title: Comparison of reoperation rates, perioperative outcomes in women with endometrial cancer when the standard of care shifts from open surgery to laparoscopy.
abstract: OBJECTIVE
  To analyze reoperation rates and perioperative outcomes after long-term follow-up of two surgical approaches in the treatment of endometrial cancer when the standard of care shifts from open surgery to laparoscopy at a university hospital.
  
  
  METHODS
  In this retrospective monocenter study a total of 267 patients with endometrial cancer were included; 107 women underwent laparoscopy and 160 laparotomy. All of the patients received total hysterectomy, bilateral salpingo-oophorectomy, and pelvic and para-aortic lymphadenectomy, depending on individual pathological features (e.g. high risk for positive lymph nodes) and the expertise of the surgeon.
  
  
  RESULTS
  Repeat surgery was needed significantly more often in the laparotomy group in comparison with the laparoscopy group (11.9 vs. 0.9 %, respectively; P < 0.001). Hospital stays were longer in the laparotomy group in comparison with laparoscopy (16.2 vs. 9.5 days; P < 0.000001). Postoperative complications were significantly more frequent in the laparotomy group in comparison with laparoscopy (25.0 vs. 10.3 %; P < 0.01). Operating times and preoperative and postoperative hemoglobin differences were similar in the two groups (193.9 vs. 190.6 min, 2.0 vs. 1.8 g/dl). Intraoperative complication rates were similar in the two groups (3.8 vs. 5.6 %).
  
  
  CONCLUSIONS
  Laparoscopy is a safe alternative to laparotomy for low risk endometrial cancer patients and offers markedly improved perioperative outcomes with a lower reoperation rate and fewer postoperative complications when the standard of care shifts from open surgery to laparoscopy in a university hospital.
authors.affiliation: Department of Obstetrics and Gynecology, Erlangen University Hospital, University of Erlangen-Nuremberg, Erlangen, Germany, alexander.boosz@klinikum-karlsruhe.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Boosz
authors.forename: Lothar
authors.initials: L
authors.lastname: Haeberle
authors.forename: Stefan P
authors.initials: SP
authors.lastname: Renner
authors.forename: Falk C
authors.initials: FC
authors.lastname: Thiel
authors.forename: Grit
authors.initials: G
authors.lastname: Mehlhorn
authors.forename: Matthias W
authors.initials: MW
authors.lastname: Beckmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Mueller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000009:adverse effects; D007902:Length of Stay; D008197:Lymph Node Excision; D008875:Middle Aged; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D010052:Ovariectomy; D059035:Perioperative Period; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D024162:Second-Look Surgery; D059039:Standard of Care