, Rahaman J, Kolev V, Hayes M. Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York Study Objective: Type II endometrial cancer is associated with poor outcomes. The purpose of this study is to report the clinical outcomes of patients who underwent laparotomy versus minimally invasive (MIS) staging surgery. Design: A retrospective search of all women who underwent staging for type II endometrial cancer was performed. The patients were divided into two groups: group A underwent laparotomy and group B underwent MIS procedures including robotic and laparoscopic approaches. Relevant demographic, clinical, and pathological data was collected. Setting: Staging surgeries took place at one large academic referral center by several board-certified gynecologic oncologists. Patients: Patients with type II endometrial cancer who underwent surgical staging between 1992 and 2014. Intervention: The Student’s t-test and the Chi Square test were used to compare the groups. The log-rank test was used to perform survival analysis using the Kaplan-Meier method. Measurements and Main Results: We identified 176 patients with type II endometrial cancer. The conversion rate was 8%. There was no difference found between the two groups in age (p=1.00), BMI (p=1.00), number of patients with early stage (stages I and II) and late stage (stages III and IV) disease (p=0.08), average number of pelvic (p=0.78) or para-aortic (p=0.68) lymph nodes removed, or number of patients who had optimal debulking (p=0.67). The median surgical time was 187 minutes (range: 50-484) in group A and 211 minutes (range: 61-350) in group B. The median blood loss was 200 mL (range: 25-1500 mL) for group A and 150 mL (range: 15-350 mL) for group B. The median follow-up time was 34.5 months (range: 1-223). The upper 25th percentile of patients had a PFS of 18 months for group A and 38 months for group B (p=0.31). Conclusion: MIS and laparotomy staging procedures for high-risk endometrial cancer appear to have similar surgical outcomes. 781 Comparison of Clinical Outcomes of Bovie Blade Versus Cold Knife Conization as a Treatment Modality of High-Grade Cervical Intraepithelial Neoplasia Hong J,1 So KA,2 Kim JW.3 1Guro Hospital College of Medicine Korea University, Seoul, Gyeonggi-do, Korea; 2Cheil General Hospital and
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Women Healthcare Center, Seoul, Gyeonggi-do, Korea; Ansan Hospital College of Medicine Korea University, Ansan, Gyeonggi-do, Korea Study Objective: To compare the clinical outcomes of Bovie blade conization (BBC) versus cold knife conization (CKC) for high-grade cervical intraepithelial neoplasia (CIN). Design: Retrospective cohort study. Setting: University teaching hospital. Patients: 792 patients with CIN 2-3 who underwent conization between 2000 and 2013. Intervention: BBC or CKC. Measurements and Main Results: Of 792 patients, 472 underwent BBC, and the remaining 320 CKC. There were no significant differences in age, parity, cervical cytology, and HPV load between two groups. Overall rate of positive resection margin was 12.4%; Fifty-one patients (10.8%) in BBC and 47 patients (14.7%) in CKC, respectively (P = 0.123). Sizes of the surgical specimens were significantly smaller in BBC than CKC (diameter, P \ 0.001; depth, P = 0.050). Recurrent disease was defined as a newly developed high-grade CIN or worse in patients having negative resection margin on surgical specimen. To analyze the actual recurrence rate, we excluded patients showing CIN persisting for no more than 12 months following conization. Overall recurrence rate was 5.5% (24/440). 11 patients (4.5%) were in BBC and 13 patients (6.7%) were in CKC. There were no differences in terms of recurrence rate (P = 0.399) and mean time to recurrence (29.1 vs. 40.4 months; P = 0.179). However, in CKC, the number of preterm delivery was higher than that of BBC (6 vs. 1; P = 0.017). Conclusion: BBC is proven to be comparable to CKC in terms of safety and oncologic outcome. 782 A Comparative Study of the Methods of Diagnosis and Outcomes of Different Uterine 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, Michigan Study Objective: To determine the methods of cancer diagnosis and outcomes 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 US cases were analyzed. Only 18% of USs were incidental diagnoses, but the frequency varied by subtype with a relatively high risk for LMS (28%) and a very low risk for MMMT (3%). The combination of endometrial sampling and intraoperative pathology assessment of imaging abnormalities lead to the detection of most women with USs. The majority of women with MMT and HGS were staged at the time of hysterectomy (97% and 100%, respectively) compared to only 69% of women with LMS and 57% with ESS (p= .015). Two of the 90 US were morcellated. Twenty-nine % of women with US had distant metastasis at time of diagnosis, and almost 50% throughout their lifetime. Alive women with no evidence of disease made up 34% of the LMS group, 47% of the MMMT group, 0% in the HGS group, and 86 % in the ESS group. Conclusion: In our retrospective analysis of US identified over 11 years in a practice group spanning urban and suburban populations, we found that the practitioner should be alert to the significant risk of incidental discovery of US at surgery. In order to optimize the surgical care of women, endometrial biopsy should be considered in screening women with signs/symptoms of
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253 Virtual Posters – Oncology
A Comparative Study of Preoperative Findings and Outcomes in Pre-Menopausal and Post-Menopausal Women With Leiomyosarcoma Aoun J,1 Baum S,2 Buekers T,3 Schiff L,4 Theoharis E,1 Tsafrir Z.1 1 Minimally 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 Study Objective: To determine the preoperative findings and outcomes in pre-menopausal and post-menopausal women with leiomyosarcoma. Design: Retrospective cohort study. Setting: Academic affiliated Health System. Patients: All patients diagnosed with LMS between January 2004 and January 2015. Intervention: For comparison, women were divided into two groups according to their menopausal status, premenopausal (49%) and postmenopausal (51%). Measurements and Main Results: A total of 39 women with LMS were identified, with a mean age at diagnosis of 59 12 years. Around half of them were pre-menopausal. Enlarging uterine fibroids on imaging were more commonly found in pre-menopausal women compared to postmenopausal women, 75% vs 25%, respectively (p= .001). Preoperative imaging more frequently detected a suspicious mass in post-menopausal women (100% versus 61% in pre-menopausal women, p= .0039). Overall, half of samples taken from the uterus were diagnostic for LMS. Around a third of women with LMS were diagnosed preoperatively. The most common stages at diagnosis were stage 1 (51%) and stage 4 (35%). Among patients who underwent LNs assessment, 27% had positive lymph nodes. Of the 31 women who had removal of the adnexa, 5 women had metastasis to at least one adnexa (16%). Post-menopausal women were at a 209% increased hazard of dying compared to pre-menopausal women (p= .041). Conclusion: In this retrospective analysis of LMS identified over 11 years in a practice group spanning urban and suburban populations, we found evidence to support that LMS is a perimenopausal tumor that can be diagnosed preoperatively in 33% of cases. Imaging that details mass characteristics and serial growth plays an important role in diagnosis. A dichotomy in disease state exists at diagnosis. 777 Outcomes of Endometrial Cancer Patients at Risk of Lymph Node Metastasis With Para-Aortic Lymphadenectomy Below the Level of Inferior Mesenteric Artery Lee J-Y,1 Lee TS.2 1Department of Obstetrics and Gynecology, Yonsei University, Seoul, Korea; 2Department of Obstetrics and Gynecology, SMG-SNU Boramae Medical Center, Seoul, Korea Study Objective: The aim of this study was to demonstrate the patterns of recurrence in patients who underwent surgical treatment including pelvic lymphadenectomy (PLND) with or without para-aortic lymphadenectomy (PALND) below the level of inferior mesenteric artery (IMA). Design: A retrospective chart review was carried out for 239 endometrial cancer patients with intermediate and high risk of recurrence between 2000 and 2011 from two medical centers. Setting: two medical centers. Patients: All patients underwent surgical staging including complete PLND with or without incomplete PALND (all cases below the level of inferior mesenteric artery). Rates of recurrence in the respective sites were compared according to the extent of lymphadenectomy. Intervention: PLND vs PALND (below the level of inferior mesenteric artery) Measurements and Main Results: Of the study population, 136 patients underwent PLND and 103 patients underwent PALND. The Kaplan-Meier curve and the log rank test showed no difference in progression-free survival between PLND group and PLND+PALND group (P=0.9763).
The rate of para-aortic node recurrence and isolated para-aortic recurrence was 7.5% (15/239) and 4.6% (11/239) in both groups. The rate of para-aortic recurrence was higher in PLND group than PLND+PALND group, although there was no statistically significance (8.8% vs 5.8%, P = 0.384). When pelvic nodes metastasis was found, the rate of para-aortic recurrence was higher in both groups (16.0% vs. 14.3%, P = 0.855). Conclusion: Para-aortic lymph node recurrence was frequently observed even in patients including PALND below IMA level. Surgical staging with PALND below the level of IMA followed by adjuvant therapy might not be sufficient to replace complete PALND up to the renal vein level as a treatment for occult metastatic nodes. 778 Laparoscopic Restaging Surgery in Patients With Unexpected Uterine Cancer Lee WM,1 Choi JS,1 Bae J,1 Koh AR,1 Jung US,2 Ko JH.3 1Division of Gynecologic Oncology and Gynecologic Minimally Invasive Surgery, Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Republic of Korea; 2Department of Obstetrics and Gynecology, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea; 3Department of Obstetrics and Gynecology, Kangwon National University Hospital, Gangwon-Do, Republic of Korea Study Objective: We investigate the feasibility of laparoscopic restaging surgery in patients with unexpected uterine cancer. Design: Retrospective study. Setting: University teaching hospital. Patients: Eight patients who underwent laparoscopic restaging surgery due to unexpected uterine cancer after prior hysterectomy or myomectomy from January 2008 to July 2014 at Hanyang university hospital. Intervention: Laparoscopic restaging surgery including pelvic lymphadenectomy, para-aortic lymphadenectomy, washing cytology, a biopsy of any suspicious lesion and removal remained uterus, ovary and fallopian tube. Measurements and Main Results: The median age of the patients and BMI were 55 (44-78) years and 23.8 (20.75-31.89)kg/m2. The median interval between prior hysterectomy and the restaging surgery was 21 (range, 10–35) days. The median values of operating time and return of bowel activity were 365 (200-475) minutes and 35 (18-50) hours, respectively. The median number of harvested pelvic and para-aortic lymph node were 17 (14-29) and 20 (7-36), respectively. In seven of the eight patients, uterine extraction was performed with vaginal or electronic morcellation. Final FIGO stage was IA in all patients. Patient 4 had a synchronous primary cancer of endometrium and left ovary, which stage were IA each other. Of the eight subjects, two received chemotherapy, and none received radiotherapy. All patients were alive without disease recurrence until now. Conclusion: The restaging surgery is necessary for patients with unexpected uterine malignancy, and laparoscopy would be the best option for complete staging and planning appropriate adjuvant treatment. 779 A Detailed Analysis of the Learning Curve: Da Vinci Robot-Assisted Radical Hysterectomy in Cervical Cancer Cao L, Xu H, Chen Y, Pan K, Liang Z. Obstetrics & Gynecology, Southwest Hospital, Third Military Medical University, Chongqing, China Study Objective: To evaluate the learning curve of da Vinci robotic surgical system for radical hysterectomy in cervical cancer and to study the key points for surgeons to shorten the learning curve quickly. Design: Retrospective review. Setting: Department of Obstetrics and Gynecology, Southwest Hospital, Third Military Medical University. Patients: Clinical data of 50 cervical cancer cases, which performed da Vinci robot-assisted radical hysterectomy by the same group of surgeons between March 2010 and April 2014. The cases were divided into 3 groups (phase I, II and III) according to the sequence of the operation.
Abstracts / Journal of Minimally Invasive Gynecology 22 (2015) S1–S253 Demographic data, surgical parameters and histopathology details were analyzed. Intervention: We performed da Vinci robot-assisted radical hysterectomy. The learning curve was evaluated using the cumulative summation (CUSUM) technique. Measurements and Main Results: The mean operating time (273.988.5 min) of phase I was significantly longer than phase II (222.051.4min) (p = 0.032) and phase III (218.250.6 min) (p = 0.015). Significant differences were found among the 3 groups which the number of pelvic autonomic nerve preservation and para-aortic lymph node resection, (p \ 0.005). There were no significant differences between the three groups with respect to lymph node yield and identifying positive lymph nodes, and pathologic outcome. Time to resume voiding function did differ between the three groups, (p \ 0.005). The learning period of da Vinci robotic surgical system for radical hysterectomy to reach a turning point was calculated to be 30 cases. Conclusion: An extended learning period can be required for da Vinci robotic surgical system for radical hysterectomy, during which pathologic outcome of radical hysterectomy may not be adversely affected. As for the surgeons with abundant experiences of laparoscopic surgery for cervical cancer surgery, after about 30 resections, they can overcome the learning curve and master da Vinci robotic surgical system for radical hysterectomy in cervical cancer. 780 Clinical Outcomes of Type II Endometrial Cancer in Open Versus Minimally Invasive Staging Surgery Farag S, Andikyan V, Fields J, Kanis M, Rahaman J, Kolev V, Hayes M. Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York Study Objective: Type II endometrial cancer is associated with poor outcomes. The purpose of this study is to report the clinical outcomes of patients who underwent laparotomy versus minimally invasive (MIS) staging surgery. Design: A retrospective search of all women who underwent staging for type II endometrial cancer was performed. The patients were divided into two groups: group A underwent laparotomy and group B underwent MIS procedures including robotic and laparoscopic approaches. Relevant demographic, clinical, and pathological data was collected. Setting: Staging surgeries took place at one large academic referral center by several board-certified gynecologic oncologists. Patients: Patients with type II endometrial cancer who underwent surgical staging between 1992 and 2014. Intervention: The Student’s t-test and the Chi Square test were used to compare the groups. The log-rank test was used to perform survival analysis using the Kaplan-Meier method. Measurements and Main Results: We identified 176 patients with type II endometrial cancer. The conversion rate was 8%. There was no difference found between the two groups in age (p=1.00), BMI (p=1.00), number of patients with early stage (stages I and II) and late stage (stages III and IV) disease (p=0.08), average number of pelvic (p=0.78) or para-aortic (p=0.68) lymph nodes removed, or number of patients who had optimal debulking (p=0.67). The median surgical time was 187 minutes (range: 50-484) in group A and 211 minutes (range: 61-350) in group B. The median blood loss was 200 mL (range: 25-1500 mL) for group A and 150 mL (range: 15-350 mL) for group B. The median follow-up time was 34.5 months (range: 1-223). The upper 25th percentile of patients had a PFS of 18 months for group A and 38 months for group B (p=0.31). Conclusion: MIS and laparotomy staging procedures for high-risk endometrial cancer appear to have similar surgical outcomes. 781 Comparison of Clinical Outcomes of Bovie Blade Versus Cold Knife Conization as a Treatment Modality of High-Grade Cervical Intraepithelial Neoplasia Hong J,1 So KA,2 Kim JW.3 1Guro Hospital College of Medicine Korea University, Seoul, Gyeonggi-do, Korea; 2Cheil General Hospital and
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Women Healthcare Center, Seoul, Gyeonggi-do, Korea; Ansan Hospital College of Medicine Korea University, Ansan, Gyeonggi-do, Korea Study Objective: To compare the clinical outcomes of Bovie blade conization (BBC) versus cold knife conization (CKC) for high-grade cervical intraepithelial neoplasia (CIN). Design: Retrospective cohort study. Setting: University teaching hospital. Patients: 792 patients with CIN 2-3 who underwent conization between 2000 and 2013. Intervention: BBC or CKC. Measurements and Main Results: Of 792 patients, 472 underwent BBC, and the remaining 320 CKC. There were no significant differences in age, parity, cervical cytology, and HPV load between two groups. Overall rate of positive resection margin was 12.4%; Fifty-one patients (10.8%) in BBC and 47 patients (14.7%) in CKC, respectively (P = 0.123). Sizes of the surgical specimens were significantly smaller in BBC than CKC (diameter, P \ 0.001; depth, P = 0.050). Recurrent disease was defined as a newly developed high-grade CIN or worse in patients having negative resection margin on surgical specimen. To analyze the actual recurrence rate, we excluded patients showing CIN persisting for no more than 12 months following conization. Overall recurrence rate was 5.5% (24/440). 11 patients (4.5%) were in BBC and 13 patients (6.7%) were in CKC. There were no differences in terms of recurrence rate (P = 0.399) and mean time to recurrence (29.1 vs. 40.4 months; P = 0.179). However, in CKC, the number of preterm delivery was higher than that of BBC (6 vs. 1; P = 0.017). Conclusion: BBC is proven to be comparable to CKC in terms of safety and oncologic outcome. 782 A Comparative Study of the Methods of Diagnosis and Outcomes of Different Uterine 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, Michigan Study Objective: To determine the methods of cancer diagnosis and outcomes 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 US cases were analyzed. Only 18% of USs were incidental diagnoses, but the frequency varied by subtype with a relatively high risk for LMS (28%) and a very low risk for MMMT (3%). The combination of endometrial sampling and intraoperative pathology assessment of imaging abnormalities lead to the detection of most women with USs. The majority of women with MMT and HGS were staged at the time of hysterectomy (97% and 100%, respectively) compared to only 69% of women with LMS and 57% with ESS (p= .015). Two of the 90 US were morcellated. Twenty-nine % of women with US had distant metastasis at time of diagnosis, and almost 50% throughout their lifetime. Alive women with no evidence of disease made up 34% of the LMS group, 47% of the MMMT group, 0% in the HGS group, and 86 % in the ESS group. Conclusion: In our retrospective analysis of US identified over 11 years in a practice group spanning urban and suburban populations, we found that the practitioner should be alert to the significant risk of incidental discovery of US at surgery. In order to optimize the surgical care of women, endometrial biopsy should be considered in screening women with signs/symptoms of