Risk of endometrial and ovarian cancer in patients with a history of endometriosis-related infertility

August 2004, Vol. 11, No. 3 Supplement TheJournal of the American Association of Gynecologic Laparoscopists

(18.8%), and 39 women (25%) were obese (body mass index greater than 30). Preoperative staging included: clinical examination, transvaginal ultrasound, computed tomography scan or magnetic resonance imaging, and chest radiograph. We aimed to do all the procedures laparoscopically including peritoneal washings. Measuremerzts arzd Mairz Results. In seven women (4.3%), a laparotomy was necessary in order to complete the procedure. Operative morbidity included one uneventful case of gas embolism, one case of bladder injury repaired at the time of laparoscopy, and five cases of subcutaneous emphysema, which resolved spontaneously. The mean duration of hospital stay was 5 days. The mean number of lymph nodes removed was 10. Clinical staging underestimated the extent of the disease in 13% of cases. After a median period of 72 months of follow-up, the disease reoccurred in 13 women (8.5 %), 9 of which have since died. Five-year survival rate was 91.9%. However, there was no port site recurrence found in this series. Conclusion. Our results indicate that the surgical treatment of endometrial cancer can be safely performed laparoscopically in the majority of stage I cases. Laparoscopy was as radical as laparotomy, with minimal operative morbidity and a similar survival rate. Compared with the vaginal approach, it offers the advantage of complete staging, with clear inspection of the whole peritoneal cavity and lymphadenectomy in one surgical step.

83. Risk of Endometrial and Ovarian Cancer in Patients with a History of Endometriosis-Related Infertility R Victory, J Berman, M Diamond, M Kruger, S McNeeley, D Vista-Deck, SL Hendrix. Wayne State University, Detroit, Michigan. Study Objective. Infertility patients have been shown to be at increased risk for gynecologic malignancies. Thus, we sought to determine the relationship between endometriosis and endometrial and ovarian cancers in patients with a history of infertility. Desigrz. Analysis of patients in the Women's Health Initiative (WHI) database. Abstracted data included patient demographics, history of endometriosis related infertility, endometrial cancer and/or ovarian cancer. Covariates included age, body mass index (BMI), race, hormone replacement therapy (HRT), education, income, insurance type, smoking, and diabetes. Settirzg. Primarily academic centers involved in WHI enrollment. Patierzts. A total of 161 809 women were analyzed with 26 148 attempting conception, without success, for more than 1 year. Of these, 11 164 patients had infertility-related diagnoses, including 1970 patients with a history of endometriosis. Irzterverztiorz. Data were analyzed based on screening questionnaires conducted at study entry. Measuremerzts arzd Mairz Results. By Z2 analysis, patients with endometriosis had a significantly increased incidence of endometrial cancer (p <.001), but not ovarian cancer (p =.781). Logistic regression models controlled for covari-

ates demonstrated no significant predictive value of endometriosis for endometrial or ovarian cancer (all p >.05). For endometrial cancer, age greater than 65 (OR = 3.04, p <.001) diabetes (OR = 2.00, p =.016) and BMI (OR = 1.47, p =.044) significantly increased risks of endometrial cancer. For ovarian cancer, only diabetes (OR = 2.22, p =.049) was significantly related to ovarian cancer in this select group of patients. Corzclusiorz. Infertility patients with a history of endometriosis do not appear to be at increased risk for endometrial or ovarian cancer. Increasing age, BMI, and a history of diabetes may contribute to substantial increases in risks of gynecologic malignancies.

Plenary 14--New Instrumentation II 84. Prospective, Randomized Clinical Study to Evaluate the Safety and Efficacy of FlowFil Compared with a Balloon Uterine Stent in Preventing Postoperative Uterine Bleeding and Adhesion Formation after Hysteroscopic Resections 1E Zupi, 2A Piredda, 2D Marconi, 2G Sorrenti, 2B De Vivo, 2Z Zumpano, 1C Exacoustos, 3F Zullo. 1Tor Vergata University of Rome, Rome, Italy; 2S. Giuseppe Hospital Rome, Rome, Italy; 3Magna Graecia University of Catanzaro, Catanzaro, Italy. Study Objective. The aim of our study was to investigate the intrauterine use of FlowFil, a SprayGel polymer, which is already well accepted in the prevention of pelvic adhesions. FlowFil was compared with a balloon uterine stent in preventing postoperative uterine bleeding and adhesion formation after operative hysteroscopy. Methods. Sixty consecutive patients undergoing operative hysteroscopy for endometrial polyps, submucosal myomas, synechiae, or uterine Mullerian anomalies (septa) were enrolled in our study. Patients were randomized in two groups. In group A (30 patients), after surgery, uterine cavity was filled with FlowFil; in group B (30 patients) the balloon uterine stent (Cook) was placed within the uterine cavity. Patients were all evaluated postoperatively by ultrasound after 1, 14, 30 days and by hysteroscopy after 1 month. Measuremerzts arzd Mairz Results. Postoperative intrauterine adhesions were noted in four cases (14%) in group A and in six cases (21%) in group B. This difference was not found to be statistically different (p =.0428) though a trend towards fewer adhesion formation was apparent in the FlowFil group. Postoperative bleeding was seen to be significantly lower (p =.0428) in the FlowFil group relative to the balloon stent group. SF-36 questionnaire will be reported. Conclusion. FlowFil appears to be more effective relative to the balloon stent in obtaining tamponade of postoperative bleeding, potentially due to its ability to conform better to the uterine cavity. Both devices appeared to be equivalent in preventing incidence, extent, and severity of postoperative adhesion formation, although a Fend towards lower and less dense adhesion formation was seen in the

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