Transcript Endometrial cancer and Cervical Cancer GynOP register 2008

Endometrial cancer and Cervical Cancer
Gynop-registret 2008-2012
Christer Borgfeldt
MD, PhD
Associate Professor
Skånes University Hospital, Lund, Sweden
Gynop
1 January 2008 to 31 December 2012.
• primary endometrial cancer patients with
curative intension n=2893
• cervical cancer patients with removal of at
least one lymph node n=249
Primary endometrial cancer patients with
curative intension n=2893
Abdominal
Laparoscopic
N
Mean
SD
N
Mean
SD
p-value
Age
2444
69
10.0
354
68
10.9
n.s.
BMI
2125
29
7.5
303
29
6.0
n.s.
Uterus weight (gram)
1515
156
185
223
127
73
=0.02
Endometrial cancer
Numbers per year and
relation Laparoscopy vs Laparotomy
700
Abdominellt
Laparoskopiskt
600
500
400
300
200
100
0
2008
Laparoscopy (%)
2%
2009
5%
2010
13 %
2011
16 %
2012
24 %
Endometrial cancer with curative intension
pelvic nodes less than 5
Abdominal
Laparoscopic
N
Mean
SD
N
Mean
SD
p-value
Op time (min)
2092
111
52
269
130
57
<0.001
Bleeding (mL)
2094
283
403
269
134
333 <0.001
LOS (days)
2051
4.3
6.2
263
2.2
1.9
<0.001
Days to normal
ADL
1479
9.0
9,19
171
5.9
6.2
<0.001
Endometrial cancer with curative intension
pelvic nodes 5 or more
Abdominal
Laparoscopic
N
Mean
SD
N
Mean
SD
p-value
Op time (min)
441
176
70
85
202
58
=0.001
Bleeding (mL)
442
378
350
83
103
109
<0.001
LOS (days)
439
6.0
4.7
80
2.7
3.0
<0.001
Days to normal
ADL
295
13.4
11
54
6.2
6.0
<0.001
Endometrial cancer with curative intension
pelvic nodes 10 or more and para-aortic nodes 5 or more
Abdominal
Laparoscopic
N
Mean
SD
N
Mean
SD
p-value
Age
156
66.5
7.7
46
69.2
8.3
=0.039
BMI
142
28.4
5.4
42
27.3
6.0
n.s.
Uterus weight (gram)
74
235
252
25
111
77
=0.019
Op time (min)
156
210
82
46
206
58
n.s.
Bleeding (mL)
156
423
360
44
108
129
<0.001
LOS (days)
153
6.4
4.9
42
2.6
2.9
<0.001
Days to normal ADL
109
15.4
11.4
32
6.6
5.5
<0.001
Pelvic lymph nodes (n)
155
32.5
11.8
46
19.0
7.1
<0.001
Para-aortic lymph nodes (n)
156
13.1
6.5
46
11.9
6.5
n.s.
Complications
Abdominal
Laparoscopic
n
%
n
%
P-value
Intraoperative
complication
116
4.6 %
9
2.5 %
<0.001
Blood transfusion
137
5.4 %
5
1.4 %
=0.005
Re-admittance one or
more nights
192
8.0 %
18
6.0 %
n.s.
Re-operation
76
3.3 %
2
0.6 %
=0.017
Patient reported complications
at 8 weeks after surgery
2595 (90 %) out of 2893 patients
Abdominal
Laparoscopic
n
%
n
%
Uncomplicated
1328
58
200
63
Minor complication
532
23
66
21
Major complication
171
8
7
2
Major and minor
complication
26
1
1
0.3
No answer this question
220
10
44
14
Total
2277
100
318
100
Relative Risk for major complication
Laparotomy vs Laparoscopy 0.29 (95 % CI 0.14-0.58)
Cervical cancer patients
with removal of at least one lymph node
FIGO stage
Abdominal
Robotic
Total
Not specified Ia2 to
IIa
7
0
7
3%
Ia2
26
15
41
16%
Ib1
137
43
180
72%
IIa
15
6
21
8%
Total
185
64
249
100%
Cervical cancer patients
with removal of at least one lymph node
Abdominal
Robotic
N
Mean
SD
N
Mean
SD
p=
Age (years)
185
45.7
13.0
64
45.4
13.6
0.853
BMI
167
25.7
4.7
54
27.0
6.1
0.111
Operating time (min)
184
217
60
64
204
57
0.121
Estimated blood loss
(mL)
184
495
478
64
102
95
0.000
Length of hospital
stay (days)
182
6.1
10.7
59
2.5
2.1
0.011
Days to Normal
Activity of Daily
Living
145
13.4
10.1
38
9.7
8.5
0.038
Cervical cancer patients
with removal of at least one lymph node
Abdominal
Robotic
Intraoperative complications
n
n
p=
N Patients
13
2
0.030
Type of intraoperartive complication
Ureter
1
Bladder
1
Bleeding
8
Vessel injuri
4
2
Cervical cancer patients
with removal of at least one lymph node
Abdominal
Robotic
Postoperative complications
n
n
p=
Re-operations
6
3
ns
Re-admission one night
8
5
ns
Re-admission two nights or more
15
5
ns
Cervical cancer patients
with removal of at least one lymph node
Abdominal
No. of pelvic lymphnodes
Robotic
N
Mean
SD
N
Mean
SD
p=
184
31.4
14.5
64
23.3
11.3
0.000
13.8
56
25.9
9.6
0.001
Patients with 10 or more lymph nodes removed
No. of pelvic lymphnodes
175
32.6
Laparoscopic surgery
is preferable to laparotomy for
endometrial cancer patients
•
•
•
•
•
shorter time to normal ADL
shorter hospital stay
less blood loss
less serious post-operative complications
less re-operations
Laparoscopic robotic assisted surgery
is preferable to laparotomy for
cervical cancer patients
•
•
•
•
shorter time to normal ADL
shorter hospital stay
less blood loss
less intra-operative complications
Laparotomy vs Laparoscopy
in endometrial cancer
• Several studies have shown NO
difference in recurrence free survival and
overall survival in endometrial cancer
• Why is not all endometrial cancer patients
offered laparoscopic surgery?
• Why is not all cervical cancer patients offered
laparoscopic robot assisted surgery?