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Comparison of robot-assisted total laparoscopic hysterectomy and total abdominal hysterectomy for treatment of endometrial cancer in obese and morbidly obese patients

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Abstract

The objective of our study was to compare clinical and pathologic outcomes of robot-assisted and open abdominal techniques for treatment of uterine cancer in obese patients. Institutional review board approval was obtained. Patient demographic data, pathological data, and surgical data were collected by retrospective chart review. Data were analyzed using SAS statistical software. One-hundred and eighty-nine consecutive cases of suspected uterine cancer were identified from October 2003 until January 2009. Of these, 116 patients (61%) had a body mass index (BMI) over 30. There were 66 completed robot-assisted hysterectomies (RAHs), 43 total abdominal hysterectomies (TAHs), and seven patients that were converted from RAH to open abdominal hysterectomy. There were no significant differences in preoperative patient demographics, including body mass index (BMI), medical co-morbidities, or preoperative cytology, except for parity. There were no differences in postoperative grade, stage, lymph vascular space invasion, positive pelvic washings, mean number of pelvic lymph nodes, or proportion of patients undergoing pelvic lymphadenectomy. Length of stay and estimated blood loss were lower for the robotic technique; RAHs had a significantly longer operative time, however. Postoperative blood transfusions and wound infections were more frequent in the TAH group. Of the RAH group there were seven conversions to TAH (10%). Differences in surgical times with and without lymphadenectomy were least in patients in the largest BMI category of >50. Length of time required for RAH was significantly longer then TAH in obese and morbidly obese patients, however benefits to patients of a minimally invasive approach included reduced incidence of wound infections, reduced transfusion rates, reduced blood loss, and shortened length of stay. These data also suggest the greatest advantage of robotic technology over laparotomy in patients with BMI over 50.

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References

  1. Jemal A, Siegel R, Ward E et al (2008) Cancer statistics, 2008 CA. Cancer J Clin 58:71

    Article  Google Scholar 

  2. Elliot E, Matanoski G, Rosenshein N, Grumbine F, Diamond E (1990) Body fat patterning n women with endometrial cancer. Gynecol Oncol 39:253–258

    Article  Google Scholar 

  3. Folsom A, Kay S, Potter J, Prineas R (1989) Association of incident carcinoma of the endometrium with body weight and fat distribution in older women: early findings of the Iowa Women’s Health Study. Cancer Res 49:6828–6831

    CAS  PubMed  Google Scholar 

  4. Tretli S, Magnus K (1990) Height and weight in relation to uterine corpus cancer morbidity and mortality. A follow-up study of 5700,000 women in Norway. Int J Cancer 46:165–172

    Article  CAS  PubMed  Google Scholar 

  5. Calla E, Rodriguez C, Walker-Thurmond K, Tun M (2003) Overweight, obesity and mortality from cancer in a prospectively studied cohort of US adults. NEJM 243(17):1625–1637

    Article  Google Scholar 

  6. Mikuta J (1988) International federation of gynecology and obstetrics staging of endometrial cancer. Cancer 71:1460–1463

    Google Scholar 

  7. Walker J, Mannel R, Piedmonte M, Schlaerth J, Spirtos N, Spiegel G (2006) Phase III Trial of laparoscopy (scope) vs TAH (open) for surgical resection and comprehensive surgical staging of uterine cancer: a Gynecologic Oncology Group (GOG) study funded by NCI. Gynecol Oncol 101(suppl):S11–S12

    Google Scholar 

  8. Hatch K (2003) Laparoscopic lymphadenectomy and laparoscopic-assisted vaginal hysterectomy (editorial). Gynecol Oncol 90:503–504

    Article  PubMed  Google Scholar 

  9. Ribeiro S, Ribeiro R, Santos N, Pinotti J (2003) A randomized study of total abdominal, vaginal, and laparoscopic hysterectomy. Int J Gynaecol Obstet 83:37–43

    Article  CAS  PubMed  Google Scholar 

  10. Cho Y-H, Kim D-Y, Kim J-H, Kim Y-M, Kim Y-T, Nam J-H (2007) Laparoscopic management of early uterine cancer: 10 year experience in Asan medical Center. Gyncol Oncol 106:585–590

    Article  Google Scholar 

  11. Boggess J, Gehrig P, Cantrell L, Shafer A, Ridgeway M, Skinner E, Fowler W (2008) A comparative study of 3 surgical methods for hysterectomy with staging for endometrial cancer: robotic assistance, laparoscopy, laparotomy. Am J Obstet Gynecol 199:360 e1–360 e9

    Google Scholar 

  12. Denardis S, Holloway R, Bigsby I, Dirk P, Ahmad S, Finkler N (2008) Robotically assisted laparoscopic hysterectomy versus total abdominal hysterectomy and lymphadenectomy for endometrial cancer. Gynecol Oncol 111:412–417

    Article  PubMed  Google Scholar 

  13. Bell M, Torgerson J, Seshadri-Kreaden U, Suttle AW, Hunt S (2008) Comparison of outcomes and cost for endometrial cancer staging via traditional laparotomy, standard laparoscopy and robotic techniques. Gynecol Oncol 111:407–411

    Article  PubMed  Google Scholar 

  14. Holtz D, Miroshnichenko G, Finnergan M, Dunton C (2008) Endometrial cancer surgery costs: Da Vinci robot versus laparoscopy. Gynecol Oncol 108(Suppl 1):A322

    Google Scholar 

  15. Seamon L, Henretta M, Kim K, Carlson M, Cohn D, Fowler J (2008) Robotic versus laparoscopic hysterectomy and lymphadenectomy for endometrial cancer: conversion rates and operating time. Gynecol Oncol 108(Suppl 1):A142

    Google Scholar 

  16. Ahlering T, Skarecky D, Lee D, Clayman R (2003) Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol 170:1738–1741

    Article  PubMed  Google Scholar 

  17. Eltabbakh G, Shamonki M, Moody J et al (2000) Hysterectomy for obese women with endometrial cancer: laparoscopy or laparotomy? Gynecol Oncol 78:329–335

    Article  CAS  PubMed  Google Scholar 

  18. Scribner D, Walker J, Johnson G et al (2002) Laparoscopic pelvic and paraaortic lymph node dissection in the obese. Gynecol Oncol 84:426–430

    Article  PubMed  Google Scholar 

  19. Eisenhauer E, Wyppych K, Mehrar B et al (2007) Comparing surgical outcomes in obese women undergoing laparotomy, laparoscopy or laparotomy with panniculectomy for the staging of uterine malignancy. Ann Surg Oncol 14:2384–2391

    Article  PubMed  Google Scholar 

  20. Gehrig P, Cantrell L, Shafer A, Abaid L, Mendivil A, Boggess J (2008) What is the optimal minimally invasive surgical procedure for endometrial cancer staging in the obese and morbidly obese woman? Gynecol Oncol 111:41–45

    Article  PubMed  Google Scholar 

  21. Seamon L, Bryant S, Rheaume P, Kimall K, Kerr K, Huh W, Folwer J, Phillips G, Cohn D (2009) A cohort study of surgical staging in obese patients with endometrial cancer: is comprehensive staging feasible when performed robotically. Gynecol Oncol 112:S166 (abstract 329)

    Article  Google Scholar 

  22. Seamon L, Cohn D, Henretta M, Kim K, Carlson M, Phillip SG, Fowler J (2009) Minimally invasive comprehensive surgical staging for endometrial cancer: robotics or laparoscopy? Gynecol Oncol 113(1):36–41

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    N. Nevadunsky, R. Clark, S. Ghosh, M. Muto, R. Berkowitz, A. Vitonis & C. Feltmate

  2. Gillette Center For Women’s Cancer, Dana-Farber Harvard Cancer Center, Boston, MA, USA

    M. Muto, R. Berkowitz & C. Feltmate

Authors
  1. N. Nevadunsky
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  2. R. Clark
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  3. S. Ghosh
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  4. M. Muto
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  5. R. Berkowitz
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  6. A. Vitonis
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  7. C. Feltmate
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Correspondence to N. Nevadunsky.

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Nevadunsky, N., Clark, R., Ghosh, S. et al. Comparison of robot-assisted total laparoscopic hysterectomy and total abdominal hysterectomy for treatment of endometrial cancer in obese and morbidly obese patients. J Robotic Surg 4, 247–252 (2010). https://doi.org/10.1007/s11701-010-0222-y

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  • DOI: https://doi.org/10.1007/s11701-010-0222-y

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