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Correa-Paris A, Gorraiz Ochoa V, Hernandez Gutiérrez A, Gilabert Estellés J, Díaz-Feijoo B, Gil-Moreno A. Simple radiologic assessment of visceral obesity and prediction of surgical morbidity in endometrial cancer patients undergoing laparoscopic aortic lymphadenectomy: A reliability and accuracy study. J Obstet Gynaecol Res 2023; 49:988-997. [PMID: 36593218 DOI: 10.1111/jog.15528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/05/2022] [Indexed: 01/04/2023]
Abstract
AIM To evaluate the reliability of sagittal abdominal diameter (SAD)-a surrogate of visceral obesity-in magnetic resonance imaging, and its accuracy to predict the surgical morbidity of aortic lymphadenectomy. METHODS We conducted a multicenter reliability (phase 1) and accuracy (phase 2) cohort study in three Spanish referral hospitals. We retrospectively analyzed data from the STELLA-2 randomized controlled trial that included high-risk endometrial cancer patients undergoing minimally invasive surgical staging. Patients were classified into subgroups: conventional versus robotic-assisted laparoscopy, and transperitoneal versus extraperitoneal technique. In the first phase, we measured the agreement of three SAD measurements (at the umbilicus, renal vein, and inferior mesenteric artery) and selected the most reliable one. In phase 2, we evaluated the diagnostic accuracy of SAD to predict surgical morbidity. Surgical morbidity was the main outcome measure, it was defined by a core outcome set including variables related to blood loss, operative time, surgical complications, and para-aortic lymphadenectomy difficulty. RESULTS In phase 1, all measurements showed good inter-rater and intra-rater agreement. Umbilical SAD (u-SAD) was the most reliable one. In phase 2, we included 136 patients. u-SAD had a good diagnostic accuracy to predict surgical morbidity in patients undergoing transperitoneal laparoscopic lymphadenectomy (0.73 in ROC curve). It performed better than body mass index and other anthropometric measurements. We calculated a cut-off point of 246 mm (sensitivity: 0.56, specificity: 0.80). CONCLUSIONS u-SAD is a simple, reliable, and potentially useful measurement to predict surgical morbidity in endometrial cancer patients undergoing minimally invasive surgical staging, especially when facing transperitoneal aortic lymphadenectomy.
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Affiliation(s)
- Alejandro Correa-Paris
- Obstetrics and Gynecology Department, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Verónica Gorraiz Ochoa
- Obstetrics and Gynecology Department, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Juan Gilabert Estellés
- Obstetrics and Gynecology Department, Hospital General de Valencia, Valencia, Spain.,University of Valencia, Valencia, Spain
| | - Berta Díaz-Feijoo
- Obstetrics and Gynecology Department, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Gil-Moreno
- Obstetrics and Gynecology Department, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain.,Biomedical Research Group in Gynecology, Vall d'Hebron Institut de Recerca, Barcelona, Spain
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An Update on Screening and Prevention for Breast and Gynecological Cancers in Average and High Risk Individuals. Am J Med Sci 2020; 360:489-510. [DOI: 10.1016/j.amjms.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/22/2020] [Accepted: 06/03/2020] [Indexed: 11/21/2022]
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Corrado G, Mereu L, Bogliolo S, Cela V, Gardella B, Sperduti I, Certelli C, Pellegrini A, Posar G, Zampa A, Tateo S, Gadducci A, Spinillo A, Vizza E. Comparison between single-site and multiport robot-assisted hysterectomy in obese patients with endometrial cancer: An Italian multi-institutional study. Int J Med Robot 2020; 16:e2066. [PMID: 31850677 DOI: 10.1002/rcs.2066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/29/2019] [Accepted: 12/06/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of this study is to compare robotic single-site hysterectomy (RSSH) and robotic multiport hysterectomy (RMPH) for endometrial cancer (EC) in obese patients in terms of surgical outcomes. METHODS This retrospective study compares RSSH with RMPH in obese patients with EC and FIGO stages I to II divided in three classes according to their body mass index (BMI): class A (30-34.9 kg/m2 ), class B (35-39.9 kg/m2 ), and class C (>40 kg/m2 ). RESULTS We included 225 patients (RSSH: 76; RMPH: 149). The operative time and estimated blood loss (EBL) were lower in the A class of the RSSH group. The EBL and the conversion rate increased when the BMI increased in the RSSH group. The hospital stay was higher in the A class of the RMPH group. CONCLUSIONS The advantages of RSSH in terms of reduced invasiveness remain true only in the first BMI class, whereas they are lost when the BMI increased.
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Affiliation(s)
- Giacomo Corrado
- Department of Woman, Child Health and Public Health, Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Liliana Mereu
- Obstetrics and Gynecological Department, Santa Chiara Hospital, Trento, Italy
| | - Stefano Bogliolo
- Department of Gynecologic Oncology, Division of Gynecology, European Institute of Oncology, Milan, Italy
| | - Vito Cela
- Department of Obstetrics and Gynaecology, University of Pisa, Pisa, Italy
| | - Barbara Gardella
- Department of Obstetrics and Gynaecology, IRCCS-Fondazione Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Isabella Sperduti
- Scientific Direction, "Regina Elena" National Cancer Institute, IRCCS, Rome, Italy
| | - Camilla Certelli
- Department of Experimental Clinical Oncology, Gynecologic Oncology Unit, "Regina Elena" National Cancer Institute, IRCCS, Rome, Italy
| | - Alice Pellegrini
- Obstetrics and Gynecological Department, Santa Chiara Hospital, Trento, Italy
| | - Giulia Posar
- Department of Obstetrics and Gynaecology, University of Pisa, Pisa, Italy
| | - Ashanti Zampa
- Department of Experimental Clinical Oncology, Gynecologic Oncology Unit, "Regina Elena" National Cancer Institute, IRCCS, Rome, Italy
| | - Saverio Tateo
- Obstetrics and Gynecological Department, Santa Chiara Hospital, Trento, Italy
| | - Angiolo Gadducci
- Department of Obstetrics and Gynaecology, University of Pisa, Pisa, Italy
| | - Arsenio Spinillo
- Department of Obstetrics and Gynaecology, IRCCS-Fondazione Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - Enrico Vizza
- Department of Experimental Clinical Oncology, Gynecologic Oncology Unit, "Regina Elena" National Cancer Institute, IRCCS, Rome, Italy
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Reyes Claret A, Martínez Canto MC, Robles Gourley A, Llull Gomila M, Martín Jiménez Á. Transperitoneal Laparoscopic Para-Aortic Lymphadenectomy and Body Mass Index: Is It Really a Limiting Factor for the Procedure? J Laparoendosc Adv Surg Tech A 2020; 30:416-422. [PMID: 32023169 DOI: 10.1089/lap.2019.0529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To explore if obesity measured by body mass index (BMI) ≥30 kg/m2 represents a limiting factor for para-aortic lymphadenectomy done with a transperitoneal laparoscopic approach. Materials and Methods: Retrospective observational study with 146 consecutive patients, diagnosed with a gynecological cancer submitted to para-aortic surgical staging between January 2010 and December 2018. The mean age was 52 years and the mean BMI was 27 kg/m2. 72.6% (106 patients) had BMI <30 kg/m2 and 27.4% (40 patients) had BMI ≥30 kg/m2. Half of the patients did not have prior abdominal surgeries. Results: The statistical analysis showed that there were no significant differences between two groups depending on their BMI in the lymph node count: BMI <30 kg/m2 14 nodes versus BMI ≥30 kg/m2 10 nodes (P = .122); rate of intraoperative complications: BMI <30: 6.3% versus BMI ≥30: 0% (P = .180), postoperative complications: BMI <30: 6.6% versus BMI ≥30: 5% (P = .723); feasibility rate: BMI <30: 97.1% versus BMI ≥30: 95.6% (P = .063) or the mean hospital stay BMI <30: 2.47 ± 2.05 days (standard deviation [SD]), BMI ≥30: 2.64 ± 0.93 days (SD) (P = .171). The only significant difference observed was due to the operating time: BMI <30: 103.1 ± 60.8 (SD) versus BMI ≥30: 146.9 ± 82.5 (SD) (P = .019), being longer in obese patients. Conclusions: Obesity, estimated by BMI, does not seem to represent a limiting factor for this surgical procedure in our series. We feel it is a feasible and justified approach in obese patients when other surgical procedures have to be carried out in the same surgical act. Probably, other factors and anthropometric measurements are more accurate to select patients in which this approach is feasible.
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Affiliation(s)
- Albert Reyes Claret
- Gynecologic Oncology Department, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | | | - Ana Robles Gourley
- Obstetrics and Gynaecology Department, Hospital Comarcal d'Inca, Inca, Spain
| | - Marina Llull Gomila
- Gynecologic Oncology Department, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | - Ángel Martín Jiménez
- Gynecologic Oncology Department, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
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Nakao K, Sasaki H, Nishimura T, Banno H, Otsuka K, Hirabuki S, Hoshiba T. Periaortic Abdominal Fat Area as a Predictor of Surgical Difficulties during Extraperitoneal Laparoscopic Para-aortic Lymphadenectomy. J Minim Invasive Gynecol 2019; 27:1377-1382. [PMID: 31676398 DOI: 10.1016/j.jmig.2019.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 10/17/2019] [Accepted: 10/20/2019] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE To evaluate whether obesity is a marker of surgical difficulty during extraperitoneal para-aortic lymphadenectomy. DESIGN Retrospective observational cohort study. SETTING Tertiary medical center in the Kanazawa area of Japan. PATIENTS Eighty-four patients with primary endometrial cancer who underwent extraperitoneal laparoscopic para-aortic lymphadenectomy (LPAND) between January 2005 and December 2017 were included. INTERVENTIONS We investigated the correlation between operative times and body mass indexes, visceral fat areas, and periabdominal artery fat areas (PAFAs). The number of lymph nodes harvested was used as an indicator of the degree of surgical completion. MEASUREMENTS AND MAIN RESULTS There was no correlation between the operative time and body mass index. Significant correlations were observed between operative time and visceral fat area (p = .026; r = 0.243) and between operative time and PAFA (p = .007; r = 0.293). A multivariate analysis showed that PAFA was a significant independent marker that could be used to predict prolonged operative times for extraperitoneal LPAND (p = .045; odds ratio, 3.05). The number of para-aortic lymph nodes harvested was not significant in the high- and low-PAFA groups (22 and 25, respectively; p = .525). CONCLUSION PAFA is an adequate marker of prolonged operative time for extraperitoneal LPAND among patients with endometrial cancer.
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Affiliation(s)
- Kohshiro Nakao
- Department of Obstetrics and Gynecology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan (all authors)..
| | - Hiromasa Sasaki
- Department of Obstetrics and Gynecology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan (all authors)
| | - Toshiya Nishimura
- Department of Obstetrics and Gynecology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan (all authors)
| | - Harumichi Banno
- Department of Obstetrics and Gynecology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan (all authors)
| | - Kaori Otsuka
- Department of Obstetrics and Gynecology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan (all authors)
| | - Shinya Hirabuki
- Department of Obstetrics and Gynecology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan (all authors)
| | - Tsutomu Hoshiba
- Department of Obstetrics and Gynecology, Ishikawa Prefectural Central Hospital, Ishikawa, Japan (all authors)
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Cusimano MC, Simpson AN, Dossa F, Liani V, Kaur Y, Acuna SA, Robertson D, Satkunaratnam A, Bernardini MQ, Ferguson SE, Baxter NN. Laparoscopic and robotic hysterectomy in endometrial cancer patients with obesity: a systematic review and meta-analysis of conversions and complications. Am J Obstet Gynecol 2019; 221:410-428.e19. [PMID: 31082383 DOI: 10.1016/j.ajog.2019.05.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE DATA Robotic assistance may facilitate completion of minimally invasive hysterectomy, which is the standard of care for the treatment of early-stage endometrial cancer, in patients for whom conventional laparoscopy is challenging. The aim of this systematic review was to assess conversion to laparotomy and perioperative complications after laparoscopic and robotic hysterectomy in patients with endometrial cancer and obesity (body mass index, ≥30 kg/m2). STUDY We systematically searched MEDLINE, EMBASE, and Evidence-Based Medicine Reviews (January 1, 2000, to July 18, 2018) for studies of patients with endometrial cancer and obesity (body mass index, ≥30 kg/m2) who underwent primary hysterectomy. STUDY APPRAISAL AND SYNTHESIS METHODS We determined the pooled proportions of conversion, organ/vessel injury, venous thromboembolism, and blood transfusion. We assessed risk of bias with the Institute of Health Economics Quality Appraisal Checklist for single-arm studies, and Newcastle-Ottawa Quality Scale for double-arm studies. RESULTS We identified 51 observational studies that reported on 10,800 patients with endometrial cancer and obesity (study-level body mass index, 31.0-56.3 kg/m2). The pooled proportions of conversion from laparoscopic and robotic hysterectomy were 6.5% (95% confidence interval, 4.3-9.9) and 5.5% (95% confidence interval, 3.3-9.1), respectively, among patients with a body mass index of ≥30 kg/m2, and 7.0% (95% confidence interval, 3.2-14.5) and 3.8% (95% confidence interval, 1.4-9.9) among patients with body mass index of ≥40 kg/m2. Inadequate exposure because of adhesions/visceral adiposity was the most common reason for conversion for both laparoscopic (32%) and robotic hysterectomy (61%); however, intolerance of the Trendelenburg position caused 31% of laparoscopic conversions and 6% of robotic hysterectomy conversions. The pooled proportions of organ/vessel injury (laparoscopic, 3.5% [95% confidence interval, 2.2-5.5]; robotic hysterectomy, 1.2% [95% confidence interval, 0.4-3.4]), venous thromboembolism (laparoscopic, 0.5% [95% confidence interval, 0.2-1.2]; robotic hysterectomy, 0.5% [95% confidence interval, 0.1-2.0]), and blood transfusion (laparoscopic, 2.8% [95% confidence interval, 1.5-5.1]; robotic hysterectomy, 2.1% [95% confidence interval, 1.6-3.8]) were low and not appreciably different between arms. CONCLUSION Robotic and laparoscopic hysterectomy have similar rates perioperative complications in patients with endometrial cancer and obesity, but robotic hysterectomy may reduce conversions because of positional intolerance in patients with morbid obesity. Existing literature is limited by selection and confounding bias, and randomized trials are needed to inform practice standards in this population.
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Affiliation(s)
- Maria C Cusimano
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Andrea N Simpson
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics & Gynecology, St. Michael's Hospital, Toronto, Ontario, Canada
| | | | - Valentina Liani
- Faculty of Medicine and Surgery, University of Trieste, Trieste TS Italy
| | - Yuvreet Kaur
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Deborah Robertson
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics & Gynecology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Abheha Satkunaratnam
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics & Gynecology, North York General Hospital, Toronto, Ontario, Canada
| | - Marcus Q Bernardini
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada; Division of Gynecologic Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Sarah E Ferguson
- Department of Obstetrics & Gynecology, University of Toronto, Toronto, Ontario, Canada; Division of Gynecologic Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Nancy N Baxter
- Department of Surgery, Toronto, Ontario, Canada; Division of General Surgery, St. Michael's Hospital, Toronto, Ontario, Canada.
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Harrison RF, Mcnamara JE, Beaumont CB, Sadowski EA, Chappell RJ, Shahzad MM, Spencer RJ, Al-Niaimi AN, Barroilhet LM, Rose SL, Kushner DM. Using simple radiologic measurements to anticipate surgical challenge in endometrial cancer: a prospective study. Int J Gynecol Cancer 2019; 29:102-107. [DOI: 10.1136/ijgc-2018-000037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/27/2018] [Accepted: 09/13/2018] [Indexed: 11/04/2022] Open
Abstract
ObjectivesTo determine if linear measurements of adiposity from pre-operative imaging can improve anticipation of surgical difficulty among endometrial cancer patients.MethodsEighty patients with newly diagnosed endometrial cancer were enrolled. Routine pre-operative imaging (MRI or CT) was performed. Radiologic linear measurements of the following were obtained: anterior-to-posterior skin distance; anterior skin to anterior edge of L5 distance (total anterior); anterior peritoneum to anterior edge of L5 distance (visceral obesity); and posterior edge of L5 to posterior skin distance (total posterior). Surgeons completed questionnaires quantifying preoperative anticipated operative difficulty and postoperative reported operative difficulty. The primary objective was to assess for a correlation between linear measurements of visceral fat and reported operative difficulty.ResultsSeventy-nine patients had questionnaires completed, preoperative imaging obtained, and surgery performed. Univariate analysis showed all four linear measurements, body mass index, weight, and anticipated operative difficulty were associated with increased reported operative difficulty (P< 0.05). Multivariate analysis demonstrated that body mass index and linear measurements visceral obesity and total posterior were independently associated with increased reported operative difficulty (P< 0.05). Compared with body mass index, the visceral obesity measurement was more sensitive and specific for predicting increased reported operative difficulty (visceral obesity; sensitivity 54%, specificity 91 %; body mass index; sensitivity 38%, specificity 89%). A difficulty risk model combining body mass index, visceral obesity, and total posterior demonstrated better predictive performance than any individual preoperative variable.ConclusionsSimple linear measurements of visceral fat obtained from preoperative imaging are more predictive than body mass index alone in anticipating surgeon-reported operative difficulty. These easily obtained measurements may assist in preoperative decision making in this challenging patient population.
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Corrado G, Vizza E, Cela V, Mereu L, Bogliolo S, Legge F, Ciccarone F, Mancini E, Gallotta V, Baiocco E, Monterossi G, Perri MT, Zampa A, Pasciuto T, Scambia G. Laparoscopic versus robotic hysterectomy in obese and extremely obese patients with endometrial cancer: A multi-institutional analysis. Eur J Surg Oncol 2018; 44:1935-1941. [DOI: 10.1016/j.ejso.2018.08.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/14/2018] [Accepted: 08/28/2018] [Indexed: 11/26/2022] Open
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Left Lateral Endosurgical Extraperitoneal Total Hysterectomy with Para-Aortic and Pelvic Lymphadenectomy: A Novel Approach for the Obese Patient with Endometrial Cancer. J Minim Invasive Gynecol 2017; 25:730-736. [PMID: 29229578 DOI: 10.1016/j.jmig.2017.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/24/2017] [Accepted: 11/28/2017] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To describe the left lateral extraperitoneal approach to perform complete para-aortic and pelvic lymphadenectomy and transverse total hysterectomy from left to right as a novel approach to treat obese patients with endometrial cancer. Laparoscopic management of obese patients represents a challenge for the gynecologic surgeon. The extraperitoneal approach is technically easier in the obese patient because it naturally creates a bowel-free operative field. DESIGN A prospective pilot bicentric and descriptive study (Canadian Task Force classification III) evaluating the feasibility and reproducibility of the transverse total hysterectomy and complete lymphadenectomy through left endoscopic extraperitoneal approach in obese patients with endometrial cancer. SETTING A comprehensive cancer center in Toulouse and a teaching university hospital in Madrid. PATIENTS Sixteen consecutive overweight or obese patients (body mass index > 25 kg/m2) with high-risk endometrial cancer. INTERVENTIONS Currently, the left extraperitoneal approach is routinely used to perform complete para-aortic and pelvic lymphadenectomy. It provides direct access to the left ureter and uterine pedicle. This access can be extended to the right side when performing a transverse extrafascial hysterectomy from left to right. The procedure starts from the left extraperitoneal space, where the left uterine artery is sectioned and the vesicovaginal and rectovaginal septa are developed, without opening the peritoneum. Colpotomy is performed from the left to the right side. Once the right ureter is identified, the right uterine artery can be safely transected. Alternatively, the right uterine artery can be sealed and sectioned during the right pelvic lymphadenectomy. At the end of the procedure the peritoneum is opened to complete the surgery. MEASUREMENTS AND MAIN RESULTS Between May 2015 and February 2016, 16 consecutive obese patients were successfully treated using this technique. Median patient age was 62 years (range, 44-78), and median body mass index was 32.5 kg/m2 (range, 26-42). In 3 cases the right uterine artery was sealed during the right pelvic lymphadenectomy, in 11 cases after completing vaginal opening, and in 2 cases after peritoneal opening. The median operative time was 137.5 minutes (range, 66-260). The median blood loss was 85 mL (range, 0-260), and no blood transfusion was required in any of our 16 patients. No significant complications occurred. CONCLUSION The full extraperitoneal approach represents an interesting alternative strategy for the surgical treatment of obese patients with high-risk endometrial cancer.
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Predictive Factor of Conversion to Laparotomy in Minimally Invasive Surgical Staging for Endometrial Cancer. Int J Gynecol Cancer 2016; 26:290-300. [PMID: 26569058 DOI: 10.1097/igc.0000000000000594] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The aim of the study was to identify risk factors associated with laparotomy conversion during total laparoscopic hysterectomy for endometrial cancer. METHODS This is a retrospective study examining endometrial cancer cases that underwent hysterectomy-based surgical staging initiated via conventional laparoscopic approach. Factors related to patient, tumor, and surgeon were examined to establish risk of laparotomy conversion using a multivariate logistic regression model. RESULTS There were 251 cases identified including 30 cases (12.0%) of laparotomy conversion. The most common indication for laparotomy conversion was a large uterus (27.0%), followed by extensive adhesions (24.3%) and surgical complications (18.9%). Outcomes of cases resulting in laparotomy conversion include longer surgical time (333 vs 224 minutes, P < 0.001), larger blood loss (350 vs 100 mL, P < 0.001), longer hospital stay (4 vs 2 days, P < 0.001), and increased risk of hospital readmission (10% vs 1.4%, P = 0.024). In multivariate analysis, morbid obesity (odds ratio [OR], 4.51; P = 0.011), suboptimal pelvic examination or enlarged uterus during preoperative evaluation (OR, 3.55; P = 0.034), para-aortic lymphadenectomy (OR, 10.5; P = 0.001), uterine size 250 g or greater (OR, 3.49; P = 0.026), and extrauterine disease (OR, 4.68; P = 0.012) remained the independent predictors for laparotomy conversion. The following numbers of risk factors were significantly correlated with laparotomy-conversion rate: none, 1.1%; single risk factor, 5.3% (OR, 5.00; P = 0.15); double risk factors, 21.7% (OR, 24.9; P = 0.002); and triple or more risk factors, 50% (OR, 90.0; P < 0.001). Ultrasonographic 3-dimensional volumes of 496 cm in preoperative uterine size correlate with actual uterine weight of 250 g (Y = 61.5 + 0.38X, P < 0.001). CONCLUSIONS Laparotomy conversion significantly impacts outcomes of patients with endometrial cancer. In this setting, our predictive model for laparotomy conversion will be useful to guide the surgical management of endometrial cancer.
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Abdelbadee AY, Paspulati RM, McFarland HD, Bedaiwy MA, Ciancibello L, Anderson G, Zanotti KM. Computed Tomography Morphometrics and Pulmonary Intolerance in Endometrial Cancer Robotic Surgery. J Minim Invasive Gynecol 2016; 23:1075-1082. [PMID: 27449691 DOI: 10.1016/j.jmig.2016.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/06/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVES To identify morphometric characteristics of obese patients that best predict pulmonary intolerance to robotic pelvic surgery using a novel method for quantifying adipose distribution. DESIGN Retrospective study (Canadian Task Force classification II-2). SETTING University hospital. PATIENTS Fifty-nine patients with endometrial cancer who underwent robotic hysterectomy and lymphadenectomy between April 2008 and May 2014 and also underwent perioperative computed tomography (CT) imaging within 1 year. INTERVENTION Visceral fat volume (VFV) and subcutaneous fat volume (SFV) were quantified through waist circumference measurements along with average volume estimation of slices taken at 3 levels: mid-waist, L2-L3, and L4-L5. Mean and maximum values were obtained for intraoperative physiological data. MEASUREMENTS AND MAIN RESULTS The patients' mean body mass index (BMI) was 34 (range, 20-59). Along with waist circumference, VFV and SFV quantified by CT at the mid-waist, L2-L3, and L4-L5 levels were all significant independent predictors for peak airway pressure (PAP; average and maximum) and plateau airway pressure (Pplat; average and maximum) on multivariate regression analysis after adjustment for age, ethnicity, diabetes, hypertension, pulmonary disease, smoking, obstructive sleep apnea, American Society of Anesthesiologists classification, and duration of anesthesia. Compared with the other CT parameters, L2-L3 VFV was the best predictor of average PAP (β = 0.398; p = .002), maximum PAP (β = 0.493; p < .001), average Pplat (β = 0.536; p < .001), and maximum Pplat (β = 0.573; p < .001). CONCLUSION These novel CT morphometric measurements represent valid predictors of pulmonary intolerance to robotic surgery in obese patients. Of the measures analyzed, VFV at L2-L3 best predicts pulmonary tolerance in obese patients.
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Affiliation(s)
- Ahmed Y Abdelbadee
- Department of Reproductive Biology, University Hospitals Case Medical Center, Cleveland, OH; Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt
| | - Raj M Paspulati
- Radiology Department, University Hospitals Case Medical Center, Cleveland, OH
| | - Heather D McFarland
- Department of Anesthesiology and Perioperative Medicine, University Hospitals Case Medical Center, Cleveland, OH
| | - Mohamed A Bedaiwy
- Department of Obstetrics and Gynecology, Women's Health Hospital, Assiut University, Assiut, Egypt; Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Colombia, Vancouver, BC, Canada
| | - Leslie Ciancibello
- Radiology Department, University Hospitals Case Medical Center, Cleveland, OH
| | - Gina Anderson
- Radiology Department, University Hospitals Case Medical Center, Cleveland, OH
| | - Kristine M Zanotti
- Department of Reproductive Biology, University Hospitals Case Medical Center, Cleveland, OH.
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Uccella S, Bonzini M, Palomba S, Fanfani F, Ceccaroni M, Seracchioli R, Vizza E, Ferrero A, Roviglione G, Casadio P, Corrado G, Scambia G, Ghezzi F. Impact of Obesity on Surgical Treatment for Endometrial Cancer: A Multicenter Study Comparing Laparoscopy vs Open Surgery, with Propensity-Matched Analysis. J Minim Invasive Gynecol 2016; 23:53-61. [DOI: 10.1016/j.jmig.2015.08.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/05/2015] [Accepted: 08/06/2015] [Indexed: 01/17/2023]
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Hackethal A, Brennan D, Rao A, Land R, Obermair A, Nicklin J, Garrett A, Nascimento M, Crandon A, Perrin L, Chetty N. Consideration for safe and effective gynaecological laparoscopy in the obese patient. Arch Gynecol Obstet 2014; 292:135-41. [DOI: 10.1007/s00404-014-3600-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 12/11/2014] [Indexed: 12/22/2022]
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14
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Palomba S, Ghezzi F, Falbo A, Mandato VD, Annunziata G, Lucia E, Cromi A, Zannoni L, Seracchioli R, Giorda G, La Sala GB, Zullo F, Franchi M. Conversion in endometrial cancer patients scheduled for laparoscopic staging: a large multicenter analysis. Surg Endosc 2014; 28:3200-9. [DOI: 10.1007/s00464-014-3589-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 05/06/2014] [Indexed: 03/12/2023]
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15
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Siedhoff MT, Carey ET, Findley AD, Riggins LE, Garrett JM, Steege JF. Effect of Extreme Obesity on Outcomes in Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2012; 19:701-7. [DOI: 10.1016/j.jmig.2012.07.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 07/04/2012] [Accepted: 07/12/2012] [Indexed: 11/16/2022]
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16
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Magnetic resonance or computerized tomography imaging to predict difficulty of robotic surgery for endometrial cancer. J Robot Surg 2012; 6:131-7. [PMID: 27628276 DOI: 10.1007/s11701-011-0281-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 05/17/2011] [Indexed: 10/18/2022]
Abstract
To determine if the difficulty of a robotic hysterectomy for endometrial cancer can be predicted by MRI, CT or other methods. All robotic cases from 1 August 2006 through 30 July 2009 were identified. Data collected prospectively included co-morbidities, body mass index, surgical times, estimated blood loss (EBL), uterine weight, and pre- and postoperative complications. Those patients who received an MRI or CT scan prior to robotic hysterectomy had additional data gathered from imaging, including uterine volume, pelvic measurements and abdominal wall thickness. Cases were labeled difficult for the following reasons: outliers greater than 2 SD from the mean EBL, hysterectomy time and total console time. Additional factors identifying difficult cases included the need to undock to remove the specimen or conversion to laparotomy. Data were analyzed for their possible role in causing difficulty in a robotic hysterectomy. Comparative statistics utilized included chi-square and t-test, ANOVA and logistic regression analysis.From 2 August 2006 through 30 July 2009, 119 patients underwent robotic surgery for endometrial cancer and are included in this study. Of these patients, 25/119 (20.0%) were identified as difficult cases. Difficulty was found in those patients with greater than 2 SD from the mean for hysterectomy time, >90.9 min (n = 3, 2.5%), total console time of >178.1 min (n = 6, 5.0%), EBL >232 cc (n = 7, 5.9%) and undocking to remove the uterine specimen in 8 (6.7%) cases; 1/119 (0.8%) was converted to laparotomy. Lymphadenectomy (P = 0.005) was associated with case difficulty. In a logistic regression analysis CT/MRI measurements of uterine volume greater than 793 cm³ and CT/MRI pelvimetry, as well as abdominal wall thickness were independent predictors of a difficult case (P = 0.0116). MRI and CT scans can detect the probability that a robotic surgery will be difficult by determining uterine volume and pelvimetry; however, these were not the strongest predictors in our study. A narrow pelvic outlet as measured on CT/MRI and uterine volume of greater than 793 cc should raise a flag of caution when planning robotic hysterectomy for endometrial cancer.
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Kuku S, Dick J, Olaitan A. The surgical management of morbidly obese women with endometrial cancer. Health (London) 2012. [DOI: 10.4236/health.2012.412a208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Rabischong B, Larraín D, Canis M, Le Bouëdec G, Pomel C, Jardon K, Kwiatkowski F, Bourdel N, Achard JL, Dauplat J, Mage G. Long-Term Follow-Up After Laparoscopic Management of Endometrial Cancer in the Obese: A Fifteen-Year Cohort Study. J Minim Invasive Gynecol 2011; 18:589-96. [DOI: 10.1016/j.jmig.2011.05.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 05/17/2011] [Accepted: 05/26/2011] [Indexed: 10/18/2022]
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Leblanc E, Samouelian V, Boulanger L, Narducci F. [Are there still contra-indications to laparoscopic treatment of endometrial carcinoma?]. ACTA ACUST UNITED AC 2010; 38:119-25. [PMID: 20106706 DOI: 10.1016/j.gyobfe.2009.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 10/10/2009] [Indexed: 11/30/2022]
Abstract
Laparoscopic treatment is becoming a standard of care for early endometrial carcinoma. However, not all patients are suitable for this approach. A review of the current literature provides some arguments to differentiate absolute contra-indications from relative ones, for which, whenever possible, some options are suggested.
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Affiliation(s)
- E Leblanc
- Département de cancérologie gynécologique, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59020 Lille cedex, France.
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Fader AN, Michener C, Frasure H, Giannios N, Belinson J, Zanotti K. Total Laparoscopic Hysterectomy versus Laparoscopic-Assisted Vaginal Hysterectomy in Endometrial Cancer: Surgical and Survival Outcomes. J Minim Invasive Gynecol 2009; 16:333-9. [DOI: 10.1016/j.jmig.2009.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2008] [Revised: 02/11/2009] [Accepted: 02/18/2009] [Indexed: 11/29/2022]
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Relevance of surgical approach and adjuvant therapy in survival of obese patients with endometrial cancer. Am J Obstet Gynecol 2009; 200:e11; author reply e11. [PMID: 18992860 DOI: 10.1016/j.ajog.2008.07.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Accepted: 07/16/2008] [Indexed: 11/24/2022]
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