Laparoscopic Versus Abdominal Approach to Endometrial Cancer: A 10-Year Retrospective Multicenter Analysis

Abstract

Objective: The objective of this study was to give a reality-based picture of the use of laparoscopic surgery for staging endometrial cancer patients out of the experimental setting. Methods: Consecutive data of patients with endometrial cancer who underwent laparoscopic or abdominal surgical staging in 6 Italian centers were recorded. Baseline patients and tumors characteristics, surgery performed, and safety data were collected and analyzed. Results: A total of 1012 subjects (403 and 609 treated by laparoscopy and laparotomy, respectively) who received surgical stadiation for endometrial cancer were included in the final analysis. The laparoscopic approach to endometrial cancer was more commonly performed in younger and nonobese patients who had received less previous surgeries, whereas the abdominal approach was preferred for the advanced stages and rare histotypes. Irrespectively to stage, the operative time was higher for the laparoscopy than laparotomy, whereas blood loss and postoperative complications were lower in the laparoscopy group than in the laparotomy group. No difference between surgical approaches was observed in complication rates in stage I endometrial cancers, whereas they were worst in higher stages. The site, but not the incidence, of recurrences differed only for advanced stage endometrial cancers. No differences in overall, disease-free, and cancer-related survival rates were also observed. Conclusions: In the clinical practice, heterogeneous criteria are adopted to recur to laparoscopy for staging endometrial cancer. The safety and the feasibility of the laparoscopy are confirmed for stage I endometrial cancers, whereas they appear suboptimal for the advanced stages.

Conversion in endometrial cancer patients scheduled for laparoscopic staging: a large multicenter analysis

“…The effect of surgical stage on the conversion rate is here well documented. In fact, the proportion of patients with endometrial cancers at stages higher than I was significantly higher in converted patients than in laparoscopy patients conforming the high conversion rate in advanced stage endometrial cancers and that the feasibility of the laparoscopy for treating endometrial cancers is optimal for early stages alone [5].…”

“…In a wide retrospective analysis of 1,012 subjects who received surgical staging for endometrial cancer in different surgical settings, the safety and the feasibility of laparoscopic staging was confirmed for stage I endometrial cancers [5], and seemed highly feasible and quite safe in stage II endometrial cancers as well [5]. Instead, it should be used with caution in patients with stages III or IV endometrial cancers [5].…”

“…Both meta-analytic data from randomized controlled trials (RCTs) [6][7][8][9][10][11][12][13] and retrospective analyses [5] have highlighted that laparoscopy is completed successfully in a high proportion of cases. Moreover, the conversion rate varies widely among studies, from no conversion [7] to 25.8 % [11].…”

“…Several explanations and hypotheses have been advanced for this heterogeneity [2]. However, outcomes of converted patients have not been reported in RCTs [6][7][8][9][10][11][12][13] or in retrospective studies [5].…”

Laparoscopic Versus Laparotomy Approach in Surgical Treatment of Endometrial Cancer: Pelvic Lymphadenectomy Results

“…Although several studies [14,19,20] have suggested that the grade of the tumor and the histological type could draw the indication for the surgical approach. In our study, the surgical approach was not influenced by the grade of the tumor.…”