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Utility of routine postoperative hemoglobin testing after minimally invasive surgery for endometrial cancer
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Abstracts / Gynecologic Oncology 141 (2016) 2–208
360 – Poster Utility of routine postoperative hemoglobin testing after minimally invasive surgery for endometrial cancer S. Singha, T. Vardyaa, A.A. Shahb, J. Nakayamac. aUniversity Hospitals Case Medical Center, Cleveland, OH, USA, bCase Western Reserve - Mac Donald Women's Hospital, Cleveland, OH, USA, cUniversity Hospital of Cleveland, Cleveland, OH, USA
doi:10.1016/j.ygyno.2016.04.390
Objectives: To determine if routine postoperative hemoglobin (Hgb) testing is useful in guiding care for women who undergo minimally invasive surgery (MIS) for endometrial cancer (EMCA). Methods: A retrospective cohort study of patients who underwent MIS for EMCA from 2010 to 2015. We included patients who underwent standard laparoscopy (LSC) and robotic-assisted surgery. Baseline demographics and perioperative characteristics were collected. We defined clinical hemodynamic instability (HI) as development of at least one of the following: tachycardia, hypotension, low urine output, or dizziness. Results: A total of 235 patients underwent MIS for EMCA: 138 (58.7%) underwent LSC and 97 (41.3%) underwent robotic-assisted surgery. Patients with a lower body mass index were more likely to have a greater decrease in Hgb (P b .01); however, surgical history, surgery/ anesthesia time, blood loss, performance of and extent of lymphadenectomy, use of preoperative anticoagulation, and use of postoperative ketorolac were not associated with greater decreases in Hgb. Postoperatively, 52 patients (22.1%) had 1 or more sign or symptom of HI. Compared with asymptomatic patients, these clinically symptomatic patients were significantly older (68.6 vs 64.6 years old, P = .03) and had significantly greater decreases in Hgb (2.38 vs 1.96 g/dL, P = .048). Only 5 patients, all of whom were also symptomatic, required postoperative blood transfusions. No asymptomatic patients required transfusion. Symptomatic and asymptomatic patients did not differ with regard to rates of reoperation or readmission. Conclusions: These results call into question the utility of performing routine Hgb testing after MIS for EMCA. Hgb testing may only be necessary for patients who develop signs or symptoms of HI. Omission of this routine test in asymptomatic patients could result in sizable health care cost savings. In addition, these results provide more data that could be used to support the safety of same-day discharge after MIS for EMCA in appropriately selected patients.
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Objectives: The aim of this study was to investigate whether quality of lymphadenectomy (LND) affects survival in patients with endometrioid-type endometrial cancer having intermediate- or highrisk factors. Methods: Eligible patients were retrospectively enrolled from 4 tertiary centers in Korea. All patients underwent surgical staging, including hysterectomy with pelvic lymphadenectomy (PLND) with or without para-aortic lymphadenectomy (PALND) between 2000 and 2013 and finally diagnosed with FIGO stage IB to IIIC2 endometrioid adenocarcinoma. The numbers of lymph nodes (LNs) removed and positive LNs from the pelvic and para-aortic area were obtained from the pathology report. Negative LN count was defined as positive LN count subtracted from total number of LNs removed. Recurrence-free survival (RFS) and overall survival (OS) were analyzed. Results: A total of 476 patients were enrolled for analysis. PALND was performed in 298 patients (62.6%). Median pelvic LNs and paraaortic LNs removed was 23 (range, 2–74) and 7 (range, 1–58), respectively. Stage IIIC disease was seen in 164 (34.4%) patients (node-positive group). Positive LN detection rate was associated with both pelvic and para-aortic LNs removed. Isolated para-aortic lymph node metastasis presented in 6 (18.8%) of 32 patients in the group with 20 or less pelvic LNs removed, and in only 1 (1.5%) of 68 patients in the group with more than 20 pelvic LNs removed. In the node-negative group, patients who received only low-quality PLND (≤20 pelvic LNs removed) had lower RFS compared with those who received additional PALND (P = .025). In the node-positive group, total negative LN count was an independent prognostic factor as a continuous variable (RFS: HR 0.974, 95% CI 0.949–0.995; OS: HR 0.939, 95% CI: 0.899–0.981). In all patients, total negative LN count was an independent prognostic factor for RFS and OS as a continuous variable (RFS: HR 0.983, 95% CI 0.967–0.999; OS: HR 0.962, 95% CI 0.934–0.991). Quality of PLND assessed by pelvic negative LN count is the most important prognostic factor. Conclusions: Both positive node detection rate and survival were affected by number of LNs removed. Negative LN count is a reliable marker for assessing quality of LND with prognostic value in patients with intermediate- or high-risk endometrial cancer regardless of node positivity. High-quality PLND is more important than performing PALND in such patients.
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359 – Poster Survival impact of quality of lymphadenectomy in intermediateor high-risk group of endometrioid type endometrial cancer: A multicenter retrospective cohort analysis T.H. Kima, T.J. Kimb, S.J. Changc, D. Kimd, S.Y. Ryua, B.G. Kime, Y.T. Kimd, D.S. Baeb, H.S. Ryuf, J.H. Namd. aKorea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, South Korea, bSamsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, cAjou University Hospital, Suwon, South Korea, dUniversity of Ulsan College of Medicine, ASAN Medical Center, Seoul, South Korea, eSungkyunkwan University School of Medicine, Seoul, South Korea, fAjou University School of Medicine, Suwon, South Korea
OF
10–1,900 mL). Median follow-up duration was 15 months (range, 2– 59 months). Four patients (17.4%) experienced recurrence and 2 patients (8.7%) died of the diseases. Conclusions: SPLS is a potential option for selected advanced ovarian cancer cases as well as cases of early-stage disease with improvements in techniques and instrumentations. Precise selection criteria could be established through a further study in SPLS for ovarian cancer.
doi:10.1016/j.ygyno.2016.04.391
doi:10.1016/j.ygyno.2016.04.392
361 – Poster Prognostic role of preoperative serum albumin in patients with advanced ovarian cancer undergoing primary debulking surgery S.H. Shima, D.Y. Kimb, P.S. Jungc, D.S. Suhb, J.H. Kimb, Y.M. Kimb, Y.T. Kimc, J.H. Namb. aKonkuk University School of Medicine, Seoul, South Korea, bUniversity of Ulsan College of Medicine, ASAN Medical Center, Seoul, South Korea, cUniversity of Ulsan College of Medicine, ASAN Medical Center, Seoul, South Korea Objectives: Hypoalbuminemia has been reported as a risk factor for postoperative complications and unfavorable survival in cancer patients. We aimed to evaluate the predictive value of preoperative serum albumin levels on the postoperative complication rate and the impact on overall survival (OS) in patients with advanced epithelial ovarian cancer (AEOC) who are undergoing primary debulking surgery (PDS). Methods: The medical records of 276 patients with AEOC who underwent PDS at a tertiary medical center between 2009 and 2012 were reviewed. A serum albumin level less than 3.5 g/dL (35 g/L) was defined as hypoalbuminemia. All perioperative complications within 30 days after surgery, time to resumption of normal diet, and
Abstracts / Gynecologic Oncology 141 (2016) 2–208
360 – Poster Utility of routine postoperative hemoglobin testing after minimally invasive surgery for endometrial cancer S. Singha, T. Vardyaa, A.A. Shahb, J. Nakayamac. aUniversity Hospitals Case Medical Center, Cleveland, OH, USA, bCase Western Reserve - Mac Donald Women's Hospital, Cleveland, OH, USA, cUniversity Hospital of Cleveland, Cleveland, OH, USA
doi:10.1016/j.ygyno.2016.04.390
Objectives: To determine if routine postoperative hemoglobin (Hgb) testing is useful in guiding care for women who undergo minimally invasive surgery (MIS) for endometrial cancer (EMCA). Methods: A retrospective cohort study of patients who underwent MIS for EMCA from 2010 to 2015. We included patients who underwent standard laparoscopy (LSC) and robotic-assisted surgery. Baseline demographics and perioperative characteristics were collected. We defined clinical hemodynamic instability (HI) as development of at least one of the following: tachycardia, hypotension, low urine output, or dizziness. Results: A total of 235 patients underwent MIS for EMCA: 138 (58.7%) underwent LSC and 97 (41.3%) underwent robotic-assisted surgery. Patients with a lower body mass index were more likely to have a greater decrease in Hgb (P b .01); however, surgical history, surgery/ anesthesia time, blood loss, performance of and extent of lymphadenectomy, use of preoperative anticoagulation, and use of postoperative ketorolac were not associated with greater decreases in Hgb. Postoperatively, 52 patients (22.1%) had 1 or more sign or symptom of HI. Compared with asymptomatic patients, these clinically symptomatic patients were significantly older (68.6 vs 64.6 years old, P = .03) and had significantly greater decreases in Hgb (2.38 vs 1.96 g/dL, P = .048). Only 5 patients, all of whom were also symptomatic, required postoperative blood transfusions. No asymptomatic patients required transfusion. Symptomatic and asymptomatic patients did not differ with regard to rates of reoperation or readmission. Conclusions: These results call into question the utility of performing routine Hgb testing after MIS for EMCA. Hgb testing may only be necessary for patients who develop signs or symptoms of HI. Omission of this routine test in asymptomatic patients could result in sizable health care cost savings. In addition, these results provide more data that could be used to support the safety of same-day discharge after MIS for EMCA in appropriately selected patients.
UN
CO
RR
EC
TE
DP
Objectives: The aim of this study was to investigate whether quality of lymphadenectomy (LND) affects survival in patients with endometrioid-type endometrial cancer having intermediate- or highrisk factors. Methods: Eligible patients were retrospectively enrolled from 4 tertiary centers in Korea. All patients underwent surgical staging, including hysterectomy with pelvic lymphadenectomy (PLND) with or without para-aortic lymphadenectomy (PALND) between 2000 and 2013 and finally diagnosed with FIGO stage IB to IIIC2 endometrioid adenocarcinoma. The numbers of lymph nodes (LNs) removed and positive LNs from the pelvic and para-aortic area were obtained from the pathology report. Negative LN count was defined as positive LN count subtracted from total number of LNs removed. Recurrence-free survival (RFS) and overall survival (OS) were analyzed. Results: A total of 476 patients were enrolled for analysis. PALND was performed in 298 patients (62.6%). Median pelvic LNs and paraaortic LNs removed was 23 (range, 2–74) and 7 (range, 1–58), respectively. Stage IIIC disease was seen in 164 (34.4%) patients (node-positive group). Positive LN detection rate was associated with both pelvic and para-aortic LNs removed. Isolated para-aortic lymph node metastasis presented in 6 (18.8%) of 32 patients in the group with 20 or less pelvic LNs removed, and in only 1 (1.5%) of 68 patients in the group with more than 20 pelvic LNs removed. In the node-negative group, patients who received only low-quality PLND (≤20 pelvic LNs removed) had lower RFS compared with those who received additional PALND (P = .025). In the node-positive group, total negative LN count was an independent prognostic factor as a continuous variable (RFS: HR 0.974, 95% CI 0.949–0.995; OS: HR 0.939, 95% CI: 0.899–0.981). In all patients, total negative LN count was an independent prognostic factor for RFS and OS as a continuous variable (RFS: HR 0.983, 95% CI 0.967–0.999; OS: HR 0.962, 95% CI 0.934–0.991). Quality of PLND assessed by pelvic negative LN count is the most important prognostic factor. Conclusions: Both positive node detection rate and survival were affected by number of LNs removed. Negative LN count is a reliable marker for assessing quality of LND with prognostic value in patients with intermediate- or high-risk endometrial cancer regardless of node positivity. High-quality PLND is more important than performing PALND in such patients.
RO
359 – Poster Survival impact of quality of lymphadenectomy in intermediateor high-risk group of endometrioid type endometrial cancer: A multicenter retrospective cohort analysis T.H. Kima, T.J. Kimb, S.J. Changc, D. Kimd, S.Y. Ryua, B.G. Kime, Y.T. Kimd, D.S. Baeb, H.S. Ryuf, J.H. Namd. aKorea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), Seoul, South Korea, bSamsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, cAjou University Hospital, Suwon, South Korea, dUniversity of Ulsan College of Medicine, ASAN Medical Center, Seoul, South Korea, eSungkyunkwan University School of Medicine, Seoul, South Korea, fAjou University School of Medicine, Suwon, South Korea
OF
10–1,900 mL). Median follow-up duration was 15 months (range, 2– 59 months). Four patients (17.4%) experienced recurrence and 2 patients (8.7%) died of the diseases. Conclusions: SPLS is a potential option for selected advanced ovarian cancer cases as well as cases of early-stage disease with improvements in techniques and instrumentations. Precise selection criteria could be established through a further study in SPLS for ovarian cancer.
doi:10.1016/j.ygyno.2016.04.391
doi:10.1016/j.ygyno.2016.04.392
361 – Poster Prognostic role of preoperative serum albumin in patients with advanced ovarian cancer undergoing primary debulking surgery S.H. Shima, D.Y. Kimb, P.S. Jungc, D.S. Suhb, J.H. Kimb, Y.M. Kimb, Y.T. Kimc, J.H. Namb. aKonkuk University School of Medicine, Seoul, South Korea, bUniversity of Ulsan College of Medicine, ASAN Medical Center, Seoul, South Korea, cUniversity of Ulsan College of Medicine, ASAN Medical Center, Seoul, South Korea Objectives: Hypoalbuminemia has been reported as a risk factor for postoperative complications and unfavorable survival in cancer patients. We aimed to evaluate the predictive value of preoperative serum albumin levels on the postoperative complication rate and the impact on overall survival (OS) in patients with advanced epithelial ovarian cancer (AEOC) who are undergoing primary debulking surgery (PDS). Methods: The medical records of 276 patients with AEOC who underwent PDS at a tertiary medical center between 2009 and 2012 were reviewed. A serum albumin level less than 3.5 g/dL (35 g/L) was defined as hypoalbuminemia. All perioperative complications within 30 days after surgery, time to resumption of normal diet, and