Long-term follow-up after laparoscopic management of endometrial cancer: a 15-year cohort study

Abstract

The objective of this study was to evaluate longterm oncological outcomes of laparoscopic management of endometrial carcinoma (EC) in a large series of consecutive patients from two referral cancer centres. The study is a large retrospective study with 15-year follow-up. The clinical records of 207 consecutive women with clinical stage I EC managed by laparoscopy between 1990 and 2005 were reviewed. Laparoscopy included peritoneal washing, inspection of abdominal cavity, total laparoscopic hysterectomy + bilateral salpingo-oophorectomy and pelvic/para-aortic lymphadenectomy depending on the preoperative histology or frozen section results. Data collected included conversion rate, operative time, hospital stay, surgical complications, FIGO 1988 stage and 5-year survival. Laparoscopic procedures were converted to laparotomy in nine (4.3%) cases. Mean operative time was 173.2 min (70-300 min). Mean hospital stay was 5 days. The mean number of lymph nodes removed was 10 (2-25). Lymphadenectomy was considered not feasible in 20 cases (12.9%) due to technical difficulties. Intraoperative and postoperative complications were seen in 11 (5.6%) and 13 (6.6%) women, respectively. Histopathological results led to upstaging in 11.6% of cases. After a mean follow-up of 74.8 months (14-204 months), 5-year causespecific and disease-free survival rates were 93.2% and 89.3%, respectively. Twenty-one (10.6%) patients developed recurrences. No port site metastases were identified. Laparoscopic management of EC is feasible, reproducible and does not worsen patient prognosis. It allows comprehensive surgical staging and the option of lymphadenectomy in a single surgical procedure without compromising the oncological radicality required. Our results show minimal morbidity and similar long-term outcomes than those obtained by laparotomy in the literature.

Association of Obesity and Surgery Outcomes in Patients with Endometrial Cancer: A Single-Center Analysis

“…Similar to previous studies, we detected that postoperative complication rates did not differ significantly between the obese and non-obese patient groups. 10 11 15 16 On the contrary, Bouwman et al 17 reported that elevated BMI was associated with an increased risk of postoperative surgical complications in morbidly obese patients who underwent laparotomy. Patients' characteristics may explain these different results, and they also depend on surgeons' experience and type of equipment.…”

“…Many studies have established that obese patients are at a higher risk of perioperative and postoperative complications, such as longer hospital stay and increased morbidity, even when minimally invasive surgeries or laparotomy are performed. 9 10 11 Obesity is defined by the World Health Organization (WHO) by using the body mass index (BMI) cutoff point of > 30 kg/m 2 , which is calculated as weight in kg divided by height in meters squared. Body mass index has significant public health importance because it correlates well with morbidity and/or mortality and endometrial cancer risk.…”