M McCarthy Medical Student amp M Hewitt Cork University Maternity Hospital Endometrial Cancer Endometrial cancer is the 2nd most common gynaecological cancer 4 th most common malignancy in UK women ID: 1031973
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1. A surgical approach to uterine cancer in a single institution August 2006- July 2014M. McCarthy (Medical Student) & M. HewittCork University Maternity Hospital
2. Endometrial CancerEndometrial cancer is the 2nd most common gynaecological cancer4th most common malignancy in UK womenIncidence:UK Dept of health – 8,475 new incidences in 2011In Ireland 355 cases per yearCochrane review, 2012 – Appropriate to use a laparoscopic approach.
3. RobotThe first successful series of robotic hysterectomies were published in 2002The da Vinci Surgical System® introduced toCUMH in 2008
4. AimsTo assess the modality of surgical approach for endometrial cancer from April 2006 – August 2014 To assess the discharge dates associated with different modalities of treatment To assess the type and stage of tumour
5. MethodsCollected data on the surgical modalities via: 1. Theatre log books 2. In-patient computerised bed management system 3. Histology reports All data was maintained on a password protected computer within the hospital.
6. ResultsAverage Age: 60 years old Lymphadenectomy62 Lymphadenectomy (47%)71 Without (53%)133 Hysterectomies 89 robot-assisted laparoscopies 5 straight-stick laparoscopies 6 lower transverse laparotomies32 midline laparotomies 1 vaginal hysterectomy – unknown Conversion RatesThere was one conversion from Robotic-Assisted Laparoscopic to Laparotomy due to haemorrhage.
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8. Modality by YearBefore introduction of the robot: laparotomy (76% n=16) or straight stick procedure (24%, n=5).
9. Histology113 Endometrioid adenocarcinoma6 Serous Papillary Carcinomas3 Leiomyosarcoma/uterine 1 STUMP5 Mixed Mullarian Tumours (MMTs)2 Clear cell/ Endometriod and Clear Cell1 Endometrioid and sarcoma1 Atypical Hyperplasia 1 Squamous Cell Carcinoma (SCC)
10. STAGINGStage 1 - 1061a – 371b – 271c – 4Not further specified – 38Stage 2 - 5Stage 3 - 6Stage 4 – 1Information unavailable - 15
11. Results : Discharge datesMedian Discharge: Day 2 post-surgery (range 0-28)Post Robotic Hysterectomy: Mode = 1Average 2.12 (range 0 – 25)Post Straight Stick: Mode = 2Average 4 (range 2-8)Post Laparotomy: Mode = 6Average 6.67, (range 2-28)
12. CONCLUSIONCUMH have adopted recommendations that surgical management of endometrial cancer be conduced laparoscopically. Our data has demonstrated this method to be associated with better postoperative recovery in terms of earlier discharge, which is in line with international findingsLIMITATIONSRetrospectiveDidn’t investigate as to why a particular modality was chosen. Difficult to comment on lymphadenectomies. They may affect conversion rate.
13. THANKS TODr Matt HewittTheatre Managers at CUMH and CUH