Total laparoscopic hysterectomy versus abdominal hysterectomy with lymphadenectomy for early-stage endometrial cancer: A prospective randomized study
Introduction
Endometrial cancer is the most common gynecologic malignancy in developed countries [1]. The standard approach for the staging and management of endometrial cancer is abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy, peritoneal washing, pelvic and para-aortic lymphadenectomy by open technique [2].
However, the laparoscopic approach has recently been applied to women with endometrial cancer with excellent outcome [3] and several investigators have demonstrated that total or vaginally assisted laparoscopic hysterectomy, associated with laparoscopic pelvic lymphadenectomy, represents a valid alternative to open surgery [4].
Obese women are most likely to benefit from laparoscopic surgery as such surgery is associated with less post-operative pain, earlier ambulation, shorter hospital stays and fewer wound complications and pelvic abscess [5], [6].
The aim of this prospective randomized study was to compare in a series of 159 women the safety, morbidity and survival rate of total laparoscopic hysterectomy (LPS) with lymphadenectomy and abdominal hysterectomy with lymphadenectomy (LPT) for early-stage endometrial cancer.
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Materials and methods
Between November 2001 and January 2006, we conducted a prospective randomized study of all consecutive patients with clinical stage I endometrial carcinoma with the intent to perform a total laparoscopic hysterectomy (LPS) with pelvic and aortic lymph node dissection or abdominal hysterectomy (LPT) with pelvic and aortic lymph node dissection (Table 1) at the Advanced Gynecological Endoscopy Center of the Malzoni Medical Center, Avellino, Italy.
For the purpose of the study, 159 patients with
Results
Mean age, mean weight and mean BMI were similar in the two groups; likewise, no significant differences were found regarding histology type, grading, tumor stage and lymph node status; all the patients with atypical histology were equally distributed in the two groups.
Various patient characteristics are shown in the Tables 1 and 2 (variables with normal distribution are expressed as mean and 95% CI ± SD).
The length of post-operative ileus was evaluated by asking the patients when they recovered
Discussion
The surgical management for early-stage endometrial cancer is highly variable and is currently under investigation [7], [8].
The application of laparoscopy in the management of gynecologic malignancy has received much attention and given rise to considerable debate during the past few years [9].
Recently, surgeons have started to perform hysterectomy and bilateral salpingo-oophorectomy with pelvic and/or para-aortic lymph node dissection using a totally laparoscopic approach and concluded, as
Conclusion
Total laparoscopic hysterectomy with lymphadenectomy can be considered a safe and effective alternative therapeutic procedure to laparotomy for management of early-stage endometrial cancer with a significantly low morbidity than reported for the open approach without compromising the degree of oncological radicality required; moreover, laparoscopic treatment of endometrial cancer is characterized by a significantly shorter operative time, with minimal blood loss and post-operative
Conflict of interest statement
The authors declare that there are no conflicts of interest.
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