1. A surgical approach to uterine cancer in a single institution August 2006- July 2014 M. McCarthy (Medical Student) & M. Hewitt Cork University Maternity Hospital

2. Endometrial Cancer  Endometrial cancer is the 2nd most common gynaecological cancer  4 th most common malignancy in UK women  Incidence: - UK Dept of health – 8,475 new incidences in 2011 - In Ireland 355 cases per year  Cochrane review, 2012 – Appropriate to use a laparoscopic approach.

3. Robot The first successful series of robotic hysterectomies were published in 2002 The da Vinci Surgical System® introduced to CUMH in 2008

4. Aims  To assess the modality of surgical approach for endometrial cancer from April 2006 – August 2014  To assess the discharge dates associated with different modalities of treatment  To assess the type and stage of tumour

5. Methods Collected data on the surgical modalities via: 1. Theatre log books 2. In-patient computerised bed management system 3. Histology reports All data was maintained on a password protected computer within the hospital.

6. Results  Average Age: 60 years old Lymphadenectomy 62 Lymphadenectomy(47%) 71 Without(53%)  133 Hysterectomies  89 robot-assisted laparoscopies  5 straight-stick laparoscopies  6 lower transverse laparotomies  32 midline laparotomies  1 vaginal hysterectomy – unknown Conversion Rates There was one conversion from Robotic-Assisted Laparoscopic to Laparotomy due to haemorrhage.

8. Modality by Year  Before introduction of the robot: laparotomy (76% n=16) or straight stick procedure (24%, n=5).

9. Histology  113 Endometrioid adenocarcinoma  6 Serous Papillary Carcinomas  3 Leiomyosarcoma/uterine  1 STUMP  5 Mixed Mullarian Tumours (MMTs)  2 Clear cell/ Endometriod and  Clear Cell  1 Endometrioid and sarcoma  1 Atypical Hyperplasia  1 Squamous Cell Carcinoma (SCC)

10. STAGING  Stage 1 - 106  1a – 37  1b – 27  1c – 4  Not further specified – 38  Stage 2 - 5  Stage 3 - 6  Stage 4 – 1  Information unavailable - 15

11. Results : Discharge dates Median Discharge: Day 2 post-surgery (range 0-28)  Post Robotic Hysterectomy: Mode = 1 Average 2.12 (range 0 – 25)  Post Straight Stick:Mode = 2 Average 4 (range 2-8)  Post Laparotomy: Mode = 6 Average 6.67, (range 2-28)

12. CONCLUSION  CUMH have adopted recommendations that surgical management of endometrial cancer be conduced laparoscopically.  Our data has demonstrated this method to be associated with better postoperative recovery in terms of earlier discharge, which is in line with international findings LIMITATIONS  Retrospective  Didn’t investigate as to why a particular modality was chosen.  Difficult to comment on lymphadenectomies.  They may affect conversion rate.

13. THANKS TO  Dr Matt Hewitt  Theatre Managers at CUMH and CUH