Laparoscopic surgery for endometrial cancer: long-term results of a multicentric study.
OBJECTIVE
Surgical treatment of endometrial cancer was traditionally done by laparotomy, however the laparoscopic approach has gained wider acceptance by gynecologic surgeons. The primary aim of the study was to report the perioperative and postoperative outcomes of laparoscopic surgery in a major group of patients with endometrial cancer. The second aim was to study the long-term results of laparoscopic surgery in patients with endometrial cancer.


METHODS
A prospective multicentric study was conducted at three oncolaparoscopic centres; 221 women who had undergone laparoscopic (177 women) or abdominal (44 women) hysterectomy with bilateral salpingo-oophorectomy and lymphadenectomy were included in the study. Women with stage IA, grade I did not undergo lymphadenectomy unless they had a high risk histologic tumor type. Lymph node dissection was performed in 145 women with disease greater than IA or grades other than 1.


RESULTS
The mean age and weight were similar in the compared laparoscopic and open groups. Perioperative blood loss was comparable in both groups (211.2 ml vs 245.7 ml, respectively) without any significant consecutive changes in serum hemoglobin values. Although the length of operating time for the laparoscopic surgery was significantly longer than the time for the laparotomy procedure (163.3 min vs 114.7 min, p < 0.0001), the laparoscopic patients were discharged from hospital much earlier at 3.9 days (range 2-16) after the laparoscopic procedure compared with 7.3 days (range 5-16) after the abdominal procedure (p < 0.0001). The difference in surgical complications between groups was statistically insignificant (p = 0.58). Similar long-term results were noted in both groups. With a median follow-up of 33.6 months for the laparoscopy group and 45.2 months for the open group, there were no significant differences in tumor recurrence (p = 0.99] or recurrence-free survival (p = 0.86) between the two groups.


CONCLUSIONS
The study illustrates that laparoscopically assisted surgical staging of endometrial cancer is safe as an open procedure. The laparoscopic approach may also be considered for endometrial malignancy which typically occurs in obese and elderly, high-risk women. Our analysis showed no difference with respect to recurrence or survival between the compared laparoscopic and the open group.
Holub
Z
Z
Department of Obstetrics and Gynecology, Baby Friendly Hospital, Kladno, Czech Republic.
Jabor
A
A
Bartos
P
P
Eim
J
J
Urbánek
S
S
Pivovarniková
R
R
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery; D018262:Adenocarcinoma, Clear Cell / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018196:Carcinoma, Adenosquamous / Q000401:mortality / Q000601:surgery; D002296:Carcinosarcoma / Q000401:mortality / Q000601:surgery; D018283:Cystadenocarcinoma, Papillary / Q000401:mortality / Q000601:surgery; D018153:Czech Republic; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008197:Lymph Node Excision; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000601:surgery*; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D010052:Ovariectomy; D011183:Postoperative Complications; D011446:Prospective Studies; D012489:Salpingostomy