Matsuo Koji, Jung Carrie E, Hom Marianne S, Gualtieri Marc R, Randazzo Sonya C, Kanao Hiroyuki, Yessaian Annie A, Roman Lynda D
*Division of Gynecologic Oncology, Los Angeles County Medical Center, †Norris Comprehensive Cancer Center, ‡Keck School of Medicine, and §Reproductive Endocrinology and Infertility, Departments of Obstetrics and Gynecology and ∥Anesthesiology, Los Angeles County Medical Center, University of Southern California, Los Angeles, CA; and ¶Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan.
Int J Gynecol Cancer. 2016 Feb;26(2):290-300. doi: 10.1097/IGC.0000000000000594.
The aim of the study was to identify risk factors associated with laparotomy conversion during total laparoscopic hysterectomy for endometrial cancer.
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.
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 cm in preoperative uterine size correlate with actual uterine weight of 250 g (Y = 61.5 + 0.38X, P < 0.001).
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.
本研究旨在确定子宫内膜癌全腹腔镜子宫切除术中与开腹手术中转相关的危险因素。
这是一项回顾性研究，对通过传统腹腔镜方法开始进行基于子宫切除术的手术分期的子宫内膜癌病例进行检查。使用多因素逻辑回归模型检查与患者、肿瘤和外科医生相关的因素，以确定开腹手术中转的风险。
共纳入251例病例，其中30例（12.0%）进行了开腹手术中转。开腹手术中转最常见的原因是子宫较大（27.0%），其次是广泛粘连（24.3%）和手术并发症（18.9%）。导致开腹手术中转的病例结果包括手术时间更长（333分钟对224分钟，P<0.001）、失血量更大（350毫升对100毫升，P<0.001）、住院时间更长（4天对2天，P<0.001）以及再次入院风险增加（10%对1.4%，P=0.024）。在多因素分析中，病态肥胖（比值比[OR]，4.51；P=0.011）、术前评估时盆腔检查不理想或子宫增大（OR，3.55；P=0.034）、腹主动脉旁淋巴结清扫术（OR，10.5；P=0.001）、子宫大小250克或更大（OR，3.49；P=0.026）以及子宫外疾病（OR，4.68；P=0.012）仍然是开腹手术中转的独立预测因素。以下数量的危险因素与开腹手术中转率显著相关：无危险因素，1.1%；单个危险因素，5.3%（OR，5.00；P=0.15）；两个危险因素，21.7%（OR，24.9；P=0.002）；三个或更多危险因素，50%（OR，90.0；P<0.001）。术前子宫大小的超声三维体积496立方厘米与实际子宫重量250克相关（Y=61.5+0.38X，P<0.001）。
开腹手术中转对子宫内膜癌患者的结局有显著影响。在此情况下，我们的开腹手术中转预测模型将有助于指导子宫内膜癌的手术管理。
