Objective. The Laparoscopic Approach to Cervical Cancer (LACC) trial found that minimally invasive radical hysterectomy compared to open radical hysterectomy compromised oncologic outcomes and was associated with worse progression-free survival (PFS) and overall survival (OS) in early-stage cervical carcinoma. We sought to assess oncologic outcomes at multiple centers between minimally invasive (MIS) radical hysterectomy and OPEN radical hysterectomy.Methods. This is a multi-institutional, retrospective cohort study of patients with 2009 FIGO stage IA1 (with lymphovascular space invasion) to IB1 cervical carcinoma from 1/2007-12/2016. Patients who underwent preoperative therapy were excluded. Squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinomas were included. Appropriate statistical tests were used.Results. We identified 1093 cases for analysis-715 MIS (558 robotic [78%]) and 378. OPEN procedures. The OPEN cohort had more patients with tumors >2 cm, residual disease in the hysterectomy specimen, and more likely to have had adjuvant therapy. Median follow-up for the MIS and OPEN cohorts were 38.5 months (range, 0.03-149.51) and 54.98 months (range, 0.03-145.20), respectively. Three-year PFS rates were 87.9% (95% CI: 84.9-90.4%) and 89% (95% CI: 84.9-92%), respectively (P = 0.6). On multivariate analysis, the adjusted HR for recurrence/death was 0.70 (95% CI: 0.47-1.03; P = 0.07). Three-year OS rates were 95.8% (95% CI: 93.6-97.2%) and 96.6% (95% CI: 93.8-98.2%), respectively (P = 0.8). On multivariate analysis, the adjusted HR for death was 0.81 (95% CI: 0.43-1.52; P = 0.5).Conclusion. This multi-institutional analysis showed that an MIS compared to OPEN radical hysterectomy for cervical cancer did not appear to compromise oncologic outcomes, with similar PFS and OS. (c) 2022 Elsevier Inc. All rights reserved.

Objective: Treatment options for advanced cervical cancer are limited, and the response rate to single agent PD-1/PD-L1 blockade in cervical cancer is <15% in a PD-L1+ population. Targeting vascular endothelial growth factor (VEGF) in combination with PD-L1 blockade may improve clinical outcomes via enhanced T cell infiltration into tumors; this has been demonstrated in patients with recurrent cervical cancer. In NCI #10010, a phase II, multicenter, single-arm trial sponsored by the National Cancer Institute, we investigated the combination of atezolizumab and bevacizumab in the treatment of advanced cervical cancer. The primary objective was to measure the objective response rate (ORR) defined by RECIST v1.1 criteria. Secondary endpoints included progression-free survival (PFS), overall survival (OS), safety, and a range of translational parameters.

Locally advanced cervical cancer (LACC) is a significant problem. The status of the para-aortic lymph nodes (PALN) in women with LACC is critical, as positive PALN dictate extended radiation fields and portend a dismal prognosis. As 10–25% of women with LACC will have PALN metastases (Gout et al. Lancet Oncol 2012: 13), finding the ideal method to identify and treat them is paramount. A pretreatment PET scan in LACC for the purpose of nodal staging has become the standard of care in the USA. We know, however, that the false negative rate for PET in the PALN is 9–22% (Guoy et al. J Clin Oncol 2013;31:3026–33). There are, therefore, concerns that PET may fail to diagnose microscopic nodal involvement and/or that surgical removal of positive nodes affords a survival advantage. If these concerns were valid, we would expect those women who are surgically staged to have an improved outcome when compared with women who are staged radiographically. Limited evidence, however, suggests that surgical staging does not confer a survival benefit. The only published prospective randomised study (61 patients) showed a survival advantage for women who underwent clinical staging compared with surgical staging (Lai et al. Gynecol Oncol 2003;89:160–7). The most recent Cochrane review on this topic found insufficient evidence that pretreatment surgical PALN dissection was beneficial and suggested that surgery might have an adverse survival impact (Brockbank et al. Cochrane Database Syst Rev 2013;(3):CD008217). In the current retrospective series, the authors confirm that radiologic staging with PET is associated with improved survival compared surgical staging (Pomel et al. BJOG 2017;124:1089-94) It should be noted, however, that the women in the PET arm with positive iliac nodes received treatment in the PALN basin, whereas similar patients with negative PALN by surgical excision did not. Perhaps the primary hypothesis from the current study, then, should be whether elective use of extended field radiotherapy for women with PET-positive iliac nodes improves survival, rather than comparing PET and surgical staging. Regardless, it is notable that the PET group enjoyed improved disease-free and overall survival. It is also worth noting that the PET false negative rate for PALN is highest in those women who have PET-positive pelvic nodes. In one study, when suspicious pelvic nodes were present on PET, the risk for surgical PALN disease was greater (24.0 versus 2.9%, Uzan et al. Oncologist 2011;16:1021–7). It may therefore be prudent to limit surgical dissection only to those women with PET-positive pelvic nodes, or to include the PALN basin in the radiation field as was done in the current study. In other words, surgical staging may perform better as a complement to PET for women with PET-positive iliac nodes rather than as a singular staging modality. The real question may be: if PET is missing micro-metastases in PALN, is this failure clinically important if it does not negatively impact survival? The only way to answer this definitively will be via prospective randomised trials such as the proposed LiLAC study (Frumowitz. J Minim Invasive Gynecol 2014;21:3–8). Until then, judicious individualisation of pretreatment staging will probably best serve women with LACC. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Objective: Physical examination remains the cornerstone of determining treatment modality of cervical cancer. However, there is practice variation regarding the usage of imaging modalities to determine treatment approach. The goal of this study is to assess the value of pretreatment imaging in the management of stage I and II cervical cancer.

Objective. Determine whether metformin use is associated with improved survival in patients with ovarian, fallopian tube or primary peritoneal cancer.Methods. All patients with a diagnosis of first epithelial ovarian cancer from 2007 to 2011 in the combined SEER-Medicare database were identified from the SEER registry primary site codes. Comorbidities, procedures and cancer treatment ICD-9 and HCPCS codes were used to search the Medicare claims files. Medication use was determined with National Drug Codes using the Medicare Part D event files. The primary outcome, overall survival, was assessed between metformin users and non-users using a Cox Proportional Hazards survival model. To control for confounding, metformin users were matched to non-metformin users using propensity scores. Effect of dosage on survival was assessed using discrete time survival analysis with pooled logistic regression (PLR).Results. There were 2291 cases that met our inclusion criteria. Of these, 180 (7.9%) had been on metformin. The median age was 73 years, with the majority of the population being White (83.5%) and treated with primary surgery (74.1%). Metformin use was not associated with overall survival in the entire cohort (HR 0.96, 95% CI 0.75-1.23) or in the matched sample cohort (HR 0.88, 95% CI 0.66-1.17). However, exploratory regression with time-varying coefficients suggests a protective metformin effect for women alive after 30 months follow-up (HR = 0.37, 95% 0.16-0.87).Conclusion. No statistically significant association was observed between metformin use and overall survival in a matched cohort of 360 ovarian cancer patients. However, exploratory modeling suggests metformin use may be protective in a certain subgroup of patients. (C) 2017 Elsevier Inc. All rights reserved.

Objectives: The practice of selective lymphadenectomy based on uterine pathology risk factors has been popularized after risk factors for lymph node metastases were identified in large observational single institution and cooperative group studies. SLN biopsy is an alternative staging technique proposed to overcome the limitations of selective algorithms. The clinical validity of low-volume metastases identified in SLN specimens that have been ultrastaged has been questioned. The objective of this analysis is to identify whether patients with positive SLNs demonstrate the previously identified risk factors for lymph node metastases. Methods: The FIRES trial is a multi-institution, prospective cohort study measuring the accuracy of SLN mapping in clinical stage I endometrial cancer (all histologies) in identifying metastatic disease. All patients received a standardized SLN mapping technique with cervical indocyanine green injection and robotic fluorescence imaging, followed by hysterectomy with pelvic and para-aortic lymphadenectomy. All H&E-negative SLN specimens were ultrastaged with immunohistochemistry (IHC) to cytokeratin. Pathologic results of the SLNs (including volume of disease: macro metastases versus micro metastases [<2 mm and isolated tumor cells]) were evaluated along with uterine tumor risk factors. Fisher exact test was used to compare dichotomous variables between groups. Results: Among 308 patients, 37 (12%) had nodal metastases, 30 of whom mapped at least 1 SLN (81%). Twelve patients (32%) with nodal metastases were detected only with IHC (≤2 mm). Compared with patients with macro metastases, micro metastases were less likely to be associated with high grade or nonendometrioid histology (P = .02), para-aortic metastases (P = .05), and lymphovascular space invasion (P = .001). All but 1 node-positive patient (97%) (including all patients with SLN micro metastases) demonstrated at least 1 previously described uterine pathology risk factor for lymphatic spread (grade 3 histology, outer half myometrial invasion or tumor size >2 cm). Conclusions: Micro metastases within SLNs appear to be associated with known uterine risk factors for nodal metastases. This supports the validity of metastatic disease identified in SLNs with ultrastaging techniques. The disease-specific outcomes of patients with low-volume disease have not yet been established.

Objectives: Given the rarity of ovarian carcinosarcoma, we sought to analyze a contemporary multi-institutional case series of ovarian carcinosarcoma to better understand patient characteristics and outcomes of this rare epithelial ovarian cancer. Methods: After institutional review board approval was obtained, a retrospective review was performed to identify all women diagnosed with ovarian carcinosarcoma between 2000 and 2015 at the University of Virginia and the University of North Carolina. Patient characteristics and clinical history were abstracted from longitudinal medical records. Statistical analysis was performed with SPSS. The association between independent prognostic variables and overall survival was examined using Fisher exact test and independent samples t tests. Progression-free survival and overall survival were analyzed using Kaplan-Meier estimates. Results: Forty-two patients were identified with a mean age at diagnosis of 65.4 years (standard deviation [SD], 12.5). Most patients were Caucasian (90.5%) with a mean body mass index of 27.0 kg/m2 (SD 7.6) and baseline CA-125 level of 615.4 kU/L (SD 980.4). The majority (62%) of cases were FIGO stage IIIC or IV at diagnosis. All patients underwent surgical debulking and the majority (83%) received adjuvant chemotherapy. Of those treated with chemotherapy, 74% received carboplatin and paclitaxel. The median follow-up was 22.5 months (range, 1–165 mo). Fifty-two percent of patients had documented recurrence at a median time of 12 months (range, 0.2–45 mo) (Fig. 1a). The most common site of recurrence was the abdominal cavity (59.0%), followed by the pelvis (27.3%), then extra-abdominal recurrences (13.6%). The median overall survival time was 26 months (range, 0.5–147 mo) (Fig. 1b). The median overall survival was higher for stage I (36.6 mo) than stage II-IV (16.8 mo). Conclusions: As with all epithelial ovarian cancers, most patients were diagnosed after menopause with late-stage tumors. Despite consistent treatment modalities, most patients in this cohort only survived slightly more than 2 years. Unlike uterine carcinosarcoma, patients with ovarian carcinosarcoma from this cohort do not appear to have more aggressive disease than the more common histologies of epithelial ovarian cancer, which historically have a relapse rate of 80% to 85% for stage III disease. Further data pooling from multiple institutions will be needed to better describe the survival characteristics of this rare disease.

Objectives: Sentinel lymph node (SLN) mapping with indocyanine green (ICG) and near-infrared fluorescence imaging (NIRFI) has been described for cervical cancers. However, only small published series have evaluated the accuracy of this technique in this disease. The FIRES trial is a multicenter prospective cohort study including women undergoing hysterectomy and lymphadenectomy for endometrial and cervical cancer. Our objective was to evaluate the accuracy of this SLN mapping technique in detecting occult metastatic disease in cervical cancer among patients undergoing a standardized technique by surgeons at multiple centers.Methods: Patients with stage IA2 to 1B1 cervical cancer (all histologies) were enrolled in the study between February 2012 and July 2015. Patients received 1 mg of ICG intracervical injection and underwent SLN mapping using robotic NIRFI as well as completion pelvic lymphadenectomies. Negative SLN specimens underwent ultrastaging with immunohistochemistry to cytokeratin. Detection rate, sensitivity, and false-negative predictive value were calculated. Fisher exact test was used to compare dichotomous variables between node-positive and -negative groups. The study is registered with clinicaltrials.gov.Results: A total of 67 patients were enrolled at 10 centers by 17 surgeons. Of these, 14 patients (21%) had pelvic nodal metastases. In 60 patients, at least 1 SLN was detected (90%). The rate of bilateral mapping was 61%. Of the 11 patients with metastases who underwent mapping, 7 had positive SLNs (sensitivity 64%), with 4 patients having a false-negative SLN (7.5%), and a negative predictive value (NPV) of 92.5%. Of the 4 patients with false-negative SLNs, 3 mapped unilaterally with the positive non-SLN found on the unmapped side. One patient had an empty unilateral SLN specimen on final pathology (false-positive mapping). Patients who had failed bilateral mapping were significantly more likely to have positive lymph nodes (P = .01). Patients with true bilateral mapping had 100% sensitivity and NPV for detecting metastatic disease.Conclusions: Bilateral SLN mapping achieved with ICG and robotic NIRFI is associated with high accuracy in detecting metastatic cervical cancer. In the case of unilateral mapping or failed mapping, a side-specific complete lymphadenectomy should be performed. Objectives: Sentinel lymph node (SLN) mapping with indocyanine green (ICG) and near-infrared fluorescence imaging (NIRFI) has been described for cervical cancers. However, only small published series have evaluated the accuracy of this technique in this disease. The FIRES trial is a multicenter prospective cohort study including women undergoing hysterectomy and lymphadenectomy for endometrial and cervical cancer. Our objective was to evaluate the accuracy of this SLN mapping technique in detecting occult metastatic disease in cervical cancer among patients undergoing a standardized technique by surgeons at multiple centers. Methods: Patients with stage IA2 to 1B1 cervical cancer (all histologies) were enrolled in the study between February 2012 and July 2015. Patients received 1 mg of ICG intracervical injection and underwent SLN mapping using robotic NIRFI as well as completion pelvic lymphadenectomies. Negative SLN specimens underwent ultrastaging with immunohistochemistry to cytokeratin. Detection rate, sensitivity, and false-negative predictive value were calculated. Fisher exact test was used to compare dichotomous variables between node-positive and -negative groups. The study is registered with clinicaltrials.gov. Results: A total of 67 patients were enrolled at 10 centers by 17 surgeons. Of these, 14 patients (21%) had pelvic nodal metastases. In 60 patients, at least 1 SLN was detected (90%). The rate of bilateral mapping was 61%. Of the 11 patients with metastases who underwent mapping, 7 had positive SLNs (sensitivity 64%), with 4 patients having a false-negative SLN (7.5%), and a negative predictive value (NPV) of 92.5%. Of the 4 patients with false-negative SLNs, 3 mapped unilaterally with the positive non-SLN found on the unmapped side. One patient had an empty unilateral SLN specimen on final pathology (false-positive mapping). Patients who had failed bilateral mapping were significantly more likely to have positive lymph nodes (P = .01). Patients with true bilateral mapping had 100% sensitivity and NPV for detecting metastatic disease. Conclusions: Bilateral SLN mapping achieved with ICG and robotic NIRFI is associated with high accuracy in detecting metastatic cervical cancer. In the case of unilateral mapping or failed mapping, a side-specific complete lymphadenectomy should be performed.

Objectives: To evaluate whether incidence of grade 3 or 4 toxicities, dose reduction or delays, hospital admissions, or neutropenic fevers were affected by frequency of complete blood count (CBC) testing in patients undergoing chemotherapy for ovarian or endometrial cancer. Methods: Patients with endometrial or ovarian cancer who received platinum-based chemotherapy (upfront or recurrent) from January 2005 to December 2014 were identified from a clinical database. Patients were excluded if they received chemotherapy more frequently than every 21 days. Electronic charts were reviewed to collect demographic characteristics and chemotherapy regimens, laboratory results, toxicities, dosing changes, complications, and hospital admissions. SPSS software was used for data analysis with a significance level of P < .05. Results: A total of 219 patients were identified, 67 (30.6%) with endometrial cancer and 152 (69.4%) with ovarian cancer. In the majority of patients, CBCs were checked multiple times per cycle (62.6%), and they were treated with a platinum-based doublet (71.7%). Chemotherapy regimen was significantly associated with more laboratory testing per cycle as the number of agents increased (P = .001). Chemotherapy was delayed 45% of the time, whereas only 36% required a dose reduction. Both dose delay and dose reduction were significantly associated with more laboratory testing per cycle as were the rates of grade 3 or 4 hematopoietic complications. Dose delays occurred more commonly for laboratory results (50.0%) than for symptoms (29.8%). Similarly, the majority of dose reductions (57.5%) were for abnormal laboratory tests. However, when a laboratory result was the cause of the treatment change, it was most often because of a day 21 laboratory result rather than a midcycle result (90.1% vs 9.9%). There was no difference in rates of neutropenic fever or hospital admission by frequency of CBC evaluation (Table 1). Conclusions: More frequent laboratory testing detected more cases of grade 3 or 4 hematopoietic toxicities and was associated with more dose reductions and delays. However, these decisions were most frequently made based on laboratory results on the day of chemotherapy. There were no differences in number of hospitalization or cases of neutropenic fever depending on frequency of laboratory testing, suggesting that it may be safe and more cost-effective to space out routine laboratory tests for select patients.Table 1Demographic and Clinical Characteristics Study Participants.

PURPOSE: Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in gynecologic oncology surgical patients. Many centers use neuraxial analgesia (NA), which affects the timing of prophylactic anticoagulation. In 2012, we determined that the rate of VTE in patients undergoing laparotomy with NA was higher than in those who received alternative pain control. In addition, compliance with preoperative anticoagulation guidelines was only 40%. We undertook a quality initiative (QI) project to increase compliance to 80% in NA cases and maintain 90% in non-NA cases. METHODS: A multidisciplinary working group designed and deployed a QI intervention bundle. Compliance was defined as the receipt of a prophylactic dose of anticoagulant within 1 hour after NA or before skin incision regardless of anesthesia type. Data were abstracted from the medical record after the study period. Cases from the year before QI were used for comparison. Primary outcome was compliance and secondary outcome was the rate of VTE. RESULTS: One hundred women were treated under the QI project and 182 historical cases (HCs) were used for comparison. Overall compliance improved (96% QI v 73% HC; P < .001). This difference was marked in cases with NA (95% QI v 40% HC; P < .001) and remained stable in non-NA cases (97% QI v 91% HC; P = .29). The overall rate of VTE, independent of anesthesia type, remained unchanged (2.1% HC v 0% QI; P = .3). CONCLUSION: Relatively simple and inexpensive initiatives to improve routine processes within the surgical pathway are feasible and attract staff participation. Such efforts are likely to translate into greater levels of patient safety.

Objectives: Intraoperative algorithms have been described for sentinel lymph node (SLN) mapping in endometrial and cervical cancers. Their feasibility relies upon the surgeon's ability to correctly discern nodal tissue from lymphatic channels. The surgeon who erroneously removes an empty SLN specimen loses the opportunity to apply the algorithm and comprehensively stage the patient. The FIRES trial is a prospective multicenter cohort study of SLN mapping with indocyanine green (ICG) and fluorescence imaging for patients undergoing robotic hysterectomy and lymphadenectomy for endometrial and cervical cancers. This dataset was used to determine the positive predictive value of an identified SLN-containing lymphatic tissue on final pathology and factors associated with false-positive mapping.

Objectives: Opioids are increasingly used for management of pain in gynecologic oncology patients. Nationally, there has been a considerable rise in rates of opioid misuse and abuse. We suspect that women treated for gynecologic malignancies are as prone to substance abuse as the general population and should be screened accordingly, although data regarding this practice are limited. This study sought to determine the propensity for opioid abuse and evaluate risk factors.

There are limited data, and no randomized controlled trials, to guide decisions for patients with early stage uterine carcinosarcoma regarding the use of pelvic external beam radiation therapy (EBRT) versus vaginal brachytherapy (BT) following hysterectomy with lymph node assessment. We performed an observational cohort study to compare survival outcomes following adjuvant BT versus pelvic EBRT for patients with stages I-II uterine carcinosarcoma. We searched the Surveillance, Epidemiology and End Results (SEER) registry to identify a cohort of patients with FIGO I/II uterine carcinosarcoma diagnosed during 1988-2010, who underwent a total hysterectomy and for whom radiation therapy (RT) status was known. X2 tests were used to test associations between patient characteristics and RT type (None, BT alone, and EBRT ± BT). Overall and cancer-specific survival (OS and CSS), measured from date of diagnosis, were summarized within each covariate, and log-rank tests were used to evaluate for univariable associations. Cox proportional hazards models were used to model the impact of RT type on OS and CSS while adjusting for other factors. The following variables were included a priori in multivariable models: RT type, FIGO stage, race, age at diagnosis, SEER registry, and year of diagnosis. Other covariates were subject to a backwards elimination and retained only if the P value was <.1. Significance was set at α = .05; all tests are 2-sided. A total of 1581 subjects were identified, including: 803 (50.8%) no RT, 636 (40.2%) EBRT ± BT, and 142 (9.0%) BT alone. RT type was significantly associated on univariable analysis with: year of diagnosis, SEER region, FIGO stage, and census-level values for high school education and poverty. BT alone increased from 4.5% in 1988-1999 to 12.5% in 2005-2010. In univariable analyses, higher rates of OS and CSS were observed for subjects with younger age at diagnosis, non-black race, married, and FIGO stage I (vs II). Multivariable models of OS and CSS showed that RT type, including BT alone versus EBRT ± BT, was not associated with OS or CSS after adjustment for other covariates. Factors significantly associated with longer OS and CSS in the multivariable model were: lower FIGO stage, non-black race, and younger age at diagnosis. For patients with stages I-II uterine carcinosarcoma, adjuvant RT, regardless of type, did not influence OS or CSS following hysterectomy. This study addresses an existing evidence gap and identifies a trend toward increasing utilization of BT alone without evidence for efficacy. Prospective trials are warranted to provide high-quality evidence to guide adjuvant therapy decisions for these patients.

Objectives: Patient opinion of the informed consent process is poorly understood and insufficiently researched. The ideal method by which to supplement counseling is uncertain, as are the best phase of care to target, the aspect most critical to enhance, and the outcome most worth pursuing. This study prospectively assessed the feasibility of using a multimedia intervention to affect patient satisfaction at the time of informed consent for major surgery.

Objectives: Serous tubal intraepithelial carcinoma (STIC) is a rare entity that has been postulated as a precursor lesion to high-grade serous carcinoma. STIC lesions have been almost exclusively described after risk-reducing salpingo-oophorectomy (RRSO), and some institutions manage patients with STIC with adjuvant chemotherapy. The SEE-FIM pathology protocol that is typically performed during RRSO increases the diagnosis of STIC lesions. This project sought to characterize two institutions' experiences with isolated STIC lesions found in both RRSO and non-RRSO specimens.

Objectives: Patients must understand the complex treatment options offered by clinicians. This study sought to prospectively determine patients' preferred modes of learning and assess the content most relevant to making major medical decisions.

Study Objective: Studies have demonstrated that laparoscopic staging in endometrial cancer (EC) patients is safe and feasible, with comparable surgical/oncologic outcomes to laparotomy. These reports have focused on patients with Type I malignancies. The study objective was to compare the surgical and oncologic outcomes of the higher risk Type II EC patients who were staged by laparoscopy/robotics versus laparotomy. Design: Retrospective cohort study. Setting: Multi-institution, academic tertiary care centers. Patients: Patients with uterine serous, clear cell or grade 3 endometrioid adenocarcinoma. Intervention: Surgical staging via minimally invasive (MIS) or open approaches. Staging included hysterectomy/BSO/pelvic and para-aortic lymphadenectomy (LN) +/- omentectomy. Measurements and Main Results: 193 patients met criteria: 81 staged by laparotomy and 112 by MIS. Subgroups were well matched by age, BMI, history of previous abdominal surgery, histology and adjuvant therapies. 71% of MIS pts had early-stage (Stage I/II) disease versus 58% of laparotomy pts (p=.001). Median OR times for the MIS versus laparotomy cohorts were 203 and 133 min, respectively (p<.001). Median number of LNs were higher in the MIS cohort (p<.001; total 23 vs.15). Further, MIS patients experienced fewer complications when compared to the laparotomy cohort (8% vs. 35.8%;p<.001). After adjusting for stage, risk of recurrence was similar between groups (median follow-up: 23 mos; p=0.35). PFS and OS was 81.1 and 95.2 months for MIS patients and 83 and 106.8 months in laparotomy pts (p=.31 and .52, respectively). On multivariate analysis, stage, but not surgical approach, was associated with PFS and OS (p<.001). Conclusion: Type II EC patients staged by MIS techniques experienced fewer complications and similar survival outcomes when compared to those staged by laparotomy. As this patient cohort is older and most will receive adjuvant therapies, minimization of surgical morbidity and recovery times is of interest. High-risk histologic subtype should not be considered a contraindication to MIS in women with apparent early-stage disease.

OBJECTIVES.: To assess progression-free (PFS) and overall survival (OS) for women with cervical cancer who underwent type III robotic radical hysterectomy (RRH). METHODS.: A retrospective analysis of women who underwent RRH from 2005 to 2008 was performed. The data analyzed included patient demographics, histology, clinical stage, surgical margins, lymph node and disease status. Comparison was made to a group of historical open radical hysterectomies. Survival statistics were analyzed using the Kaplan-Meier method. RESULTS.: Seventy-one women underwent attempted RRH during the study period. Eight were excluded from analysis, 4 for non-cervical primary and 4 cases aborted due to extent of disease. Squamous was the most common histology (62%) followed by adenocarcinoma (32%). Median patient age was 43 years. There was one intraoperative complication (asystole after induction) and two postoperative complications (ICU admission to rule out myocardial infarction and reoperation for cuff dehiscence). Of the patients who underwent RRH, 32% received whole-pelvis radiation with chemo sensitization. The median follow-up was 12.2 months (range 0.2-36.3 months). Kaplan-Meier survival analysis demonstrated 94% PFS and OS at 36 months due to the recurrence and death of one patient. Compared with a historical cohort at our institution, there was no statistically significant difference in PFS (P=0.27) or OS (P=0.47). CONCLUSIONS.: RRH is safe and feasible and has been shown to be associated with improved operative measures. This study shows that at 3 years, RRH appears to have PFS and OS equivalent to that of traditional laparotomy. Longer follow-up is needed, but early data are supportive of at least equivalent oncologic outcomes compared with other surgical modalities.