Analysis of morbidity in patients with endometrial cancer: is there a commitment to offer laparoscopy?

Tozzi, Roberto; Malur, Sabine; Koehler, Christhardt; Schneider, Achim

doi:10.1016/j.ygyno.2004.12.048

Cited by 107 publications

(94 citation statements)

References 29 publications

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“…To prevent interpathologist variations, frozen and paraffin section analyses were performed by the same pathologists who are experienced in the gynecologic oncology field. In the cur- Several studies have demonstrated that laparoscopy causes lesser complications than laparotomy in obese women (7,8,16,(19)(20)(21)(22)(23)(24). In the current study, there was no significant difference between both the groups with respect to the incidence of operative complications.…”

Section: Discussioncontrasting

confidence: 44%

Laparoscopy versus laparotomy for the management of endometrial carcinoma in morbidly obese patients: a prospective study

Bige¹,

Demir

Saatli

et al. 2015

J Turkish German Gynecol Assoc

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Results: Postoperative complications were significantly higher in the laparotomy group. Hospital stay in the laparoscopy group was significantly lower than that in the laparotomy group. The visual pain scores were significantly higher in the laparotomy group on the first, second, and third postoperative days and on the day of discharge from the hospital. Resuming activity took a significantly longer time in the laparotomy group (34.70 days) than in the laparoscopic group (17.89 days). Conclusion:With the availability of skilled endoscopic surgeons, most obese women with early stage endometrial cancer can be safely managed by performing laparoscopy with an excellent surgical outcome, shorter hospitalization, less postoperative pain, and faster resumption of full activity. (J Turk Ger Gynecol Assoc 2015; 16: 164-9) Keywords: Laparoscopy, endometrial carcinoma, morbidly obese patients Received: 09 February, 2015 Accepted: 19 April, 2015 Available Online Date: 14 July, 2015 Laparoscopy versus laparotomy for the management of endometrial carcinoma in morbidly obese patients: a prospective study

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Section: Discussioncontrasting

confidence: 44%

Laparoscopy versus laparotomy for the management of endometrial carcinoma in morbidly obese patients: a prospective study

Bige¹,

Demir

Saatli

et al. 2015

J Turkish German Gynecol Assoc

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“…6 A morbilidade que o procedimento acarreta tem constituído o principal argumento contra a sua prática sistemática, tendo em conta a idade avança-da da maioria das doentes e a frequência de patologias associadas. 7 A pesquisa do gânglio sentinela, constituindo uma alternativa promissora porque minimamente invasiva, encontra-se dificultada pela complexidade da drenagem linfática uterina. Diferentes técnicas de mapeamento linfático e locais de injecção têm sido ensaiados, estando a sua validação limitada pela heterogeneidade nas taxas de detecção e sensibilidade, pela falta de reprodutibilidade e pela necessidade de demonstrar uma clara vantagem custo-benefício.…”

Section: Discussionunclassified

Factores Preditivos de Metastização Ganglionar Retroperitoneal no Cancro do Endométrio

et al. 2014

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Introduction: It has been suggested that a complete staging may be safely omitted in endometrial carcinoma patients at low risk for lymph node metastasis. The purposes of our study were to explore the prognostic significance of pathologic factors for pelvic and paraaortic nodal spread and to validate the Mayo algorithm in order to identify patients in whom lymphadenectomy may be avoided. Material and Methods:We conducted a retrospective review including 208 patients, regarding the evaluation of pathologic variables and nodal metastases. Statistical analysis was performed using the chi-square test, the Fisher exact test and the Student's t-test. Results: Myometrial invasion > 50% (p < 0.001), cervical invasion (p = 0.001), lymphovascular space invasion (p = 0.003) and positive peritoneal cytology (p = 0.03) were significant predictors of retroperitoneal lymph node dissemination. Pelvic lymph node metastases were predictive of positive paraaortic lymph nodes (p < 0.001). Discussion: The Mayo algorithm identified patients without pelvic or paraaortic nodal metastases with a 98.4% negative predictive value (61/62). Myometral invasion ≤ 50% and absence of cervical and lymphovascular invasion presented a negative predictive value of 98.8% (79/80). Conclusion:Although the Mayo criteria predict a very low likelihood of retroperitoneal nodal metastases, the combination of myometral invasion ≤ 50% and absence of cervical or lymphovascular invasion would have safely avoided lymphadenectomy in a larger number of women. Keywords: Endometrial Neoplasms; Lymphatic Metastasis; Lymph Node Excision; Neoplasm Staging; Predictive Value of Tests; Retroperitoneal Space; Portugal. INtRODUÇÃORepresentando a neoplasia ginecológica mais frequente nos países desenvolvidos, o carcinoma do endométrio possui, em Portugal, taxas anuais de incidência e mortalidade cifradas em 10,3 e 1,9 por 100 000 mulheres, respectivamente. Com base na clínica, na histologia e no perfil molecular, descrevem-se dois tipos de carcinoma do endométrio. Responsável por 80% dos casos, o tipo I relaciona--se com condições que configuram um estado prolongado de hiperestrogenismo não contrabalançado (anovulação, nuliparidade, menopausa tardia, administração de tamoxifeno, cirrose hepática), atinge mulheres mais jovens e obesas e corresponde a tumores do tipo endometrióide, bem diferenciados e com melhor prognóstico. O tipo II associa--se a um endométrio atrófico, raramente exibe expressão de receptores hormonais, corresponde a tipos histológicos não endometrióide (células claras, serosos, carcinossarcomas) e cursa com invasão miometrial profunda e metastização ganglionar frequente. Globalmente, o carcinoma do endométrio acomete sobretudo mulheres na sexta e sétima décadas de vida, tendo a sua incidência vindo a aumen-

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“…Niestety, u wielu pacjentek z rakiem endometrialnym współistnieją inne choroby: otyłość, nadciśnienie tęt-nicze czy też cukrzyca [1,[4][5][6]. W takich przypadkach wykonanie laparotomii powoduje wzrost ryzyka wystą-pienia powikłań [7].…”

Section: Surgical Treatment Of Endometrial Cancer: Laparotomy or Lapaunclassified

Surgical treatment of endometrial cancer: laparotomy or laparoscopy?

Majchrzak-Baczmańska¹,

Antosiak²,

Malinowski³

2013

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125 StreszczenieTradycyjną metodą postępowania w przypadku raka endometrium jest śródoperacyjne płukanie jamy otrzewnej, przeprowadzona na drodze laparotomii całkowita histerektomia, obustronne wycięcie przydatków, a także -w przypadku występowania dużego ryzyka zajęcia przez proces nowotworowy -usunięcie węzłów chłonnych miednicznych i okołoaortalnych. Początkowo alternatywę dla laparotomii w przypadku raka endometrialnego stanowiło wycięcie macicy na drodze pochwowej wspomagane laparoskopowo (laparoscopic-assisted vaginal hysterectomy -LAVH) z limfadenektomią. Obecnie częściej wykonywane jest całkowite laparoskopowe wycięcie macicy (total laparoscopic hysterectomy -TLH) z limfadenektomią.Główną zaletą zastosowania procedury laparoskopowej jest precyzyjna preparatyka, z którą wiąże się mniejsza utrata krwi niż w przypadku laparotomii. Zastosowanie procedury laparoskopowej zmniejsza liczbę śród-i pooperacyjnych powikłań, zwłaszcza takich jak: infekcja rany pooperacyjnej, rozejście się rany pooperacyjnej oraz przepuklina w ranie pooperacyjnej. Dzięki laparoskopii skrócony jest również czas hospitalizacji, co wiąże się przede wszystkim z mniejszym urazem operacyjnym, mniejszą utratą krwi podczas operacji, z mniejszą liczbą powikłań, a także z szybszą rekonwalescencją. Ponadto autorzy licznych publikacji potwierdzają swoimi badaniami brak różnicy statystycznej w liczbie pobranych do badania histopatologicznego węzłów chłonnych podczas wykonywania limfadenektomii miednicznej i okołoaortalnej na drodze laparoskopii i laparotomii, co świadczy o podobnej skuteczności obydwu metod. Dane prezentowane w dostępnych publikacjach wskazują również na porównywalny odsetek 5-letnich przeżyć i nawrotów w przypadku laparoskopii i laparotomii u pacjentek z rakiem endometrium.Pomimo korzyści, jakie płyną z wykonania procedury laparoskopowej w leczeniu raka endometrium, w dalszym ciągu wśród ginekologów pojawiają się obawy i wątpliwości związane z zastosowaniem endoskopii. Przyczyną tego jest fakt, że procedury laparoskopowe stosowane w terapii raka endometrium należą do niezwykle trudnych technik operacyjnych. Związana z tym jest dłuższa krzywa uczenia i dłuższy czas trwania operacji niż w przypadku metody otwartej.Laparoskopia w terapii raka endometrium stanowi procedurę bezpieczną onkologicznie, skuteczną i wykonalną. Słowa kluczowe: rak endometrium, laparoskopia, laparotomia. SummaryAbdominal total hysterectomy with bilateral adnexectomy, intra-operative peritoneal washing, and also lymphadenectomy in the case of a high risk of pelvic and para-aortic nodal metastasis, constitute the traditional method of treatment of endometrial cancer. The laparoscopic approach diminishes the risk of complications occurring during laparotomy. Initially, laparoscopic-assisted vaginal hysterectomy (LAVH) with lymphadenectomy was performed as an alternative to laparotomy in the case of endometrial cancer. Nowadays, total laparoscopic hysterectomy (TLH) with lymphadenectomy is used more often. Currently, numerous publications report about the safet...

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Analysis of morbidity in patients with endometrial cancer: is there a commitment to offer laparoscopy?

Cited by 107 publications

References 29 publications

Laparoscopy versus laparotomy for the management of endometrial carcinoma in morbidly obese patients: a prospective study

Laparoscopy versus laparotomy for the management of endometrial carcinoma in morbidly obese patients: a prospective study

Factores Preditivos de Metastização Ganglionar Retroperitoneal no Cancro do Endométrio

Surgical treatment of endometrial cancer: laparotomy or laparoscopy?

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