Elsevier

Gynecologic Oncology

Volume 112, Issue 1, January 2009, Pages 126-133
Gynecologic Oncology

Total laparoscopic hysterectomy versus abdominal hysterectomy with lymphadenectomy for early-stage endometrial cancer: A prospective randomized study

https://doi.org/10.1016/j.ygyno.2008.08.019Get rights and content

Abstract

Objective

The aim of this study was to compare, in a series of 159 women the feasibility, safety and morbidity of total laparoscopic hysterectomy (LPS) and abdominal hysterectomy with lymphadenectomy (LPT) for early-stage endometrial cancer and to assess disease-free survival and recurrence rate.

Methods

159 patients with clinical stage I endometrial cancer were enrolled in a prospective randomized trial and treated with LPS or LPT approach. The para-aortic lymphadenectomy was performed in all cases with positive pelvic lymph nodes discovered at frozen section evaluation, in patients with poorly differentiated tumors with myometrial invasion greater than 50% (ICG3), and non-endometrioid carcinomas.

Results

The mean operative time was 136 min ± 31 (95% CI 118–181) in the LPS group and 123 min ± 29 (95% CI 111–198) in the LPT group (P < 0.01). The mean blood loss was 50 ml ± 12 in the LPS group (95% CI 20–90) and 145 ml ± 35 in the LPT group (95% CI 60–255) (P < 0.01). The mean length of hospital stay was 5.1 ± 1.2 in the LPT group (95% CI 1–7) and 2.1 ± 0.5 in the LPS group (95% CI 1–5) (P < 0.01).

Conclusions

Laparoscopy is a suitable procedure for the treatment of patients with early endometrial cancer and may offer the potential benefits of decreased discomfort with decreased convalescence time without compromising the degree of oncological radicality required; however, it does not seem to modify the disease-free survival and the overall survival, although multicenter randomized trials and long-term follow-up are required to evaluate the overall oncologic outcomes of this procedure.

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.

Section snippets

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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