Cuff Dehiscence in Endometrial Cancer Patients after Robotic Laparoscopic Total Hysterectomy [35F]

INTRODUCTION: Cuff dehiscence (CD) is a serious complication of robotic-assisted laparoscopic total hysterectomy (RLTH), which is performed for malignant or benign indications. The primary objective of this study was to evaluate if there is a difference in incidence and risk factors of CD following RLTH among patients with endometrial cancer compared to patients without endometrial cancer. METHODS: This retrospective study included women 18 years or older who underwent RLTH performed by one of two surgeons from a single institution from January 1, 2013 through March 31, 2018. Conversion to open laparotomy, chemotherapy/radiation within a year before or after RLTH, and malignancies other than endometrial cancer were excluded. Data were abstracted from patient medical records. This study received IRB approval. RESULTS: Of 950 patients meeting inclusion criteria, 50.7% (n=482) had endometrial cancer. CD was reported in 2.5% (n=24) of all patients. While holding other variables constant, obese patients were 25.1% less likely than normal weight patients to experience CD, χ2(1, N=675)=6.49, P=.011. Additionally, CD was 2.8 times more likely to occur when surgery was performed by surgeon 1 compared to surgeon 2 while other variables in the model were held constant, χ2(1, N=675)=4.87, P=.027. No other variables (cancer status, age, sexual activity after surgery, distance from home to location of surgery, time interval from surgery to loss to follow-up) predicted CD. CONCLUSION: Endometrial cancer patients were at no greater risk of experiencing CD compared to non-cancer patients. This study suggests that BMI and surgical technique are the only variables associated with incidence of CD.