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Predictive Factor of Conversion to Laparotomy in Minimally Invasive Surgical Staging for Endometrial Cancer
  1. Koji Matsuo, MD, PhD*,,
  2. Carrie E. Jung, MD*,
  3. Marianne S. Hom, BA,
  4. Marc R. Gualtieri, MD§,
  5. Sonya C. Randazzo, MD,
  6. Hiroyuki Kanao, MD, PhD,
  7. Annie A. Yessaian, MD* and
  8. Lynda D. Roman, MD*,
  1. *Division of Gynecologic Oncology, Los Angeles County Medical Center,
  2. Norris Comprehensive Cancer Center,
  3. Keck School of Medicine, and
  4. §Reproductive Endocrinology and Infertility, Departments of Obstetrics and Gynecology and
  5. Anesthesiology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA; and
  6. Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan.
  1. Address correspondence and reprint requests to Koji Matsuo, MD, PhD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, 2020 Zonal Ave, IRD 520, Los Angeles, CA 90089. E-mail:


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 cm3 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.

  • Endometrial cancer
  • Minimally invasive surgery
  • Laparotomy
  • Conversion
  • Risk factor

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  • Supported by Ensign Endowment for Gynecologic Cancer Research (to K.M., A.A.Y., L.D.R.).

  • The authors declare no conflicts of interest.

  • Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (