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Laparoscopic Restaging Surgery in Patients With Unexpected Uterine Cancer
S228 776
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 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.