Laparoscopy as the primary modality for the treatment of women with endometrial carcinoma.
BACKGROUND
The current study was conducted to assess the feasibility of laparoscopy in the treatment of women with early stage endometrial carcinoma and to compare the surgical outcome, cost, and quality of life among these patients with those treated with laparotomy.


METHODS
A prospective study was conducted over 2 years in which all women with early stage endometrial carcinoma who could tolerate laparoscopic surgery were treated with laparoscopically assisted vaginal hysterectomy (LAVH), bilateral salpingo-oophorectomy (BSO), and lymphadenectomy. Women with a similar disease stage who underwent similar surgical procedures through laparotomy in the previous 2 years were used as the control group. Both groups were compared with regard to their characteristics, surgical outcome, and cost and were interviewed regarding their quality of life.


RESULTS
Eighty-six of 90 women with endometrial carcinoma underwent LAVH. The procedure was converted to laparotomy in 5 patients (5.8%). Laparoscopic surgery thus was successful in 90% of the women. There were no significant differences noted between those women who underwent LAVH and those who underwent total abdominal hysterectomy (TAH) (n = 57) with regard to patient characteristics, type of surgical procedure, preoperative and postoperative hematocrit, complications, patient recall of postoperative pain, and tumor recurrence. LAVH patients had significantly smaller body mass indices, a longer surgical time, more pelvic lymph nodes, a smaller decrease in postoperative hematocrit, received less pain medication, had a shorter hospital stay, an earlier return to full activity and work, and a higher level of satisfaction with their treatment, although their procedures had a higher cost compared with TAH patients.


CONCLUSIONS
The majority of women with early stage endometrial carcinoma can be treated with laparoscopy with an excellent surgical outcome, shorter hospitalization, earlier recovery, and improved quality of life, but with a higher financial cost.
Eltabbakh
G H
GH
Division of Gynecologic Oncology, University of Vermont College of Medicine, Burlington, Vermont, USA. gamal.eltabbakh@vtmednet.org
Shamonki
M I
MI
Moody
J M
JM
Garafano
L L
LL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision; D008875:Middle Aged; D009367:Neoplasm Staging; D010052:Ovariectomy / Q000379:methods; D011446:Prospective Studies; D011788:Quality of Life; D012509:Sarcoma / Q000473:pathology / Q000601:surgery*; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*