Vaginal lacerations during laparoscopic hysterectomy for endometrial cancer and local recurrence risk.

e17596 Background: Laparoscopic surgery offers equivalent oncologic outcomes as compared to open surgery, while causing lesser morbidity and resulting in a faster recovery. However, vaginal extraction of specimens may cause vaginal or perineal lacerations (VL). To date, no studies have specifically reported the impact of vaginal laceration on local recurrence after surgical treatment for endometrial cancer. The objective of this study is to assess local recurrence rates compared between cases with or without vaginal lacerations (NL). Methods: We identified all patients with endometrial cancer who underwent laparoscopic surgical management between 2014 and 2018. We assessed the rate of local recurrence between patients in VL and NL cohorts. The study included all histologic subtypes and stages. Patients with benign final pathology, cases of synchronous primaries or cases that required laparotomy for extraction were excluded. Results: Among the 540 endometrial cancer MIS cases, 338 were evaluable. There were 40 cases of vaginal laceration during specimen extraction. There was no significant difference in age, race, presence of LVSI, stage, grade, histology or use of vaginal brachytherapy between cohorts. Cases with vaginal lacerations were significantly associated with a higher median BMI of 33.6kg/m 2 (range 18.9-66) in the VL group as compared to 32.3kg/m 2 (range 19.1-66) in the NL group (p=0.03). Uterine size was greater in the laceration group (VL) with a median of 150.5 g (49 - 462g) versus 110g (33 – 573g) in the NL cohort (p <0.01). The VL cohort was more likely to have received adjuvant treatment. Specifically external beam radiation therapy (EBRT) was administered 20% in the VL group versus 8.4% in the NL group (p = 0.02) and chemotherapy was used in 27.5% of the VL group versus 9.7% in the NL group (p < 0.01). In early stage disease, more cases had non-endometrioid histology in the VL group (23% versus 11.5%, p=0.043) and had increased incidence of chemotherapy and radiation use as well (EBRT 5.6% vs 23% and chemotherapy 6.7% versus 23%, both with p= <0.01). There were no cases of isolated vaginal recurrence (0/40) in the VL group as compared to an incidence of 2% (7/298) in the NL group with a relative risk of 0.48 (CI: 0.03-8.36, p=0.62). There were 4 cases of pelvic recurrence (4/40) in the VL group and 2 cases in the NL group (2/298) with a relative risk of 2.13 (CI: 0.46-9.89, p=0.34). Conclusions: In endometrial cancer cases, we did not observe a significantly increased risk of vaginal or pelvic recurrence after a vaginal laceration at the time of specimen removal. This could be attributed to the higher rate of non-endometrioid histology in early stage disease, which resulted in higher rates of adjuvant chemotherapy or radiation treatment.