Laparoscopic surgery for early endometrial cancer.
BACKGROUND
The purpose of the present study was to evaluate learning curves and short-term outcomes following laparoscopic surgery for early endometrial cancer in women of different body mass index (BMI) classes.


METHODS
Data from 227 women planned for laparoscopic surgery for presumed stage I endometrial cancer were collected retrospectively from a Danish gynecologic oncology unit. Surgery included laparoscopic hysterectomy and bilateral salpingo-oophorectomy with or without pelvic lymphadenectomy (PLA).


RESULTS
Median length of operations was 60 min (range, 30-197) and 120 min (range, 60-230), depending on whether PLA was included. The median pelvic lymph node yield was 18 (range, 7-42). For staging with PLA there was a learning curve when measured as operative time as well as lymph node yield, and a level of proficiency was not reached after 40 operations. The women had a perioperative complication rate of 4.5% and a median hospital stay of one night. Postoperative complication rate was 12%, comprising vaginal cuff hematoma (3.1%), vaginal cuff rupture (0.9%), trocar hernia (1.3%), ureter lesion (0.4%), bowel lesion (0.4%), reoperation (0.9%) and other complications (4.5%). All peri- and postoperative outcomes were independent of BMI classes.


CONCLUSIONS
Our data suggest that laparoscopic surgery for early endometrial cancer is feasible and safe. With increasing surgeon's experience there is a significant decrease in operative time and increase in the number of lymph nodes harvested. In experienced hands, either operative time, complications or length of stay are not affected by increasing BMI, even when women are morbidly obese.
Department of Obstetrics and Gynecology, Zealand University Hospital, Roskilde, Denmark.
Gitte
G
Bennich
Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark.
Martin
http://orcid.org/0000-0002-5115-1445
M
Rudnicki
Department of Obstetrics and Gynecology, Zealand University Hospital, Roskilde, Denmark.
Pernille D
PD
Lassen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D018269:Carcinoma, Endometrioid / Q000150:complications / Q000601:surgery*; D002983:Clinical Competence; D016889:Endometrial Neoplasms / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy; D059032:Learning Curve; D008197:Lymph Node Excision; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D061646:Operative Time; D010052:Ovariectomy / Q000379:methods*; D010388:Pelvis; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D058994:Salpingectomy / Q000379:methods*; D016896:Treatment Outcome
Laparoscopy; cancer; hysterectomy; obesity; oncologic gynecology