The role of laparoscopic hysterectomy and lymph node dissection in treatment of endometrial cancer.
BACKGROUND
The development of new diagnostic and surgical methods has brought a differentiated approach to surgery of endometrial cancer. The aim of this study was to verify the peri-and postoperative differences between laparoscopic and open procedure and prepare protocol for a second phase follow-up multicentric study.


METHODS
The study includes 133 women with indications for surgery of endometrial cancer. A prospective multicentric study was undertaken at four centres in the Czech Republic. We evaluated differences in the peri-and postoperative outcomes. Sixty-eight patients treated laparoscopically were compared with 65 patients treated by an open procedure of hysterectomy and lymphadenectomy.


RESULTS
Three patients with conversion were withdrawn from the study and another 65 patients (97%) from the laparoscopic group successfully completed the procedures. Laparoscopic and abdominal hysterectomy with lymphadenectomy were performed based on the grade of the tumor and depth of myometrial invasion. Out of both groups, 75 patients underwent pelvic lymphadenectomy and 21 women underwent para-aortic lymph node dissection or sampling. Eleven patients had metastases in the pelvic or para-aortic nodes (11.7% versus 4.7% in the open procedure group). Deep myoinvasion over 50% was more frequently present in the group of abdominally-treated women. The rate of major complications (18 versus 14 cases) was higher in the laparoscopic group, but more wound infections were seen in the open procedure group.


CONCLUSIONS
The study illustrates that the laparoscopic approach to surgery is feasible and it also may be considered for endometrial cancer which typically occurs in at risk and obese women. Recovery time is reduced by avoiding an abdominal incision. Laparoscopic surgery was performed successfully in 65 women and in 8 cases (11.7%) malignant spread outside to the regional lymph nodes was found. However, the selection of patients for laparoscopy should be done considering optimal benefit and safety.
Holub
Z
Z
Department of Obstetrics and Gynaecology, Baby Friendly Hospital, Kladno, Czech Republic.
Bartos
P
P
Dorr
A
A
Eim
J
J
Jabor
A
A
Kliment
L
L
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D002277:Carcinoma / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000601:surgery*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008197:Lymph Node Excision; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome