Objective To compare the incidence of trocar site hernia in women who underwent robotically assisted laparoscopic surgery (RBT) for endometrial cancer staging with the incidence of ventral hernia formation in patients who underwent laparotomy (LAP) for the same indication. To analyze risk factors for hernia formation in women undergoing RBT for endometrial cancer. Methods We retrospectively identified all patients who underwent surgical staging for endometrial cancer via RBT or LAP from 2009–2012. Clinicopathologic data were analyzed. Appropriate statistical tests were used. Results 738 patients were staged via RBT (n=567) or LAP (n=171). Overall median age was 61 years (RBT range,33–90; LAP range,28–86; p=0.4). Median BMI was 29.5 kg/m2 (range, 17.9–66) and 30.3 kg/m2 (range, 16.8–67.2), respectively (p= 1.0). Eleven (1.9%) of 567 patients in the RBT cohort developed a trocar site hernia compared with 11 (6.4%) of 171 LAP patients who developed a ventral hernia (p= 0.002). Median time to diagnosis was 18 months (range, 3–49) and 17 months (range, 7–30), respectively (p= 0.7). Of the 11 RBT patients who developed a trocar site hernia, 10 (91%) were midline defects and 1 (9%) was a lateral defect of a prior inferior epigastric port site. No hernias required emergent operative intervention. Four (0.7%) of 567 RBT patients compared with 2 (1.2%) of 171 LAP patients required surgical hernia repair (p=0.4). Conclusions Trocar site herniation after RBT staging for endometrial cancer is uncommon and less likely to occur than ventral hernia formation with LAP staging. Furthermore, surgical revision rates are low.

Objectives: Undifferentiated endometrial sarcoma (UES) is an aggressive rare malignancy with no treatment consensus. Treatment of stage I disease is surgery with either observation or adjuvant chemo-and/or radiation therapy (RT). Our goal was to assess the outcomes of various treatment modalities, and to identify prognostic factors associated with survival. Methods: Patients with undifferentiated endometrial sarcoma reported to the National Cancer Data Base from 1998 to 2012 who underwent at least a total hysterectomy were selected. To exclude for potentially palliative interventions, we included only patients with stage I disease for this analysis. Overall survival was estimated using the Kaplan-Meier method, univariate comparisons were made with log-rank tests, and multivariable analysis was performed using Cox proportional hazards modeling. All tests were 2-tailed with threshold significance level set at P b .05. Results: A total of 2,202 undifferentiated endometrial sarcoma cancer patients were identified, and 552 patients met inclusion criteria. Increasing tumor size was significantly associated with a decrease in survival (5-year overall survival [OS] 61%, 54%, 37% for sizes b5 cm, 5-10 cm, N10 cm, respectively; P b .001). The 5-year OS for stage IA (61%) and IB (53%) was also significant (P = .01). Comparison of adjuvant therapy for stage IA showed no significant difference in treatment outcomes (P = .554). For stage IB, there was an increasing nonsignificant trend in survival when comparing no treatment, RT only, chemotherapy only, and chemotherapy + RT, respectively (5-year OS 38%, 50%, 53%, 62%, respectively; P = .125). No other factors were found to be associated with survival on univariate analyses including age, race, insurance, income, education, residential setting, year of diagnosis, facility type/ location/distance, or Lymphovascular space invasion. On multivariable analysis, only tumor size (HR 2.5, 95% CI 1.641-3.818, P = .001) and stage (HR 0.549, 95% CI 0.39-0.772, P = .001) significantly predicted survival. Conclusions: Increased tumor size in UES confined to the uterus is a poor prognostic factor. There was no difference in survival in stage IA patients receiving adjuvant therapy versus observation. When present, prognosis in stage IB disease is worse. However, the type of adjuvant therapy or combination is unclear. Optimal treatment of this disease remains elusive.

tests and Poisson regression were used to examine factors associated with delays of more than 6 weeks between diagnosis and surgery. Survival for women diagnosed between 2003 and 2006 with timely versus delayed surgery was compared using the log rank test and a Cox proportional hazards model. Results: The final study population included 112,041 women diagnosed at 1,108 continuously reporting NCDB hospitals. Survival follow-up through 2011 was available for 40,184 women. All patients underwent hysterectomy for surgical staging. Twenty-eight percent of patients underwent surgery more than 6 weeks after initial diagnosis. Poisson regression estimates indicated that patients younger than 40 years old, groups of black or Hispanic race/ethnicity, those with Medicaid or no insurance, patients from the lowest education zipcode quartiles, and those with comorbid conditions all had a significantly higher likelihood of a surgical wait time of more than 6 weeks. Patients diagnosed in 2010 to 2011 were 32.5% more likely (interrater reliability 1.32, 95% CI 1.24-1.40) to undergo surgery more than 6 weeks after diagnosis compared with patients treated in 2003. Survival for women with surgical wait times longer than 6 weeks was significantly worse compared with patients who were surgically treated within 6 weeks of diagnosis (HR 1.14, 95% CI 1.09-1.20). Conclusions: This large study demonstrates that wait times greater than 6 weeks from diagnosis of endometrial cancer to definitive surgery may have a negative impact on overall survival and that race and ethnicity, socioeconomic factors, and insurance coverage are all associated with increased likelihood of delayed surgical treatment.

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