Lymphovascular space invasion in robotic surgery for endometrial cancer.
BACKGROUND
Minimally invasive surgery has become a standard treatment for endometrial cancer and offers significant benefits over abdominal approaches. There are discrepant data regarding lymphovascular space invasion (LVSI) and positive peritoneal cytology with the use of a uterine manipulator, with previous small-scale studies demonstrating an increased incidence of these prognostically important events. We sought to determine if there was a higher incidence of LVSI in patients who underwent robot-assisted surgery for endometrial cancer.


METHODS
We performed a single-institution review of medical records for patients who underwent open abdominal or robot-assisted hysterectomy for endometrial cancer over a 24-month period. The following data were abstracted: age, tumor grade and stage, size, depth of invasion, LVSI, and peritoneal cytology. For patients with LVSI, slides were reviewed by 2 pathologists for confirmation of LVSI.


RESULTS
Of 104 patients identified, LVSI was reported in 39 (37.5%) and positive peritoneal cytology in 6 (4.8%). Rates of peritoneal cytology were not significantly different between the 2 groups (odds ratio, 0.55; 95% confidence interval, 0.10-3.17; P=.50). LVSI was reported in significantly fewer robot-assisted hysterectomies than open procedures (odds ratio, 0.39; 95% confidence interval, 0.17-0.92; P=.03). In subgroup analyses restricted to early-stage disease (stage≤II), there was no significant difference in LVSI between open and robot-assisted hysterectomies (odds ratio, 0.64; 95% confidence interval, 0.22-1.85; P=.43).


CONCLUSIONS
In this retrospective study, we found that use of a uterine manipulator in robot-assisted surgery did not increase the incidence of LVSI.
University of Colorado School of Medicine, Aurora, CO, USA.
Mark R
MR
Hopkins
Department of Pathology.
Abby M
AM
Richmond
Department of Obstetrics and Gynecology.
Georgina
G
Cheng
Department of Obstetrics and Gynecology.
Susan
S
Davidson
Department of Obstetrics and Gynecology.
Monique A
MA
Spillman
Department of Obstetrics and Gynecology.
Jeanelle
J
Sheeder
Department of Pathology.
Miriam D
MD
Post
Department of Obstetrics and Gynecology.
Saketh R
SR
Guntupalli
D016889:Endometrial Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008198:Lymph Nodes / Q000473:pathology*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010529:Peritoneal Cavity; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012371:Robotics / Q000379:methods*
Cytology; Endometrial cancer; Lymphovascular space invasion; Robotic hysterectomy; Total abdominal hysterectomy