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John F Boggess - One of the best experts on this subject based on the ideXlab platform.
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what is the optimal minimally invasive surgical procedure for endometrial Cancer Staging in the obese and morbidly obese woman
Gynecologic Oncology, 2008Co-Authors: Paola A Gehrig, Leigh A Cantrell, Aaron Shafer, Lisa N Abaid, Alberto A Mendivil, John F BoggessAbstract:Abstract Objective Thirty-three percent of U.S. women are either obese or morbidly obese. This is associated with an increased risk of death from all causes and is also associated with an increased risk of endometrial carcinoma. We sought to compare minimally invasive surgical techniques for Staging the obese and morbidly obese woman with endometrial Cancer. Materials and methods Consecutive robotic endometrial Cancer Staging procedures were collected from 2005–2007 and were compared to consecutive laparoscopic cases (2000–2004). Demographics including age, weight, body mass index (BMI), operative time, estimated blood loss, lymph node retrieval, hospital stay and complications were collected and compared. Results During the study period, there were 36 obese and 13 morbidly obese women who underwent surgery with the DaVinci® robotic system and 25 obese and 7 morbidly obese women who underwent traditional laparoscopy. For both the obese and morbidly obese patient, robotic surgery was associated with shorter operative time ( p =0.0004), less blood loss ( p p =0.004) and shorter hospital stay ( p =0.0119). Conclusions Robotic surgery is a useful minimally invasive tool for the comprehensive surgical Staging of the obese and morbidly obese woman with endometrial Cancer. As this patient population is at increased risk of death from all causes, including post-operative complications, all efforts should be made to improve their outcomes and minimally invasive surgery provides a useful platform by which this can occur.
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what is the optimal minimally invasive surgical procedure for endometrial Cancer Staging in the obese and morbidly obese woman
Gynecologic Oncology, 2008Co-Authors: Paola A Gehrig, Leigh A Cantrell, Aaron Shafer, Lisa N Abaid, Alberto A Mendivil, John F BoggessAbstract:OBJECTIVE: Thirty-three percent of U.S. women are either obese or morbidly obese. This is associated with an increased risk of death from all causes and is also associated with an increased risk of endometrial carcinoma. We sought to compare minimally invasive surgical techniques for Staging the obese and morbidly obese woman with endometrial Cancer. MATERIALS AND METHODS: Consecutive robotic endometrial Cancer Staging procedures were collected from 2005-2007 and were compared to consecutive laparoscopic cases (2000-2004). Demographics including age, weight, body mass index (BMI), operative time, estimated blood loss, lymph node retrieval, hospital stay and complications were collected and compared. RESULTS: During the study period, there were 36 obese and 13 morbidly obese women who underwent surgery with the DaVinci robotic system and 25 obese and 7 morbidly obese women who underwent traditional laparoscopy. For both the obese and morbidly obese patient, robotic surgery was associated with shorter operative time (p=0.0004), less blood loss (p<0.0001), increased lymph node retrieval (p=0.004) and shorter hospital stay (p=0.0119). CONCLUSIONS: Robotic surgery is a useful minimally invasive tool for the comprehensive surgical Staging of the obese and morbidly obese woman with endometrial Cancer. As this patient population is at increased risk of death from all causes, including post-operative complications, all efforts should be made to improve their outcomes and minimally invasive surgery provides a useful platform by which this can occur.
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a comparative study of 3 surgical methods for hysterectomy with Staging for endometrial Cancer robotic assistance laparoscopy laparotomy
American Journal of Obstetrics and Gynecology, 2008Co-Authors: John F Boggess, Paola A Gehrig, Leigh A Cantrell, Aaron Shafer, Mildred Ridgway, Elizabeth N Skinner, Wesley C FowlerAbstract:Objective The purpose of this study was to compare outcomes in women who underwent endometrial Cancer Staging by different surgical techniques. Study Design Three hundred twenty-two women underwent endometrial Cancer Staging: 138 by laparotomy (TAH); 81 by laparoscopy (TLH) and 103 by robotic technique (TRH). Results The TRH cohort had a higher body mass index than the TLH cohort ( P = .0008). Lymph node yield was highest for TRH ( P P P P P Conclusion TRH with Staging is feasible and preferable over TAH and may be preferable over TLH in women with endometrial Cancer. Further study is necessary to determine long-term oncologic outcomes.
Valerie W Rusch - One of the best experts on this subject based on the ideXlab platform.
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the international association for the study of lung Cancer lung Cancer Staging project proposals for the revision of the n descriptors in the forthcoming 8th edition of the tnm classification for lung Cancer
Journal of Thoracic Oncology, 2015Co-Authors: Hisao Asamura, Valerie W Rusch, Peter Goldstraw, John Crowley, Kari Chansky, Johan Vansteenkiste, Hirokazu Watanabe, Marcin Zielinski, David Ball, Ramon RamiportaAbstract:Introduction Nodal status is considered to be one of the most reliable indicators of the prognosis in patients with lung Cancer and thus is indispensable in determining the optimal therapeutic options. We sought to determine whether the current nodal (N) descriptors should be maintained or revised for the next edition (8th) of the International Lung Cancer Staging System. Methods The new International Association for the Study of Lung Cancer lung Cancer database was created from 94,708 patients diagnosed as having lung Cancer between 1999 and 2010. Among these, 38,910 and 31,426 patients with non–small-cell lung carcinoma were available for an analysis of the clinical (c)N and pathological (p)N status, respectively. The anatomical location of lymph node involvement was defined by either the Naruke (for Japanese data) or American Thoracic Society (for non-Japanese data) nodal charts. Survival was calculated by the Kaplan–Meier method, and prognostic groups were assessed by a Cox regression analysis. Results The current N0 to N3 descriptors for both the cN and pN status consistently separated prognostically distinct groups. The 5-year survival rates according to the cN and pN status were 60% and 75% (N0), 37% and 49% (N1), 23% and 36% (N2), and 9% and 20% (N3), respectively. The differences in survival between all neighboring nodal categories were highly significant for both the cN and pN status. With regard to pathological Staging, additional analyses regarding the prognosis were performed by further dividing N1 into N1 at a single station (N1a) and N1 at multiple stations (N1b); N2 into N2 at a single station without N1 involvement (“skip” metastasis, N2a1), N2 at a single station with N1 involvement (N2a2), and N2 at multiple stations (N2b). The survival curves for N1b and N2a2 overlapped each other, and N2a1 had numerically a better prognosis than N1b, although the difference was not significant. Geographic difference in N-specific prognosis was observed for both c-settings and p-settings. This might have been because of the difference in the used nodal map, surgical technique, and pathologist's handling of the resected specimen. Conclusions Current N descriptors adequately predict the prognosis and therefore should be maintained in the forthcoming Staging system. Furthermore, we recommend that physicians record the number of metastatic lymph nodes (or stations) and to further classify the N category using new descriptors, such as N1a, N1b, N2a, N2b, and N3, for further testing.
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Cancer of the esophagus and esophagogastric junction data driven Staging for the seventh edition of the american joint committee on Cancer international union against Cancer Cancer Staging manuals
Cancer, 2010Co-Authors: Thomas W Rice, Valerie W Rusch, Hemant Ishwaran, Eugene H BlackstoneAbstract:BACKGROUND: Previous American Joint Committee on Cancer/International Union Against Cancer (AJCC/UICC) stage groupings for esophageal Cancer have not been data driven or harmonized with stomach Cancer. At the request of the AJCC, worldwide data from 3 continents were assembled to develop data-driven, harmonized esophageal Staging for the seventh edition of the AJCC/UICC Cancer Staging manuals. METHODS: All-cause mortality among 4627 patients with esophageal and esophagogastric junction Cancer who underwent surgery alone (no preoperative or postoperative adjuvant therapy) was analyzed by using novel random forest methodology to produce stage groups for which survival was monotonically decreasing, distinctive, and homogeneous. RESULTS: For lymph node-negative pN0M0 Cancers, risk-adjusted 5-year survival was dominated by pathologic tumor classification (pT) but was modulated by histopathologic cell type, histologic grade, and location. For lymph node-positive, pN+M0 Cancers, the number of Cancer-positive lymph nodes (a new pN classification) dominated survival. Resulting stage groupings departed from a simple, logical arrangement of TNM. Stage groupings for stage I and II adenocarcinoma were based on pT, pN, and histologic grade; and groupings for squamous cell carcinoma were based on pT, pN, histologic grade, and location. Stage III was similar for histopathologic cell types and was based only on pT and pN. Stage 0 and stage IV, by definition, were categorized as tumor in situ (Tis) (high-grade dysplasia) and pM1, respectively. CONCLUSIONS: The prognosis for patients with esophageal and esophagogastric junction Cancer depends on the complex interplay of TNM classifications as well as nonanatomic factors, including histopathologic cell type, histologic grade, and Cancer location. These features were incorporated into a data-driven Staging of these Cancers for the seventh edition of the AJCC/UICC Cancer Staging manuals. Cancer 2010. © 2010 American Cancer Society.
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7th edition of the ajcc Cancer Staging manual esophagus and esophagogastric junction
Annals of Surgical Oncology, 2010Co-Authors: Thomas W Rice, Eugene H Blackstone, Valerie W RuschAbstract:Department ofSurgery, Thoracic Service, Memorial Sloan-Kettering Cancer Center, New York, NYIn previous editions of the American Joint Committeeon Cancer (AJCC) Cancer Staging Manual, esophagealCancer Staging was neither data driven nor harmonized withstomach Cancer. The new Staging system presented in the7th edition of the AJCC Cancer Staging Manual, in con-trast, is data driven and harmonized.
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a Cancer Staging primer esophagus and esophagogastric junction
The Journal of Thoracic and Cardiovascular Surgery, 2010Co-Authors: Thomas W Rice, Eugene H Blackstone, Valerie W RuschAbstract:Staging Cancer of the esophagus and esophagogastric junction has been extensively changed and improved in the 7th edition of the American Joint Committee on Cancer (AJCC), Cancer Staging Manual. Changes address problems of empiric stage grouping and lack of harmonization with stomach Cancer. This was accomplished by assembling worldwide data and using modern machine learning techniques for data-driven Staging. Improvements include new definitions of Tis, T4, regional lymph node, N classification, and M classification, and addition of the nonanatomic Cancer characteristics: histopathologic cell type, histologic grade, and Cancer location. Stage groupings were constructed by adherence to principles of Staging, including monotonic decreasing survival with increasing stage group, distinct survival between groups, and homogeneous survival within groups.
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the impact of lymph node station on survival in 348 patients with surgically resected malignant pleural mesothelioma implications for revision of the american joint committee on Cancer Staging system
The Journal of Thoracic and Cardiovascular Surgery, 2008Co-Authors: Raja M Flores, Tom Routledge, Venkatraman E Seshan, Joseph Dycoco, Maureen F Zakowski, Yael Hirth, Valerie W RuschAbstract:Objectives The propensity of malignant pleural mesothelioma to metastasize to N1 or N2 nodes and their corresponding prognostic value is unclear. The American Joint Committee on Cancer Staging system groups N1 and N2 disease together as stage III. The goal of this study was to define the prognostic value of specific nodal stations. Methods Patients with malignant pleural mesothelioma who underwent resection were identified from an institutional database. Nodal stations were defined by the American Joint Committee on Cancer lung Cancer node map classification. Survival was analyzed by the Kaplan–Meier method, log-rank test, and Cox proportional hazards analysis. Results From 1990 to 2006, 348 patients were identified: 279 men and 69 women with a median age of 67 years (range 26–85 years). Extrapleural pneumonectomy was performed in 223 cases, and pleurectomy/decortication was performed in 125 cases. Survival differences ( P P P P P P = .4), and male gender (hazard ratio 1.4, P Conclusion This study confirms a preferential pattern of drainage of malignant pleural mesothelioma to N2 rather than N1 lymph nodes, but suggests that N1 only nodal involvement should be classified as lower stage disease. Multiple N2 nodal site involvement could potentially be classified as higher stage disease than single station N2. Our results emphasize the need for larger, confirmatory multicenter studies that could lead to revision of the current Staging system.
Lynn T Tanoue - One of the best experts on this subject based on the ideXlab platform.
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the iaslc lung Cancer Staging project background data and proposals for the application of tnm Staging rules to lung Cancer presenting as multiple nodules with ground glass or lepidic features or a pneumonic type of involvement in the forthcoming eighth edition of the tnm classification
Journal of Thoracic Oncology, 2016Co-Authors: Frank C Detterbeck, Wilbur A Franklin, Andrew G Nicholson, Nicolas Girard, Douglas A Arenberg, William D Travis, Peter J Mazzone, Edith M Marom, Jessica S Donington, Lynn T TanoueAbstract:Abstract Introduction Application of tumor, node, and metastasis (TNM) classification is difficult in patients with lung Cancer presenting as multiple ground glass nodules or with diffuse pneumonic-type involvement. Clarification of how to do this is needed for the forthcoming eighth edition of TNM classification. Methods A subcommittee of the International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee conducted a systematic literature review to build an evidence base regarding such tumors. An iterative process that included an extended workgroup was used to develop proposals for TNM classification. Results Patients with multiple tumors with a prominent ground glass component on imaging or lepidic component on microscopy are being seen with increasing frequency. These tumors are associated with good survival after resection and a decreased propensity for nodal and extrathoracic metastases. Diffuse pneumonic-type involvement in the lung is associated with a worse prognosis, but also with a decreased propensity for nodal and distant metastases. Conclusion For multifocal ground glass/lepidic tumors, we propose that the T category be determined by the highest T lesion, with either the number of tumors or m in parentheses to denote the multifocal nature, and that a single N and M category be used for all the lesions collectively—for example, T1a(3)N0M0 or T1b(m)N0M0. For diffuse pneumonic-type lung Cancer we propose that the T category be designated by size (or T3) if in one lobe, as T4 if involving an ipsilateral different lobe, or as M1a if contralateral and that a single N and M category be used for all pulmonary areas of involvement.
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the iaslc lung Cancer Staging project background data and proposed criteria to distinguish separate primary lung Cancers from metastatic foci in patients with two lung tumors in the forthcoming eighth edition of the tnm classification for lung Cancer
Journal of Thoracic Oncology, 2016Co-Authors: Frank C Detterbeck, Wilbur A Franklin, Andrew G Nicholson, Nicolas Girard, Douglas A Arenberg, William D Travis, Peter J Mazzone, Edith M Marom, Jessica S Donington, Lynn T TanoueAbstract:Abstract Introduction It can be difficult to distinguish between a second primary and a metastasis in patients with lung Cancer who have more than one pulmonary site of Cancer. Methods A systematic review of the literature was conducted by a subcommittee of the International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee to develop recommendations to identify second primary lung Cancers. The process entailed review of knowledge relating to the mechanism of metastasis, determination of clonality, and outcomes of patients with resected tumors. Results It is easier to determine that two tumors are different than that they are the same; finding similarities does not establish that they are the same. For example, most second primary lung Cancers are of the same histotype. Few criteria are reliable by themselves; these include different histologic Cancer types or matching DNA breakpoints by sequencing and a comprehensive histologic assessment of resected specimens. Characteristics that are suggestive but associated with potential misclassification include the presence or absence of biomarkers, imaging characteristics, and the presence or absence of nodal involvement. Conclusions Clinical and pathologic (i.e., after resection) criteria are presented to identify two foci as separate primary lung Cancers versus a metastasis. Few features are definitive; many commonly used characteristics are suggestive but associated with a substantial rate of misclassification. Careful review by a multidisciplinary tumor board, considering all available information, is recommended.
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the new lung Cancer Staging system
Chest, 2009Co-Authors: Frank C Detterbeck, Daniel J Boffa, Lynn T TanoueAbstract:The International Association for the Study of Lung Cancer (IASLC) has conducted an extensive initiative to inform the revision of the lung Cancer Staging system. This involved development of an international database along with extensive analysis of a large population of patients and their prognoses. This article reviews the recommendations of the IASLC International Staging Committee for the definitions for the TNM descriptors and the stage grouping in the new non-small cell lung Cancer Staging system.
Frank C Detterbeck - One of the best experts on this subject based on the ideXlab platform.
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the iaslc lung Cancer Staging project summary of proposals for revisions of the classification of lung Cancers with multiple pulmonary sites of involvement in the forthcoming eighth edition of the tnm classification
Journal of Thoracic Oncology, 2016Co-Authors: Frank C Detterbeck, Wilbur A Franklin, Andrew G Nicholson, Nicolas Girard, Douglas A Arenberg, William D Travis, Edith M Marom, Jessica S Donington, Vanessa Bolejack, Peter J MazzoneAbstract:Abstract Introduction Patients with lung Cancer who harbor multiple pulmonary sites of disease have been challenging to classify; a subcommittee of the International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee was charged with developing proposals for the eighth edition of the tumor, node, and metastasis (TNM) classification to address this issue. Methods A systematic literature review and analysis of the International Association for the Study of Lung Cancer database was performed to develop proposals for revision in an iterative process involving multispecialty international input and review. Results Details of the evidence base are summarized in other articles. Four patterns of disease are recognized; the clinical presentation, pathologic correlates, and biologic behavior of these suggest specific applications of the TNM classification rules. First, it is proposed that second primary lung Cancers be designated with a T, N, and M category for each tumor. Second, tumors with a separate tumor nodule of the same histologic type (either suspected or proved) should be classified according to the location of the separate nodule relative to the index tumor—T3 for a same-lobe, T4 for a same-side (different lobe), and M1a for an other-side location—with a single N and M category. Third, multiple tumors with prominent ground glass (imaging) or lepidic (histologic) features should be designated by the T category of the highest T lesion, the number or m in parentheses (#/m) to indicate the multiplicity, and a collective N and M category for all. Finally, it is proposed that diffuse pneumonic-type lung Cancers be designated by size (or T3) if in one lobe, T4 if involving multiple same-side lobes, and M1a if involving both lungs with a single N and M category for all areas of involvement. Conclusion We propose to tailor TNM classification of multiple pulmonary sites of lung Cancer to reflect the unique aspects of four different patterns of presentation. We hope that this will lead to more consistent classification and clarity in communication and facilitate further research in the nature and optimal treatment of these entities.
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the iaslc lung Cancer Staging project background data and proposed criteria to distinguish separate primary lung Cancers from metastatic foci in patients with two lung tumors in the forthcoming eighth edition of the tnm classification for lung Cancer
Journal of Thoracic Oncology, 2016Co-Authors: Frank C Detterbeck, Wilbur A Franklin, Andrew G Nicholson, Nicolas Girard, Douglas A Arenberg, William D Travis, Peter J Mazzone, Edith M Marom, Jessica S Donington, Lynn T TanoueAbstract:Abstract Introduction It can be difficult to distinguish between a second primary and a metastasis in patients with lung Cancer who have more than one pulmonary site of Cancer. Methods A systematic review of the literature was conducted by a subcommittee of the International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee to develop recommendations to identify second primary lung Cancers. The process entailed review of knowledge relating to the mechanism of metastasis, determination of clonality, and outcomes of patients with resected tumors. Results It is easier to determine that two tumors are different than that they are the same; finding similarities does not establish that they are the same. For example, most second primary lung Cancers are of the same histotype. Few criteria are reliable by themselves; these include different histologic Cancer types or matching DNA breakpoints by sequencing and a comprehensive histologic assessment of resected specimens. Characteristics that are suggestive but associated with potential misclassification include the presence or absence of biomarkers, imaging characteristics, and the presence or absence of nodal involvement. Conclusions Clinical and pathologic (i.e., after resection) criteria are presented to identify two foci as separate primary lung Cancers versus a metastasis. Few features are definitive; many commonly used characteristics are suggestive but associated with a substantial rate of misclassification. Careful review by a multidisciplinary tumor board, considering all available information, is recommended.
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the iaslc lung Cancer Staging project background data and proposals for the application of tnm Staging rules to lung Cancer presenting as multiple nodules with ground glass or lepidic features or a pneumonic type of involvement in the forthcoming eighth edition of the tnm classification
Journal of Thoracic Oncology, 2016Co-Authors: Frank C Detterbeck, Wilbur A Franklin, Andrew G Nicholson, Nicolas Girard, Douglas A Arenberg, William D Travis, Peter J Mazzone, Edith M Marom, Jessica S Donington, Lynn T TanoueAbstract:Abstract Introduction Application of tumor, node, and metastasis (TNM) classification is difficult in patients with lung Cancer presenting as multiple ground glass nodules or with diffuse pneumonic-type involvement. Clarification of how to do this is needed for the forthcoming eighth edition of TNM classification. Methods A subcommittee of the International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee conducted a systematic literature review to build an evidence base regarding such tumors. An iterative process that included an extended workgroup was used to develop proposals for TNM classification. Results Patients with multiple tumors with a prominent ground glass component on imaging or lepidic component on microscopy are being seen with increasing frequency. These tumors are associated with good survival after resection and a decreased propensity for nodal and extrathoracic metastases. Diffuse pneumonic-type involvement in the lung is associated with a worse prognosis, but also with a decreased propensity for nodal and distant metastases. Conclusion For multifocal ground glass/lepidic tumors, we propose that the T category be determined by the highest T lesion, with either the number of tumors or m in parentheses to denote the multifocal nature, and that a single N and M category be used for all the lesions collectively—for example, T1a(3)N0M0 or T1b(m)N0M0. For diffuse pneumonic-type lung Cancer we propose that the T category be designated by size (or T3) if in one lobe, as T4 if involving an ipsilateral different lobe, or as M1a if contralateral and that a single N and M category be used for all pulmonary areas of involvement.
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the new lung Cancer Staging system
Chest, 2009Co-Authors: Frank C Detterbeck, Daniel J Boffa, Lynn T TanoueAbstract:The International Association for the Study of Lung Cancer (IASLC) has conducted an extensive initiative to inform the revision of the lung Cancer Staging system. This involved development of an international database along with extensive analysis of a large population of patients and their prognoses. This article reviews the recommendations of the IASLC International Staging Committee for the definitions for the TNM descriptors and the stage grouping in the new non-small cell lung Cancer Staging system.
Paola A Gehrig - One of the best experts on this subject based on the ideXlab platform.
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what is the optimal minimally invasive surgical procedure for endometrial Cancer Staging in the obese and morbidly obese woman
Gynecologic Oncology, 2008Co-Authors: Paola A Gehrig, Leigh A Cantrell, Aaron Shafer, Lisa N Abaid, Alberto A Mendivil, John F BoggessAbstract:Abstract Objective Thirty-three percent of U.S. women are either obese or morbidly obese. This is associated with an increased risk of death from all causes and is also associated with an increased risk of endometrial carcinoma. We sought to compare minimally invasive surgical techniques for Staging the obese and morbidly obese woman with endometrial Cancer. Materials and methods Consecutive robotic endometrial Cancer Staging procedures were collected from 2005–2007 and were compared to consecutive laparoscopic cases (2000–2004). Demographics including age, weight, body mass index (BMI), operative time, estimated blood loss, lymph node retrieval, hospital stay and complications were collected and compared. Results During the study period, there were 36 obese and 13 morbidly obese women who underwent surgery with the DaVinci® robotic system and 25 obese and 7 morbidly obese women who underwent traditional laparoscopy. For both the obese and morbidly obese patient, robotic surgery was associated with shorter operative time ( p =0.0004), less blood loss ( p p =0.004) and shorter hospital stay ( p =0.0119). Conclusions Robotic surgery is a useful minimally invasive tool for the comprehensive surgical Staging of the obese and morbidly obese woman with endometrial Cancer. As this patient population is at increased risk of death from all causes, including post-operative complications, all efforts should be made to improve their outcomes and minimally invasive surgery provides a useful platform by which this can occur.
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what is the optimal minimally invasive surgical procedure for endometrial Cancer Staging in the obese and morbidly obese woman
Gynecologic Oncology, 2008Co-Authors: Paola A Gehrig, Leigh A Cantrell, Aaron Shafer, Lisa N Abaid, Alberto A Mendivil, John F BoggessAbstract:OBJECTIVE: Thirty-three percent of U.S. women are either obese or morbidly obese. This is associated with an increased risk of death from all causes and is also associated with an increased risk of endometrial carcinoma. We sought to compare minimally invasive surgical techniques for Staging the obese and morbidly obese woman with endometrial Cancer. MATERIALS AND METHODS: Consecutive robotic endometrial Cancer Staging procedures were collected from 2005-2007 and were compared to consecutive laparoscopic cases (2000-2004). Demographics including age, weight, body mass index (BMI), operative time, estimated blood loss, lymph node retrieval, hospital stay and complications were collected and compared. RESULTS: During the study period, there were 36 obese and 13 morbidly obese women who underwent surgery with the DaVinci robotic system and 25 obese and 7 morbidly obese women who underwent traditional laparoscopy. For both the obese and morbidly obese patient, robotic surgery was associated with shorter operative time (p=0.0004), less blood loss (p<0.0001), increased lymph node retrieval (p=0.004) and shorter hospital stay (p=0.0119). CONCLUSIONS: Robotic surgery is a useful minimally invasive tool for the comprehensive surgical Staging of the obese and morbidly obese woman with endometrial Cancer. As this patient population is at increased risk of death from all causes, including post-operative complications, all efforts should be made to improve their outcomes and minimally invasive surgery provides a useful platform by which this can occur.
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a comparative study of 3 surgical methods for hysterectomy with Staging for endometrial Cancer robotic assistance laparoscopy laparotomy
American Journal of Obstetrics and Gynecology, 2008Co-Authors: John F Boggess, Paola A Gehrig, Leigh A Cantrell, Aaron Shafer, Mildred Ridgway, Elizabeth N Skinner, Wesley C FowlerAbstract:Objective The purpose of this study was to compare outcomes in women who underwent endometrial Cancer Staging by different surgical techniques. Study Design Three hundred twenty-two women underwent endometrial Cancer Staging: 138 by laparotomy (TAH); 81 by laparoscopy (TLH) and 103 by robotic technique (TRH). Results The TRH cohort had a higher body mass index than the TLH cohort ( P = .0008). Lymph node yield was highest for TRH ( P P P P P Conclusion TRH with Staging is feasible and preferable over TAH and may be preferable over TLH in women with endometrial Cancer. Further study is necessary to determine long-term oncologic outcomes.
