A propensity score-matched case-control study of laparoscopy and laparotomy for endometrial cancer

Abstract

OBJECTIVE: A surgery is essential for the management of early endometrial carcinoma. Due to the comorbidities associated with the disease, the complications of surgery are common. Laparoscopic surgery may reduce surgical complications but also have oncological risks. We aimed to compare recurrence and overall survival (OS) associated with laparoscopy and laparotomy for early endometrial cancer. METHODS:We included women treated for presumed early endometrial carcinoma at the Clinics Hospital of Ribeirão Preto Medical School from January 1998 to December 2017. We designed a 1:2 propensity score-matched case-control and compared the patients' characteristics, short-term outcomes, recurrence, and OS.RESULTS: A total of 252 women were included in this study, 168 underwent laparotomy, and 84 underwent laparoscopy. The two groups were well balanced according to most of the variables, and obesity was a characteristic of patients in both groups. Laparoscopy was associated with increased surgical time (194.7 min vesus 165.6 min; p<0.001) and reduced rate of surgical complications (6.5% versus 0; p=0.038). Laparoscopic surgery was not associated with the risk of tumor recurrence (HR: 0.41, 95%CI 0.14-1.19, p=0.100) or all-cause mortality (HR: 0.49, 95%CI 0.18-1.35, p=0.170).CONCLUSION: Laparoscopy was safe in terms of oncological outcomes and was associated with a lower rate of surgical complications.Our data support the use of minimally invasive surgery as the preferential approach in the management of early endometrial carcinoma.

A Comparative Cohort Study of Laparoscopy Versus Laparotomy for the Treatment of Iranian Endometrial Cancer Patients

“…In a meta-analysis that was performed on eight RCTs, intraoperative complications were the same in both laparoscopy and laparotomy methods in the treatment of endometrial cancer. However, in the same study, investigation of postoperative complications, the blood loss in laparoscopy was less than in laparotomy in the treatment of endometrial cancer (2). A cohort study on endometrial cancer showed that intraoperative blood loss was less in the laparoscopic (174.2 mL ± 229.6 mL) than in the laparotomy group (234.4 mL ± 178.2 mL) (16).…”

“…However, Obesity is a condition that usually exists with endometrial carcinoma, and as a result, there are comorbidities such as HTN, pulmonary disease, and DM in these patients. As a result, these conditions can cause problems such as abdominal wall infection, increased blood loss, incomplete staging, and increased surgical time in these patients (2,3). Various surgical methods, including conventional laparoscopy, robotic-assisted, and laparotomy are methods that can be used as surgery 2…”

“…(4-6). Laparoscopy and robotic surgery are the preferred methods for treating endometrial cancer in recent decades (2,7,8). Several studies have been done in this field and demonstrated the benefits of laparoscopic surgery over laparotomy.…”

“…Several studies have been done in this field and demonstrated the benefits of laparoscopic surgery over laparotomy. Better postoperative quality of life, accelerating postoperative recovery, pain reduction, and reduced surgical morbidity are some advantages of the laparoscopic technique (2,9,10). This study compares laparoscopic surgery and laparotomy in terms of the advantages and disadvantages of the treatment of early-stage endometrial cancer in Iranian patients at a referral center of gyneco-oncology.…”

A propensity score-matched retrospective cohort study of hysterectomies for benign disease during the COVID-19 pandemic

“…Since there were more patients in the group whose surgery happened before the pandemic, we used propensity score matching with a ratio of 2 controls per 1 case to compare both groups. Equal variables for matching were ethnicity, marital status, educational level, type of surgery, and surgery length 11 . Nominal variables were adjusted for this method.…”