Endometrial Cancer: Route of Surgery

Abstract

Abstract

Background: Factors utilized when deciding route of hysterectomy for endometrial cancer have not been well-defined. Objective: The aim of this study was to evaluate a cohort of patients with endometrial cancer who underwent surgical staging via a vaginal, laparoscopic, robotic-assisted, or laparotomy approach, to arrive at better definitions for different routes of surgery utilized for endometrial cancer and the factors used in the decision for route selection. Design: This study was a single-institution retrospective review from January 2009 to December 2014. Materials and Methods: All patients with a diagnosis of endometrial cancer who underwent surgical staging were included. Data were collected for all patients, including demographics, pathology, preoperative clinical examination, and histology and operative procedural information. Results: For this study, 334 patients were included. Routes were robotic (n = 143), vaginal (n = 89), laparotomy (n = 46) and laparoscopy (n = 56). Multivariate analysis identified age, obesity, and coronary artery disease as being independently associated with a vaginal approach. High-risk histology (nonendometrioid, grade 3) and presence of an enlarged uterus were independently associated with surgical staging via laparotomy. Conclusions: Route of surgery for patients with endometrial cancer should be individualized by patient and oncologic factors. For a subset of patients with significant medical comorbidities, vaginal hysterectomy is an appropriate option. (J GYNECOL SURG 32:79)