Robot Assisted Comprehensive Surgical Staging for Endometrial Cancer: A Validation Study

Nitin A. Wadhwa*, Dennis Mauricio, Isabel Eisner, Ruchi K. Wadhwa and Pankaj Singhal

Robot Assisted Comprehensive Surgical Staging for Endometrial Cancer: A Validation Study

Endometrial cancer is the most common gynecologic malignancy in
the United States, afflicting approximately 61,380 annually.

It is well-known today that most clinical stage I endometrial carcinomas
are limited to the uterus, but 20% have occult metastatic disease on final pathology
after surgical staging.

Prior to 1988, endometrial adenocarcinomas were clinically staged diseases,
primarily relying upon physical examination and radiological evidence.

A landmark trial by the Gynecologic Oncology Group (GOG),
known as GOG 33, was conducted in 1987 and paved the way for the adoption
of surgical staging for all endometrial carcinoma.

The study prospectively examined patients with clinical stage 1 carcinoma
of the endometrium and evaluated the surgical pathologic behaviors of these tumors.

The results were remarkable that 22% of patients assumed to have stage
1 uterine confined disease were found to have extrauterine spread
at the time of surgery with microscopic pelvic
and/or para-aortic metastases in 11% of women.

Since the publication of the study, minimally invasive techniques
have become the standard of care for the comprehensive surgical staging
of endometrial carcinomas.

In gynecologic surgery, the 1990s were notable for the advancement of
laparoscopic techniques, as well as for the development of more
advanced surgical equipment.

Multi-institutional clinical trials followed to compare laparotomy and laparoscopy.
For example, in 2009, the GOG LAP 2 study was the most prominent prospective
trial to compare these techniques during surgical staging procedures.

Gynecol Obstet Res Open J. 2019; 6(1): 20-26. doi: 10.17140/GOROJ-6-151