Laparoscopic surgery for endometrial cancer: long-term results of a multicentric study

Purpose of investigation: Surgical treatment of endometrial cancer was traditionally done by laparotomy, however the laparoscopic approach has gained wider acceptance by gynecologic surgeons. The primary aim of the study was to report the perioperative and postoperative outcomes of laparoscopic surgery in a major group of patients with endometrial cancer. The second aim was to study the long-term results of laparoscopic surgery in patients with endometrial cancer.

Material and method: A prospective multicentric study was conducted at three oncolaparoscopic centres; 221 women who had undergone laparoscopic (177 women) or abdominal (44 women) hysterectomy with bilateral salpingo-oophorectomy and lymphadenectomy were included in the study. Women with stage IA, grade I did not undergo lymphadenectomy unless they had a high risk histologic tumor type. Lymph node dissection was performed in 145 women with disease greater than IA or grades other than 1.

Results: The mean age and weight were similar in the compared laparoscopic and open groups. Perioperative blood loss was comparable in both groups (211.2 ml vs 245.7 ml, respectively) without any significant consecutive changes in serum hemoglobin values. Although the length of operating time for the laparoscopic surgery was significantly longer than the time for the laparotomy procedure (163.3 min vs 114.7 min, p < 0.0001), the laparoscopic patients were discharged from hospital much earlier at 3.9 days (range 2-16) after the laparoscopic procedure compared with 7.3 days (range 5-16) after the abdominal procedure (p < 0.0001). The difference in surgical complications between groups was statistically insignificant (p = 0.58). Similar long-term results were noted in both groups. With a median follow-up of 33.6 months for the laparoscopy group and 45.2 months for the open group, there were no significant differences in tumor recurrence (p = 0.99] or recurrence-free survival (p = 0.86) between the two groups.

Conclusion: The study illustrates that laparoscopically assisted surgical staging of endometrial cancer is safe as an open procedure. The laparoscopic approach may also be considered for endometrial malignancy which typically occurs in obese and elderly, high-risk women. Our analysis showed no difference with respect to recurrence or survival between the compared laparoscopic and the open group.

Endometrial carcinoma; Surgery; Laparoscopy; Hysterectomy; Complications; Recurrence; Survival

[1] Childers J.M., Brzechffa P., Hatch K. D., Surwit E. A.: "Laparoscopically assisted surgical staging (LASS) of endometrial cancer". Gynecol. Oncol., 1993, 47, 669.

[2] Eltabbakh G. H.,S hamonki M. I.,M oody J. M., Garafano L. L.: "Laparocopy as the primary modality for the treatment of women with endometrial carcinoma". Cancer, 2001, 91, 378.

[3] GemignaniM . L.,C urtin J.P.,Z elmanovich J.,P atel D. A.,V enkatraman E., Barakat R. R.: "Laparoscopic-assisted vaginal hysterectomy for endometrial cancer: clinical outcomes and hospital charges". Gynecol. Oncol., 1999, 73, 5.

[4] Malur S., Possover M.,M ichels W.,S chneider A.: "Laparoscopicassisted vaginal versus abdominal surgery in patients with endometrial cancer - a prospective randomized trial". Gynecol. Oncol., 2001, 80, 239.

[5] Scribner D.R., Walker J.,J ohnson G. A.,M cMeekin S. D., Gold M. A.,M anne! R. S.: "Laparoscopic pelvic and paraaortic lymph node dissection: analysis of the first 100 cases". Gynecol. Oncol., 2001, 82, 498.

[6] Magrina J. F.,M utone N. F.,W eaver A. L.,M agtibayP .M .,F owler R. S., Cornella J. L.: "Laparoscopic lymphadenectomy and vaginal or laparoscopic hysterectomy with bilateral salpingooophorectomy for endometrial cancer: morbidity and survival". Am. J. Obstet. Gynecol., 1999, 181, 376.

[7] Holub Z., Bartos P., Eim J.: "Laparoscopic surgery of endometrial cancer. Preliminary results of a multicentric study". Gynaecol. Endosc., 1999, 8, 271.

[8] Kadar N.: "Laparoscopic pelvic lymphadenectomy in obese women with gynecologic malignancies". J. Am. Assoc. Gynecol. Laparosc., 1995, 2, 163.

[9] Hidlebaugh D. A., Orr R. K.: "Staging endometroid adenocarcinoma. Clinical and financial comparison of laparoscopic and traditional approaches". J. Reprod. Med., 1997, 42, 482.

[10] Manolitas T. P., Fowler J.M.: "Role of laparoscopy in the management of the adnexal mass and staging gynecologic cancers". Clin. Obstet. Gynecol., 2001, 44, 495.

[11] Magrina J. F.: "Laparoscopic surgery for gynecologic cancers". Clin. Obstet. Gynecol., 2000, 43, 619.

[12] Kaplan E. L.,M eier P.: "N on-parametric estimation from incomplete observation". J. Am. Stat. Assoc., 1958, 53, 457.

[13] Eltabbakh G. H., Shamonki M. I.,M oody J.M.,G arafano L. L.: "Hysterectomy for obese women with endometrial cancer: laparoscopy or laparotomy". Gynecol. Oncol., 2000, 78, 329.

[14] Holub Z., Bartos P., labor A., Eim J., Fischlova D., Kliment L.: "Laparoscopic surgery in obese women with endometrial cancer". J. Am. Assoc. Gynecol. Laparosc., 2000, 7, 83.

[15] Querleu D.: "Laparoscopic and vaginal approach to surgery of endometrial cancer" (abstract). II. International Conference: Laparoscopy in Gynaecologic Oncology, Prague, 1998, 5.

[16] Bendetti-Panici P.,M aneschi F., Cutillo G., D'Andrea G., Manci A.,R abitti C. et al.: "Anatomical and pathological study of retroperitoneal nodes in endometrial cancer". Int. J. Gynecol. Cancer, 1998, 8, 322.

[17] Homesley H. D., Kadara A., Barret R. J., Lentz S.: "Selective pelvic and para-aortic lymphadenctomy does not increase morbidity in surgical staging of endometrial carcinoma". Am. J. Obstet. Gynecol., 1992, 167, 1225.

[18] Muntz H. G.,G off 8. A.,M adsen B. L.,Y on J. L.: "Port-site recurrence after laparoscopic surgery for endometrial carcinoma". Obstet. Gynecol., 1999, 93, 807.

[19] Agostini A., Cohen D., Cravello L., Bretelle F.,R oger V., Blanc B.: "Port-site recurrence following laparoscopic para-aortic lymphadenectomy for squamous carcinoma of the cervix". Eur. J. Obstet. Gynecol. Reprod. Biol., 2001, 98, 258.

[20] Hertel H., Fleck M., Kuhne-Heid R., Schneider A.: "Trocar-site metastasis is not always due to laparoscopy". Surg. Endosc., 2001, 15, 896.