Comparing Surgical Route for Type II Endometrial Cancer: Perioperative and Long Term Clinical Outcomes Open Access

Gattoc, Leda Portia (Fall 2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/5h73pw05j?locale=en
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Abstract

Objectives: Type II endometrial cancers (serous, clear cell and carcinosarcoma) only account for approximately 10% of cancers, but they are responsible for a significant proportion of the morbidity and mortality. The goal of this study was to compare survival and perioperative outcomes in women with type II endometrial cancers who underwent staging via laparotomy (XL) vs. minimally invasive approach (MIS).

Methods: All patients who underwent surgery for Type II endometrial cancer at two academic cancer centers in Detroit,  Michigan  between January 2005 and December 2015 were retrospectively reviewed. Patients who received neoadjuvant chemotherapy or radiation, and those with endometrioid histology were excluded. Clinical, demographic characteristics, surgical outcomes were examined using univariate and multivariable analysis.  Survival analysis was calculated using Kaplan-Meier estimates and Cox proportional hazards regression.

Results: A total of 249 patients were included, 193 underwent laparotomy, and 58 MIS, including conventional laparoscopic or robotic surgery. The majority had stage I disease (IA, 104 [41.3%] and IB, 20[7.9%]). Stages II, III, and IV were identified in 18 (7.1%), 79 (31.6%), and 31 (12.4%) respectively. Multivariate analysis demonstrated being African American (OR 0.29; 95%CI 0.14 - 0.61), having mixed histology(OR 0.29; 95% CI 0.16 - 0.98), and stage III-IV disease (OR 0.46; 95%CI 0.21-0.97) were inversely associated with undergoing MIS. MIS was associated with ability to complete staging. Higher perioperative transfusions, EBL >250 cc and longer hospital stay were also associated with laparotomy. Higher lymph node yield was associated with MIS compared to laparotomy. Recurrence rate was 38 % for the laparotomy group and 19% for MIS. There was no difference in 3 year-PFS after controlling for age, race, procedure, histology, stage and adjuvant therapy. There was no difference in overall survival between laparotomy and MIS for type II endometrial cancers in this series.

Conclusions: Certain clinical and demographic factors such as African American race, mixed histology and stage were associated with undergoing laparotomy for type II endometrial cancers. MIS approaches offered less morbidity and ability to complete staging.

Table of Contents

Table of Contents

Introduction ……………………………………………………………………………….1

Background ……………………………………………………………………………….4

Methods  ………………………………………………………………..…………………9

Results  …………………………………………………………………………………..12

Discussion ……………………………………………………………………………….16

References ……………………………………………………………………………….20

Tables and Figures ………………………………………………………………………23

Supplemental Data ………………………………………………………………………34

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