Vaginal lacerations during laparoscopic hysterectomy for endometrial cancer and local recurrence risk

TL;DR

This study finds no increased risk of vaginal recurrence but a possible increase in pelvic recurrence after vaginal lacerations during laparoscopic hysterectomy for endometrial cancer.

Contribution

The study provides new insights into recurrence risks associated with vaginal lacerations during minimally invasive surgery for endometrial cancer.

Findings

No significant increase in vaginal recurrence after vaginal lacerations during surgery.

Possible increase in pelvic recurrence linked to vaginal lacerations.

No definitive evidence that specimen removal in a bag affects recurrence risk.

Abstract

•There appears to be no increase in vaginal recurrence of endometrial cancer in patients who had a vaginal laceration at time of uterine removal during laparoscopic surgery.•There may be an increase in pelvic recurrence in patient who have a vaginal laceration at time of uterine removal during laparoscopic surgery.•Further studies are needed to assess if removal of specimen in a bag changes risk of recurrence of endometrial cancer.

There appears to be no increase in vaginal recurrence of endometrial cancer in patients who had a vaginal laceration at time of uterine removal during laparoscopic surgery.

There may be an increase in pelvic recurrence in patient who have a vaginal laceration at time of uterine removal during laparoscopic surgery.

Further studies are needed to assess if removal of specimen in a bag changes risk of recurrence of endometrial cancer.

Laparoscopic surgery (MIS) offers equivalent oncologic outcomes as compared to open surgery, while causing lesser morbidity and resulting in a faster recovery. Vaginal extraction of specimens may cause vaginal or perineal lacerations (VL). The objective of this retrospective study was to assess local recurrence rates compared between cases with vaginal laceration (VL) or without vaginal lacerations (NL).

We identified patients with endometrial cancer who underwent MIS between 2014 and 2018. We assessed the rate of local recurrence between patients in VL and NL cohorts. The study included all histologic subtypes and stages while benign final pathology, synchronous primaries or cases that required laparotomy for extraction were excluded.

338 MIS cases were evaluable of which 40 cases had a vaginal laceration during specimen extraction. There was no significant difference in age, race, presence of LVSI, stage, grade, histology or use of vaginal brachytherapy between cohorts. Cases with vaginal lacerations were significantly associated with a higher median BMI and larger uterine size. The VL cohort was more likely to have received adjuvant treatment. In early stage disease, more cases had non-endometrioid histology in the VL group and had increased incidence of chemotherapy and radiation use as well. There were no cases of isolated vaginal recurrence (0/40) in the VL group as compared to an incidence of 2 % (7/298) in the NL group with a relative risk of 0.48 (CI: 0.03–8.36, p = 0.62). There were 4 cases of pelvic recurrence (4/40) in the VL group and 2 cases in the NL group (2/298) with a relative risk of 2.13 (CI: 0.46–9.89, p = 0.34).

In endometrial cancer cases, we did not observe a significantly increased risk of vaginal or pelvic recurrence after a vaginal laceration at the time of specimen removal.

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