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Study of Outcomes After Total Laparoscopic Hysterectomy for Early-Stage Endometrial Cancer in Our Department
Abstracts / Journal of Minimally Invasive Gynecology 23 (2016) S1–S252 vertical skin incision and a 2 cm rectus fasciotomy are performed to enter the peritoneal cavity. A reusable single-port trocar is inserted into the abdominal cavity, and the abdomen is insufflated to 12 mmHg. Pelvic washings are collected and sent for pathological examination. Both Fallopian tubes are clamped distal to the uterine cornua, ligated and transected with a vessel sealing device. A rigid Hopkins high-definition three-chip camera is used. At the end of the procedures, specimens are placed in specimen bag and removed through the umbilicus after first removing the port device. PK forceps is used in the left robotic arm, and monopolar scissors in the right arm. Measurements and Main Results: This technique offers satisfactory surgical outcome. Operative time can be maintained in 50 minutes, blood loss is negligible, and, hospital stay for one day. Conclusion: Farghaly’s Technique of robot-assisted risk reducing bilateral total salpingectomy (RRBTS) is safe, feasible, cost effective, with acceptable operative, and clinical outcomes. It retains the advantage of minimally invasive surgery. In addition, total salpingectomy followed by delayed oophorectomy yield, the best possible quality of life for those patients due to preservation of both ovaries. 741 The Contribution of Genetic Polymorphisms in Development of Hysteromyoma in Women of Russia’s Central Region Ponomarenko I, Churnosov M. Department of Medical Biological Disciplines, Belgorod State University, Belgorod, Belgorod Region, Russian Federation Study Objective: Study of role of the combination genetic polymorphisms rs12324955, rs1782507 and rs3092921 in formation of hysteromyoma. Design: Prospective cohort study. Setting: Perinatal center St. Joasaph Belgorod Regional Clinic Hospital. Patients: The research group consisted of 1245 women between 2010 and 2013, of which 250 hysteromyoma patients and 995 persons of the control group. Main group and control group included Russian women who were native of Central Region of Russia and who were not relatives to each other. Patients with hysteromyoma were provided with clinical and gynecological examination, ultrasound investigation if pelvic floor, hysteroscopy with further target diagnostic curettage and scrape hystologic study. Intervention: Typing of single nucleotide polymorphism of the following genes was performed for patients with hysteromyoma women from control group: rs12324955, rs1782507 and rs3092921. Analysis of roles of combinations of genetic variants in occurrence of hysteromyoma was performed with the help of APSampler software. Measurements and Main Results: It has been discovered that combination of genetic variants GG rs12324955 with A rs1782507 and C rs3092921 occur in 40.64% of sick women, respectively, which is 1.16 times lower than that occur in control group (47.09%, p=0.04). When there are these combination of polymorphic markers, pathology risk of hysteromyoma is significantly lower (OR=0.77, CI 0.57-0.98). Conclusion: Protective meaning at formation of hysteromyoma belongs to combination of genetic variants GG rs12324955 with A rs1782507 and C rs3092921(OR=0.77). The study was supported by the Russian Foundation for Basic Research (No.- 15-44-03194). 742 Patient Outcomes in Cases of Endometrial Cancer (EMC) and Endometrial Hyperplasia (EH) Diagnosed Following Uterine Morcellation at the Time of Hysterectomy Belniak MH,1 Zhou XC.2 1University of Connecticut, Farmington, Connecticut; 2Gynecologic Oncology, Hartford HealthCare Cancer Institute at the Hospital of Central Connecticut, New Britain, Connecticut Study Objective: To evaluate outcomes in cases of EMC and EH diagnosed following uterine morcellation during hysterectomy. Design: Case series with 11-48 months of patient follow up.
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Setting: 3 academic-affiliated community hospitals. Patients: Patients who underwent uterine morcellation at the time of hysterectomy between 2005 and 2013 who had final pathology of EMC or EH. 11 patients were identified: 4 with EMC, 3 with complex atypical hyperplasia, 1 with complex hyperplasia without atypia, and 3 with simple hyperplasia without atypia. Intervention: Patient demographics, preoperative imaging and endometrial sampling results, tumor grade and histology, stage, uterine weight, surgery performed, mode of morcellation, second surgery performed, complications, adjuvant treatments, current disease status/survival, and recurrences were abstracted from patient records. Measurements and Main Results: Mean uterine weight was 157g (SD=43). The mean weight of specimens from abdominal mechanical morcellation was 133g (SD=49); those from vaginal non-mechanical morcellated specimens was 251 g (SD=102). Among patients with preoperative endometrial sampling, 67% (4/6) had more severe postoperative pathology. The final stages for the endometrial cancers were IA (3 cases) and IB (1 case). Size of identified tumors ranged from microscopic to 13 cm, myometrial invasion ranged from 0-66%, and there were no cases with cervical or lymphovascular space invasion. Three patients underwent a second surgery and none were upstaged. One patient received adjuvant radiation and a second patient received adjuvant radiation and hormonal therapy. There have been no recurrences to date. Conclusion: Mechanical morcellation could have been avoided in cases with EMC or EH diagnosed on final pathology. Further investigation into patient outcomes following inadvertently morcellated malignancies is required. 743 Study of Outcomes After Total Laparoscopic Hysterectomy for Early-Stage Endometrial Cancer in Our Department Watanabe M, Shibuya H, Kobayashi Y, Iwashita M. KYORIN University School of Medicine, Mitaka, Tokyo, Japan Study Objective: According to the Treatment Guidelines for Uterine Body Cancer by Japan Society of Gynecologic Oncology (JSGO), pelvic lymphadenectomy can omit in patients with endometrioid adenocarcinoma G1 or G2 and %1/2 myometrial invasion, no findings of extrauterine lesion. Therefore we omit pelvic lymphadenectomy by a case. We reviewed cases underwent total laparoscopic hysterectomy (TLH) for early-stage endometrial cancer retrospectively. Design: Retrospective study. Setting: Academic affiliated community hospital. Patients: The subject of this study is 28 patients with atypical endometrial hyperplasia complex (AEHC) or stage IA endometrial cancer (endometrial adenocarcinomaG1-G2) underwent TLH in our department between April 2013 and December 2015. Intervention: In our department, TLH for early-stage endometrial cancer has been performed since April 2013. Measurements and Main Results: We compared preoperative histopathological diagnosis and imaging examination with postoperative histopathological diagnosis. There are 22 cases (AEHC 10, endometrial cancer 12) with no myometrial invasion , and 5 cases (AEHC 1, endometrial cancer 4) with %1/2 myometrial invasion pointed out by preoperative MRI. As a result of the postoperative histopathological study of endometrial cancer patients have no myometrial invasion before surgery, there were 2 cases without myometrial invasion, 7 cases with \1/ 2 myometrial invasion, and 3 cases with R1/2 myometrial invasion. In comparison of pre- and postoperative histology, 8 of 11 cases of AEHC and 4 of 16 cases with stage IA endometrial cancer were upgraded. A case with endometrial polyp was diagnosed stage IA endometrial cancer. 6 cases had postoperative adjuvant therapy, and there were 2 cases had recurrent. 2 recurrent cases are currently under treatment. Conclusion: Pelvic lymphadenectomy in patients with the low risk of recurrence was considered to be able to omit. But there were the cases upgraded by postoperative histology or recurrent cases, so the further study about the indication of omitting lymphadenectomy seemed to be necessary.
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Setting: 3 academic-affiliated community hospitals. Patients: Patients who underwent uterine morcellation at the time of hysterectomy between 2005 and 2013 who had final pathology of EMC or EH. 11 patients were identified: 4 with EMC, 3 with complex atypical hyperplasia, 1 with complex hyperplasia without atypia, and 3 with simple hyperplasia without atypia. Intervention: Patient demographics, preoperative imaging and endometrial sampling results, tumor grade and histology, stage, uterine weight, surgery performed, mode of morcellation, second surgery performed, complications, adjuvant treatments, current disease status/survival, and recurrences were abstracted from patient records. Measurements and Main Results: Mean uterine weight was 157g (SD=43). The mean weight of specimens from abdominal mechanical morcellation was 133g (SD=49); those from vaginal non-mechanical morcellated specimens was 251 g (SD=102). Among patients with preoperative endometrial sampling, 67% (4/6) had more severe postoperative pathology. The final stages for the endometrial cancers were IA (3 cases) and IB (1 case). Size of identified tumors ranged from microscopic to 13 cm, myometrial invasion ranged from 0-66%, and there were no cases with cervical or lymphovascular space invasion. Three patients underwent a second surgery and none were upstaged. One patient received adjuvant radiation and a second patient received adjuvant radiation and hormonal therapy. There have been no recurrences to date. Conclusion: Mechanical morcellation could have been avoided in cases with EMC or EH diagnosed on final pathology. Further investigation into patient outcomes following inadvertently morcellated malignancies is required. 743 Study of Outcomes After Total Laparoscopic Hysterectomy for Early-Stage Endometrial Cancer in Our Department Watanabe M, Shibuya H, Kobayashi Y, Iwashita M. KYORIN University School of Medicine, Mitaka, Tokyo, Japan Study Objective: According to the Treatment Guidelines for Uterine Body Cancer by Japan Society of Gynecologic Oncology (JSGO), pelvic lymphadenectomy can omit in patients with endometrioid adenocarcinoma G1 or G2 and %1/2 myometrial invasion, no findings of extrauterine lesion. Therefore we omit pelvic lymphadenectomy by a case. We reviewed cases underwent total laparoscopic hysterectomy (TLH) for early-stage endometrial cancer retrospectively. Design: Retrospective study. Setting: Academic affiliated community hospital. Patients: The subject of this study is 28 patients with atypical endometrial hyperplasia complex (AEHC) or stage IA endometrial cancer (endometrial adenocarcinomaG1-G2) underwent TLH in our department between April 2013 and December 2015. Intervention: In our department, TLH for early-stage endometrial cancer has been performed since April 2013. Measurements and Main Results: We compared preoperative histopathological diagnosis and imaging examination with postoperative histopathological diagnosis. There are 22 cases (AEHC 10, endometrial cancer 12) with no myometrial invasion , and 5 cases (AEHC 1, endometrial cancer 4) with %1/2 myometrial invasion pointed out by preoperative MRI. As a result of the postoperative histopathological study of endometrial cancer patients have no myometrial invasion before surgery, there were 2 cases without myometrial invasion, 7 cases with \1/ 2 myometrial invasion, and 3 cases with R1/2 myometrial invasion. In comparison of pre- and postoperative histology, 8 of 11 cases of AEHC and 4 of 16 cases with stage IA endometrial cancer were upgraded. A case with endometrial polyp was diagnosed stage IA endometrial cancer. 6 cases had postoperative adjuvant therapy, and there were 2 cases had recurrent. 2 recurrent cases are currently under treatment. Conclusion: Pelvic lymphadenectomy in patients with the low risk of recurrence was considered to be able to omit. But there were the cases upgraded by postoperative histology or recurrent cases, so the further study about the indication of omitting lymphadenectomy seemed to be necessary.