Safety of perioperative aspirin therapy in minimally invasive endometrial cancer staging

Study Objective: To investigate if low-dose aspirin influences the risk of bleeding and hemorrhagic complications during minimally invasive surgical staging for endometrial cancer. Design: Retrospective study (Canadian Task Force classification II-2.). Setting: University teaching hospital. Patients: Three hundred seventeen endometrial cancer patients undergoing laparoscopic staging. Interventions: Laparoscopic surgical staging included total laparoscopic hysterectomy plus bilateral salpingo-oophorectomy ± retroperitoneal staging. Measurement and Main Results: Forty-three (14%) low-dose aspirin users were compared with 274 (86%) nonaspirin users. Aspirin-treated patients were older than patients in the control group (71 [range, 50-85] vs 64 [range, 27-92] years old, p<.001). No between-group differences in intraoperative bleeding (p = .32), hemoglobin drop (p = .91), transfusions (p= .09), and hemorrhagic complications rate (p = .58) were recorded. Aspirin users had a lower lymphadenectomy rate in comparison with patients in the control group (p = .001). However, according to a subanalysis of patients undergoing retroperitoneal staging (20 aspirin users vs 200 patients in the control group), no differences in bleeding (p = .53), hemorrhagic complications (p = 1.0), or transfusion rate (p = .25) were observed. Conclusion: Low-dose aspirin does not influence the risk of bleeding and hemorrhagic complications in endometrial cancer patients undergoing minimally invasive staging. Hence, the choice to continue or cease the use of low-dose aspirin should be guided only by perioperative cardiovascular risk stratification.