title: Is early stage endometrial cancer safely treated by laparoscopy? Complications of a multicenter study and review of recent literature.
abstract: BACKGROUND
  To compare the complications after total laparoscopic hysterectomy (LPS) and abdominal hysterectomy with lymphadenectomy (LPT) for early stage endometrial cancer in a series of 226 women and to assess the disease-free survival and the recurrence rate.
  
  
  METHODS
  Two hundred and twenty six patients with clinical stage I endometrial cancer were enrolled in a multicenter study and underwent surgical staging consisting of inspecting the intraperitoneal cavity, peritoneal washing, total hysterectomy, bilateral salpingo-oophorectomy, and in all cases we performed systematic bilateral pelvic lymphadenectomy by LPS or LPT approach.
  
  
  RESULTS
  One patient of the LPS group had an uretero-vaginal fistula and another patient had an ureteral stricture temporarily treated with a stent. One patient of the LPS group had a bowel perforation due to dense adhesions with the peritoneum under the umbilicus, resolved with a bowel resection and an end-to-end anastomosis. In three patients of the LPS group we observed a vaginal cuff dehiscence and in one case a pelvic lymphocyst was reported.
  
  
  CONCLUSIONS
  The low intraoperative and postoperative complications rate, observed in the LPS group, highlights the feasibility, safety and efficacy of this surgical approach. The operating time was longer in the LPS group but the recurrence rate and the complication rate appear similar and not more than what is traditionally expected with the LPT approach, although further studies and cost-benefit analyses are required to determine whether the use of LPS improves the outcome over standard LPT and whether the advantages of this technique could be extended to a larger proportion of patients.
authors.affiliation: Department of Obstetrics and Gynecology, Sant' Anna Clinic Institute, Brescia, Italy. raffaeletinelli@tiscali.it
authors.forename: Raffaele
authors.initials: R
authors.lastname: Tinelli
authors.forename: Mario
authors.initials: M
authors.lastname: Malzoni
authors.forename: Ettore
authors.initials: E
authors.lastname: Cicinelli
authors.forename: Andrea
authors.initials: A
authors.lastname: Fiaccavento
authors.forename: Riccardo
authors.initials: R
authors.lastname: Zaccoletti
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Barbieri
authors.forename: Andrea
authors.initials: A
authors.lastname: Tinelli
authors.forename: Ciro
authors.initials: C
authors.lastname: Perone
authors.forename: Francesco
authors.initials: F
authors.lastname: Cosentino
mesh_terms: D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D010535:Laparoscopy; D008197:Lymph Node Excision; D015337:Multicenter Studies as Topic; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D015996:Survival Rate; D016896:Treatment Outcome