Positive Peritoneal Washes in Robotic Assisted Laparoscopic Hysterectomy for Endometrial Carcinoma
MM Pinto, A Domfeh, D Silasi, M Azodi, V Parkash. Yale University, New Haven, CT
Background: Laparoscopic hysterectomy is reported to have an artifact of vascular pseudoinvasion, especially seen in low risk endometrial carcinoma cases. This has been attributed to the use of the uterine balloon manipulator technique during laparascopy. This is seen as endometrial glands and stroma in large caliber vascular spaces. We studied our cases of endometrial carcinoma to determine if a similar artifactual dissemination was noted with pelvic washings in patients with Robotic Assisted Laparoscopic Hysterectomy.
Design: A review of our pathology data base was conducted to find all cases of endometrial carcinoma with pelvic washings during a 22 month period (since the use of robotic surgery for endometrial carcinoma at our institution). The clinicopathologic parameters of all cases of endometrial carcinoma with positive washings were compared, with special attention to the surgical technique used.
Results: 95 cases of EMCA were staged over a 22 month period at our institution. Of these 95 cases, 45 had Robotic Assisted Laparascopic Hysterectomy (RALH). 24 cases were high grade carcinoma (including 20 cases of serous, clear cell and malignant mixed mullerian type- so called type 2 endometrial carcinoma), only 8 of which were staged using RALH. Washings were positive in 15 cases, of which 8 were in RALH cases. The RALH cases consisted of 5 low endometrioid carcinomas and 3 serous carcinomas. Of the non-robotic cases 4 were serous, 2 endometrioid and 2 were MMMT. There were no appreciable differences between the patients with RALH and positive washings, and non robotic surgery and positive washings. The number of cases with low grade carcinoma with positive washings was slightly higher in the RALH group (5/37 (13.5%) versus 4/31 (12.1%)) but did not achieve statistical significance.
Conclusions: The factors that cause artifactual tumor dissemination into vascular channels during laparoscopic assisted hysterectomy, do not appear to result in tumor contamination of the peritoneal washings. More detailed studies, with a larger cohort of cases, are needed to verify this result.
Wednesday, March 24, 2010 1:00 PM
Poster Session VI # 62, Wednesday Afternoon