Vaginal Cuff Dehiscence after Robotic Hysterectomy in Endometrial Cancer vs. Non-Cancer Patients

Abstract

Introduction: Vaginal cuff dehiscence (CD) after hysterectomy is a relatively uncommon but potentially serious complication of robotic-assisted laparoscopic total hysterectomy (RLTH), which is performed for benign and malignant indications. This study aimed to determine if there is a difference in the 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 2013 through 2018. Patients who underwent conversion to laparotomy, chemotherapy and/or radiation within a year before or after RLTH, and with malignancies other than uterine cancer were excluded. Data were abstracted from patient medical records. 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 controlling for other variables, obese patients were 25.1% less likely than non-obese patients to experience CD (p=.011). Additionally, CD was 2.8 times more likely to occur when surgery was performed by surgeon A compared to surgeon B (p=0.027). 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. Conclusions: Endometrial cancer patients were not at greater risk of experiencing CD compared to non-cancer patients. Surgeon differences and BMI were associated with incidence of CD, and patients with a normal BMI were most likely to report experiencing CD.