Robotic-assisted laparoscopic hysterectomy and lymphadenectomy for endometrial cancer: Analysis of surgical performance.

OBJECTIVES: To provide an objective analysis of surgical performance of robotic-assisted laparoscopic hysterectomy (RALH) with lymphadenectomy for endometrial cancer during the learning phase of the procedure and to assess opportunities for improvement. METHODS: From July 2006 to March 2008, 100 patients with endometrial cancer underwent RALH with lymphadenectomy using the da Vinci Robotic Surgical System. Data were analyzed for operative time (OT), estimated blood loss (EBL), length of stay (LOS), intra-operative complications, surgical-pathologic factors, and post-operative complications using an intent-to-treat analysis. A comparison of the data on a quartile (Q) basis was performed for the 100 RALH cases and separately for the 65 cases that had a complete pelvic-and-aortic lymphadenectomy (PAL). RESULTS: Age and body mass index (BMI) did not change significantly during the study. More grade 3 tumors were treated in the last 50 cases (22% vs. 10%, p<0.05). Stage III tumors were identified in 18.7% cases in Q2-4 and none in Q1 (p<0.05). The number of patients undergoing complete PAL and the number of aortic lymph nodes (LN) removed per case increased each quarter. There were 4 (4%) conversions to laparotomy. Delayed vaginal cuff healing decreased from 16% in Q1 to 0% in Q3-4. No case required blood transfusion. Comparing first 10 cases to the last 10 cases, the total LN counts increased from 15 to 21 nodes, the aortic LN counts increased from 4.7 to 8.0, and the OT decreased from 203 to 160 min. Intra-surgeon analysis revealed an improvement in the total LN yields from first 50 to second 50 cases for each surgeon. CONCLUSIONS: Operative times decreased and aortic dissections improved with increasing LN counts during the first 100 cases of RALH. Furthermore, patient safety and improvement in surgical performance was demonstrated.

Erosive vulvar lichen planus: a cohort at risk for cancer?

OBJECTIVE: To determine the occurrence of cancer, including vulvovaginal squamous cell carcinoma (SCC), among women after diagnosis of erosive vulvar lichen planus (LP). STUDY DESIGN: Retrospective review of 113 patients diagnosed with erosive vulvar LP over an 8-year period (average follow-up, 5 years). RESULTS: A diagnosis of cancer was made in 5 women after diagnosis of erosive vulvar LP. Of these, 1 had stage II vulvar SCC after treatment for stage IIB cervical cancer, and 2 with oral LP had subsequent diagnoses of oral or esophageal SCC. The remaining 2 cancer diagnoses included cervical adenocarcinoma in situ and rectal adenocarcinoma. CONCLUSION: Of 113 women with erosive vulvar LP, 1 had subsequent development of vulvar SCC. Estimating the risk of SCC among women with vulvar LP is difficult because of the low prevalence of each disorder. Additionally, given the age of the patient and multifocal involvement, association with human papillomavirus was likely. Rather, this cohort exemplifies the need for long-term evaluation in the management of vulvar LP.