Comparison of the results of surgical treatment using laparoscopy and laparotomy in patients with endometrial cancer

Abstract

The objective of the current study was to compare the results of surgical treatment in endometrial cancer with the use of laparoscopy and the traditional approach of laparotomy. Our goal was to evaluate and compare the morbidity, recurrence rate, and disease-free survival in both groups. This article is a retrospective study. A chart review of 45 patients treated by laparoscopy between 1994 and 2002 and 136 patients treated by laparotomy between 2001 and 2002 was performed. Disease-free survival in both groups was evaluated with the Kaplan-Meier method and was compared using the log-rank test. The rate of recidive was 6% in the laparoscopy group and 13% in the laparotomy group. There was no statistically significant difference in disease-free survival and recidive rate between the laparoscopy and laparotomy groups. Laparoscopic management in endometrial cancer does not worsen the prognosis, and the disease-free survival is similar to that resulting from the traditional approach. The benefits of minimal invasive surgery are quicker postoperative recovery, shorter hospital stay, and no wound complications.

Laparoscopic-assisted vaginal hysterectomy with laparoscopic pelvic and paraaortic staging for early endometrial cancer

“…Also, initially, a longer operating time should be considered. Hitherto, there have been no reports in the scientific literature describing a worse prognosis (i.e., with regard to recurrence rate, overall survival) for LAVH ± LAE compared with laparotomy ± LAE in FIGO stage I endometrial cancer [53,60]. Long-term results of large, prospective, randomized trials with sufficient statistical power are lacking though [3,18,51].…”

“…In this respect, 11 studies have been identifiedone of which is a prospective, randomized trial [18,46]with no difference regarding recurrence rate and overall survival compared with the open approach being found [18,40,42,43,[47][48][49][50][51][52][53]. Chu et al [10] have reported three patients with vaginal cuff recurrence after LAVH for endometrial cancer, warning not to implement this surgical method too fast (Table 2).…”

The Modern Surgical Strategy for Endometrial Cancer: Laparoscopic Surgery

“…Many retrospective studies [13][14][15][16][17][18][19][20][21][22][23][24][25], prospective nonrandomized studies [26][27][28][29], and meta-analyses [49•, 50-52, 53•] published during the last decade have suggested that laparoscopic surgery has an improved outcomes profile in terms of estimated blood loss and transfusion requirements, recovery of bowel movement, postoperative hospital stay, and perioperative complications compared with laparotomy in the surgical management of endometrial cancer. These findings have been confirmed in recent RCTs comparing laparoscopy and laparotomy for surgical staging of endometrial cancer (Table 1) The following discussion of outcomes and complications of laparoscopic surgery compared with laparotomy is based on the results of the eight RCTs presented in Table 1.…”

“…Retrospective [13][14][15][16][17][18][19][20][21][22][23][24][25] or prospective, nonrandomized studies [26][27][28][29] have shown comparable survival outcomes for laparoscopic surgery and laparotomy. Four RCTs reported the long-term survival outcomes after laparoscopic surgery compared with laparotomy in patients with endometrial cancer (Table 1) [33, 35, 36, 45••].…”

“…Indeed, whilst endometrial cancer is the first gynecologic cancer to be treated laparoscopically, a laparoscopic approach also is being used for the surgical management of malignant disease. Following the first report on the use of laparoscopic surgery for endometrial cancer by Childers et al [12], the feasibility, safety, and efficacy of laparoscopic surgery in the surgical management of endometrial cancer has been reported in numerous retrospective studies [13][14][15][16][17][18][19][20][21][22][23][24][25], prospective nonrandomized studies [26][27][28][29], or randomized, controlled trials (RCTs) [30][31][32][33][34][35][36][37][38][39][40][41][42]43 This review provides an update on the role of laparoscopic surgery for the surgical management of endometrial cancer with particular emphasis on feasibility, safety, and efficacy based on the results of randomized, controlled trials comparing laparoscopy and laparotomy for surgical staging of endometrial cancer.…”