title: Comparison of Perioperative and Oncologic Outcomes with Laparotomy, and Laparoscopic or Robotic Surgery for Women with Endometrial Cancer.
abstract: OBJECTIVE
  To compare perioperative outcomes and oncologic outcomes in endometrial cancer patients treated with laparotomy, and laparoscopic or robotic surgery.
  
  
  METHODS
  Endometrial cancer patients who underwent primary surgery from January 2011 to December 2014 were retrospectively reviewed. Perioperative outcomes, including estimated blood loss (EBL), operation time, number of lymph nodes retrieved, and intra and postoperative complications, were reviewed. Recovery time, disease free survival (DFS) and overall survival (OS) were compared.
  
  
  RESULTS
  Of the total of 218 patients, 143 underwent laparotomy, 47 laparoscopy, and 28 robotic surgery. The laparotomy group had the highest EBL (300, 200, 200 ml, p<0.05) while the robotic group had the longest operative time (302 min) as compared with laparoscopy (180 min) and laparotomy (125 min) (p<0.05). Intra and postoperative complications were not different with any of the surgical approaches. No significant difference in number of lymph nodes retrieved was identified. The longest hospital stay was reported in the laparotomy group (four days) but there was no difference between the laparoscopy (three days) and robotic (three days) groups. Recovery was significantly faster in robotic group than laparotomy group (14 and 28 days, p=0.003). No significant difference in DFS and OS at 21 months of median follow up time was observed among the three groups.
  
  
  CONCLUSIONS
  Minimally invasive surgery has more favorable outcomes, including lower blood loss, shorter hospital stay, and faster recovery time than laparotomy. It also has equivalent perioperative complications and short term oncologic outcomes. MIS is feasible as an alternative option to surgery of endometrial cancer.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chulalongkorn University, Bangkok, Thailand E-mail : T_manchana@hotmail.com.
authors.forename: Tarinee
authors.initials: T
authors.lastname: Manchana
authors.forename: Pimpitcha
authors.initials: P
authors.lastname: Puangsricharoen
authors.forename: Nakarin
authors.initials: N
authors.lastname: Sirisabya
authors.forename: Pongkasem
authors.initials: P
authors.lastname: Worasethsin
authors.forename: Apichai
authors.initials: A
authors.lastname: Vasuratna
authors.forename: Wichai
authors.initials: W
authors.lastname: Termrungruanglert
authors.forename: Damrong
authors.initials: D
authors.lastname: Tresukosol
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D018284:Cystadenocarcinoma, Serous / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000401:mortality; D010535:Laparoscopy / Q000401:mortality*; D007813:Laparotomy / Q000401:mortality*; D007902:Length of Stay; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D019990:Perioperative Care; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000401:mortality*; D015996:Survival Rate