Does Robotic Hysterectomy Increase the Incidence of Lymphovascular Space Invasion in Endometrial Cancer?
Baraa Alosh, Dongping Shi, Zaid Al-Wahab, Sudeshna Bandyopadhyay, Haitham Arabi, Robert Morris, Nagla Salem, Rouba Ali-Fehmi. Wayne State University, Detroit, MI; King Khaled National Guard Hospital, Jeddah, Saudi Arabia
Background: Lymphovascular space invasion (LVSI) is an independent risk factor for nodal disease and poor outcome in endometrial cancer. Uterine manipulators are a useful adjunct for robotic-assisted laparoscopic hysterectomy (RALH), but some surgeons avoid their use for fear of altering pathology or interpretation of LVSI. The aim of the study is to compare the incidence of LVSI in FIGO stages IA, IB and II endometrial cancer operated by laparotomy (TAH) vs. RALH.
Design: We retrospectively compared clinico-pathological data and tumor pathology from patients with endometrial cancer operated by laparotomy (TAH) vs. RALH. The data for two hospitals from May-2005 to July-2012 were reviewed for age, tumor histology, grade, FIGO stage, LVSI, depth of invasion, and tumor size. A ConMed V-Care® uterine manipulator was used in all robotic cases.
Results: 365 endometrial cancer cases (223 TAH, 142 RALH) with stages IA (115), IB (180) and II (70) diseases were reviewed. Histology types were endometrioid (68%), serous (9%), carcinosarcoma (5%) and others (18%). No significant difference in the age, grade, histology and myometrial invasion between TAH and RALH groups. LVSI was identified in 161 cases (44%) including 48 stage IA (41%), 77 IB (42%) and 36 stage II (52%). Overall, RALH group has a statistically significantly higher LVSI for stage IA (p=0.013) but not stage IB (p=0.65) or II (p=0.28) compared to the TAH group.
|TAH %||RALH %||p- Value|
|2||29 (56%)||23 (44%)||7 (38%)||11 (62%)||0.277|