The role of laparoscopic surgery in the management of endometrial cancer

Abstract

Objective To assess the place of laparoscopically assisted vaginal hysterectomy in the treatment of endometrial cancer. Design A retrospective uncontrolled case series. Setting Gynaecological Oncology Department, Queen Elizabeth Hospital, Gateshead. Population Women with endometrial cancer referred to this centre from August 1992 to August 1997. Main outcome measures Success of laparoscopically assisted vaginal hysterectomy, operative morbidity, and the length of hospital stay. Results Laparoscopically assisted vaginal hysterectomy was successful in 35 of 40 women (88%). Five women required laparotomy. Two women sustained injury to the inferior epigastric vessels. One sustained injury to the small intestine requiring later laparotomy and three women required a blood transfusion. The mean hospital stay was 3.3 days (SD 1.5). Three women died of the disease within one year of their operation. Conclusion Laparoscopically assisted vaginal hysterectomy is a feasible treatment for endometrial cancer. It can be performed successfully in high risk population who are medically unfit and overweight. However, a larger randomised study is required to assess the morbidity compared with the traditional open approach.

Comparison of Laparoscopy and Laparotomy for Management of Endometrial Carcinoma: A Meta-analysis

“…Some studies have reported that obesity is a key risk factor for conversion to open surgery, 30,31 whereas other investigators advocate the advantages of laparoscopy in obese women. 32,33 The impact of obesity on the outcome of laparoscopic treatment of endometrial cancer remains a controversial matter; the results of large randomized trials are needed to resolve this issue. Because the most analyzed studies in the current investigation were performed using a retrospective study design, selection bias may exist in the comparison of the surgical outcome and postoperative complications based on the body mass index (BMI) status of patients.…”

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

“…The operating time was shorter in the laparotomy group (143.8 [45-265] vs. 211.5 [100-325] minutes; P < 0.001). However, the postoperative hospital admission was shorter in the laparoscopy group (4.1 [2][3][4][5][6][7][8][9][10] vs. 7.5 [3-27] days; P < 0.001). More lymphadenectomy procedures were made in laparoscopic group due to higher percentage of FIGO stage IB in this group (Table 2).…”

Cáncer de endometrio en grandes obesas: tratamiento quirúrgico

“…De hecho, las linfadenectomías pélvicas han podido realizarse en un número elevado de casos por vía laparoscópica, mientras que por la vía laparotómica ha habido un mayor porcentaje de problemas técnicos que han impedido completar adecuadamente la estadificación. Los autores de este estudio, como diversos autores, aceptan que la obesidad puede asociarse a un aumento de la tasa de conversión a LPM (básicamente debido al difícil tratamiento anestésico de estas mujeres), a un aumento del tiempo quirúrgico y a un aumento en la tasa de complicaciones peroperatorias respecto a la de mujeres con IMC menores que recibieron intervención por vía laparoscópica [27][28][29][30][31] .…”