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Published on: August 2, 2024
Endometrial Cancer Recurrence Risk Following Robotic Hysterectomy
Sean Zhu1, Ericka Wiebe2, Haley Frerichs3
1Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Foothills Medical Centre, 1403 29 Street NW, Calgary, AB T2N 2T9, Canada.
Background:
Minimally invasive surgery is widely used in endometrial cancer management, but recurrence remains a concern.
Methods:
A retrospective review of 1201 patients treated from 2012 to 2019 with robotic laparoscopy was conducted. Recurrence-free survival and hazard ratios were calculated using multivariate Cox models.
Results:
Of 1278 patients, 155 cases of recurrent disease were identified. Age (HR 1.01, p = 0.045), LVSI (HR 3.54, p < 0.001), stage and high-grade histology (HR 3.39, p < 0.001) were associated with increased risk of recurrence. Hazard ratios for stages IB, II and III/IV were 1.92 (p = 0.007), 2.67 (p = 0.001), and 3.23 (p < 0.001) respectively. The use of a uterine manipulator was an independent risk factor on multivariate analysis (HR 2.12, p < 0.001). Adjuvant chemotherapy (HR 0.67, p = 0.239) and radiotherapy (HR 0.64, p = 0.056) trends favored reduced risk but were not significant. Chemoradiotherapy was found to have a reduction in recurrence with a HR 0.44 (p = 0.002).
Conclusions:
Traditional prognostic factors remain important for patients with endometrial cancer having undergone robotic laparoscopic hysterectomy. Uterine manipulator use should be carefully reconsidered in endometrial cancer surgery.
