Laparoscopy or Laparotomy for the Management of
C. Gurkan Zorlu, MD, Tayup Simsek, MD, Eylem Seker Ari, MD
Objective: The aim of this study was to evaluate the
feasibility of laparoscopy in the management of early
stage endometrial cancer.
Methods: Fifty-two patients with endometrial cancer who
underwent surgical staging consisting of total hysterec-
tomy, bilateral salpingo-oophorectomy with pelvic lymph
node dissection, and cytology between 1998 to 2002 were
included in the study. Laparotomy and laparoscopy were
randomly offered to patients upon admittance.
Results: Of 52 patients, 26 underwent laparotomy and the
remaining 26 underwent laparoscopic staging surgery. No
significant difference existed between the demographic
characteristics of the 2 groups. The mean number of
harvested lymph nodes was 18.2 in the laparoscopic
group and 21.1 in the laparotomic group (P?0.05). Pelvic
lymph node metastases were detected in 7.7% of the
patients in the laparoscopy group and 15.4% in the lapa-
rotomy group, and the difference was not significant.
Adjuvant radiotherapy was applied later to 42.3% of the
laparoscopy group and 38.5% of the laparotomy group.
Operative morbidity was higher in the laparotomy group
mainly because of postoperative wound infection, and the
patients in the laparotomy group had a longer hospital
Conclusion: Laparoscopic surgery is a method that can
be applied as well as laparotomy in the management of
endometrial cancer. Lymph node number and detection of
lymph node metastasis did not differ significantly in lapa-
rotomic and laparoscopic approaches. Wound infections
were more frequent in laparotomies.
Key Words: Laparoscopy, Laparotomy, Endometrial cancer.
The incidence of endometrial cancer has remained stable,
but the number of deaths annually from this disease has
doubled since 1987.1Despite the fact that many gynecol-
ogists believe endometrial cancer is harmless, when com-
pared stage by stage, 5-year survival is identical to that of
cervical cancer, which is considered virulent. Thus, we are
obligated to reassess the screening, diagnostic, staging,
and therapeutic aspects and most importantly the debate
on lymphadenectomy during hysterectomy. Currently, an
extremely low prevalence is inferred for lymph node in-
volvement in stages Ia, Ib, and grade 1 neoplasm, which
comprises 40% to 60% of newly diagnosed patients.
Therefore, the removal of regional reactive lymph nodes
in this setting seems inappropriate. Furthermore, it is pos-
tulated that in early disease stages and when regional
nodes are clinically unaffected, nodes should only be
sampled for prognostic significance and not removed rad-
ically in the vain hope of curing the patient. Indeed,
evidence from laboratory studies has shown that many
lymphatic and lymphatico-venous shunts that bypass re-
gional lymph nodes exist and allow an early stage lym-
phatic and hematogenous dissemination of malignant
cells.2–6On the other hand, removal of lymph nodes if
they are grossly positive, lessening the tumor burden,
should decrease the amount of suppressive tumor anti-
gens present in the host and reduce the amount of ad-
junctive therapy required to treat residual disease. Indeed,
ineffective nodes are no longer useful to the host but now
contribute to increased tumor-induced immunologic sup-
For tumors infiltrating the inner third of the myometrium,
the actual risk of node metastases is substantial for grade
3 histologic type tumors, and for the middle third inva-
sion, the risk of node metastases is substantial for grade 2
and 3 lesions. For tumors infiltrating the outer third, the
risk is substantial for all. Thus, the risk is ignorable for
superficial invasion and substantial for deep myometrial
invasion for all grades (20% to 45%). The negligible risk of
Akdeniz University School of Medicine, Antalya, Turkey (Dr Zorlu).
Gynecologic Oncology Unit, Akdeniz University School of Medicine, Antalya,
Turkey (Dr Simsek).
Department of Obstetrics and Gynecology, Akdeniz University School of Medicine,
Antalya, Turkey (Dr Ari).
Address reprint requests to: C. Gurkan Zorlu, MD, Portakal Cicegi Bulvari 16/21
07160 Yesilbahce, Antalya, Turkey. Telephone: 90 242 3131111, Fax: 90 242
3131010, E-mail: email@example.com
© 2005 by JSLS, Journal of the Society of Laparoendoscopic Surgeons. Published by
the Society of Laparoendoscopic Surgeons, Inc.