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Comparison of minimally invasive versus open surgery in the treatment of endometrial carcinosarcoma
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  1. Silvana Pedra Nobre1,
  2. Jennifer J. Mueller1,
  3. Ginger J. Gardner1,
  4. Kara Long Roche1,
  5. Carol L Brown1,
  6. Robert A Soslow2,
  7. Kaled M. Alektiar3,
  8. Yukio Sonoda1,
  9. Vance A. Broach1,
  10. Elizabeth L. Jewell1,
  11. Oliver Zivanovic1,
  12. Dennis S Chi1,
  13. Nadeem R Abu-Rustum1 and
  14. Mario M. Leitao, Jr.1
  1. 1 Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  2. 2 Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  3. 3 Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
  1. Correspondence to Dr Mario M. Leitao, Jr., Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; leitaom{at}mskcc.org

Abstract

Objective The aim of this study was to compare perioperative and oncologic outcomes between minimally invasive and open surgery in the treatment of endometrial carcinosarcoma.

Methods We retrospectively identified all patients with newly diagnosed endometrial carcinosarcoma who underwent primary surgery via any approach at our institution from January 2009 to January 2018. Patients with known bulky disease identified on preoperative imaging were excluded. The χ2 and Mann–Whitney U tests were used to compare categorical and continuous variables, respectively. Kaplan–Meier curves were used to estimate survival, and compared using the log rank test.

Results We identified 147 eligible patients, of whom 37 (25%) underwent an open approach and 110 (75%) underwent minimally invasive surgery. Within the minimally invasive group, 92 (84%) of 110 patients underwent a robotic procedure and 14 (13%) underwent a laparoscopic procedure. Four minimally invasive cases (4%) were converted to open procedures. Median age, body mass index, operative time, stage, complication grade, and use of adjuvant treatment were clinically and statistically similar between groups. Median length of hospital stay in the open group was 4 days (range 3–21) compared with 1 day (range 0–6) in the minimally invasive group (p<0.001). The rates of any 30-day complication were 46% in the open and 8% in the minimally invasive group (p<0.001). The rates of grade 3 or higher complications were 5.4% and 1.8%, respectively (p=0.53). Median follow-up for the entire cohort was 30 months (range 0.4–121). Two-year progression-free survival rates were 52.8% (SE±8.4) in the open group and 58.5% (SE±5.1) in the minimally invasive group (p=0.7). Two-year disease-specific survival rates were 66.1% (SE±8.0) and 81.4% (SE±4.1), respectively (p=0.8).

Conclusions In patients with clinical stage I endometrial carcinosarcoma, minimally invasive compared with open surgery was not associated with poor oncologic outcomes, but with a shorter length of hospital stay and a lower rate of overall complications.

  • carcinosarcoma
  • gynecologic surgical procedures
  • postoperative complications
  • surgical oncology
  • surgical procedures
  • operative
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Footnotes

  • Twitter @VanceBroach, @leitaomd

  • Contributors Conceptualization, formal analysis, investigation, methodology, and roles/writing: SPN and ML. Data curation: SPN. Funding acquisition, project administration, supervision, and validation: ML. Writing—review and editing: all authors. Final approval: all authors.

  • Funding This research was funded in part through the National Institutes of Health/National Cancer Institute Cancer Center Support Grant P30 CA008748.

  • Competing interests ML is an ad hoc speaker for Intuitive Surgical, Inc. Outside the submitted work, ML reports personal fees from JNJ/Ethicon. EJ reports personal fees from Covidien/Medtronic. DSC reports personal fees from Bovie Medical Co, Verthermia Inc (now Apyx Medical Corp), C Surgeries, and Biom ‘Up. NRA-R reports grants from Stryker/Novadaq, Olympus, and GRAIL.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by our institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. For data please contact the corresponding author.

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