Scholars@Duke publication: Relationship between minimally invasive hysterectomy, pelvic cytology, and lymph vascular space invasion: a single institution study of 458 patients.

Relationship between minimally invasive hysterectomy, pelvic cytology, and lymph vascular space invasion: a single institution study of 458 patients.

Publication , Journal Article

Zhang, C; Havrilesky, LJ; Broadwater, G; Di Santo, N; Ehrisman, JA; Lee, PS; Berchuck, A; Alvarez Secord, A; Bean, S; Bentley, RC; Valea, FA

Published in: Gynecol Oncol

May 2014

Published version (DOI) Link to item

OBJECTIVE: The aim of this study is to determine whether a minimally invasive approach to hysterectomy is associated with an increased rate of lymph vascular space invasion (LVSI) and/or malignant pelvic peritoneal cytology in endometrial cancer. METHODS: We performed a single institution analysis of 458 women with endometrial cancer who underwent either total abdominal hysterectomy (TAH) or minimally invasive hysterectomy (MIH) with use of a disposable uterine manipulator. All patients had endometrial cancer diagnosed by endometrial biopsy at a single academic institution between 2002 and 2012. Exclusion criteria were pre-operative D&C and/or hysteroscopy, uterine perforation or morcellation, and conversion to laparotomy. Multivariate logistic regression models to determine if type of hysterectomy predicts either LVSI or presence of abnormal cytology were controlled for grade, stage, depth of invasion, tumor size, cervical and adnexal involvement. RESULTS: LVSI was identified in 39/214 (18%) MIH and 44/242 (18%) TAH (p=0.99). Pelvic washings were malignant in 14/203 (7%) MIH and 16/241 (7%) TAH (p=1.0). Washings were atypical or inconclusive in 16/203 (8%) MIH and 6/241 (2.5%) TAH (p=0.014). In multivariate analyses, type of hysterectomy was not a significant predictor of either LVSI (p=0.29) or presence of malignant washings (p=0.66), but was a predictor of atypical or inconclusive washings (p=0.03). CONCLUSION: Minimally invasive hysterectomy with use of a uterine manipulator for endometrial cancer is not associated with LVSI or malignant cytology. Algorithms that better determine the etiology and implications of inconclusive or atypical pelvic cytology are needed to inform the possible additional risk associated with a minimally invasive approach to endometrial cancer.

Duke Scholars

Author Laura Jean Havrilesky Obstetrics and Gynecology, Gynecologic Oncology

Author Andrew Berchuck Obstetrics and Gynecology, Gynecologic Oncology

Author Angeles Alvarez Secord Obstetrics and Gynecology, Gynecologic Oncology

Author Sarah Muntzing Bean Pathology

Author Rex Colle Bentley Pathology

Published In

Gynecol Oncol

DOI

10.1016/j.ygyno.2014.02.025

EISSN

1095-6859

Publication Date

May 2014

Volume

133

Issue

Start / End Page

211 / 215

Location

United States

Related Subject Headings

Retrospective Studies
Peritoneal Lavage
Pelvis
Oncology & Carcinogenesis
Neoplasm Invasiveness
Myometrium
Multivariate Analysis
Middle Aged
Lymphatic Metastasis
Lymph Node Excision

Citation

APA

Chicago

ICMJE

MLA

NLM

Zhang, C., Havrilesky, L. J., Broadwater, G., Di Santo, N., Ehrisman, J. A., Lee, P. S., … Valea, F. A. (2014). Relationship between minimally invasive hysterectomy, pelvic cytology, and lymph vascular space invasion: a single institution study of 458 patients. Gynecol Oncol, 133(2), 211–215. https://doi.org/10.1016/j.ygyno.2014.02.025

Zhang, Chelsea, Laura J. Havrilesky, Gloria Broadwater, Nicola Di Santo, Jessie A. Ehrisman, Paula S. Lee, Andrew Berchuck, et al. “Relationship between minimally invasive hysterectomy, pelvic cytology, and lymph vascular space invasion: a single institution study of 458 patients.” Gynecol Oncol 133, no. 2 (May 2014): 211–15. https://doi.org/10.1016/j.ygyno.2014.02.025.

Zhang C, Havrilesky LJ, Broadwater G, Di Santo N, Ehrisman JA, Lee PS, et al. Relationship between minimally invasive hysterectomy, pelvic cytology, and lymph vascular space invasion: a single institution study of 458 patients. Gynecol Oncol. 2014 May;133(2):211–5.

Zhang, Chelsea, et al. “Relationship between minimally invasive hysterectomy, pelvic cytology, and lymph vascular space invasion: a single institution study of 458 patients.” Gynecol Oncol, vol. 133, no. 2, May 2014, pp. 211–15. Pubmed, doi:10.1016/j.ygyno.2014.02.025.

Zhang C, Havrilesky LJ, Broadwater G, Di Santo N, Ehrisman JA, Lee PS, Berchuck A, Alvarez Secord A, Bean S, Bentley RC, Valea FA. Relationship between minimally invasive hysterectomy, pelvic cytology, and lymph vascular space invasion: a single institution study of 458 patients. Gynecol Oncol. 2014 May;133(2):211–215.