Laparoscopically assisted vaginal hysterectomy versus abdominal hysterectomy in stage I endometrial cancer

Department of Obstetrics and Gynaecology, Jordan University Hospital, P.O. Box 2756, Tela'a Al-Ali 11953, Amman, Jordan.
International Journal of Gynecological Cancer (Impact Factor: 1.96). 01/2002; 12(1):57-61. DOI: 10.1046/j.1525-1438.2002.01038.x
Source: PubMed


The purpose of this study was to evaluate and compare laparoscopic treatment for stage I endometrial cancer with the traditional transabdominal approach. From July 1996 to July 1998, 61 patients with clinical stage I endometrial cancer were treated at the Gynaecology Oncology Unit at the Royal North Shore of Sydney, Australia. Twenty-nine patients were treated with laparoscopic assisted vaginal hysterectomy (LAVH) and bilateral salpingo-oophrectomy (BSO) plus minus laparoscopic pelvic lymphadenectomy (LPLA), while 32 patients were treated with the traditional laparotomy and underwent total abdominal hysterectomy (TAH) and BSO plus minus pelvic lymphadenectomy (PLA). The main outcomes studied were operative time, blood loss, blood transfusion, intraoperative complications, postoperative complications, duration of hospital stay, and number of lymph nodes obtained. In conclusion, laparoscopic treatment of endometrial cancer is safe in the hands of experienced operators with minimal intraoperative and postoperative complications. This procedure is associated with significantly less blood loss and shorter hospitalization; however, it is associated with significantly longer operating time. Proper selection of patients for the laparoscopic procedure is the vital step in achieving the major goals of this approach.

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Available from: Kamil Fram, Jan 16, 2015
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    • "The laparoscopy-related benefits observed in women with benign indications could, therefore, be reduced or different in these patients. A few randomized studies evaluating different aspects of laparoscopy versus laparotomy in patients with endometrial cancer have been published [7] [8] [9] [10] [11] [12] [13]. In a recent review by Hauspy et al., comparing laparoscopic approach with open surgery in endometrial cancer patients, the same benefits of laparoscopy were observed as for women with benign indication, and, based on currently available data, they recommend that women with endometrial cancer should be offered minimally invasive surgery as part of their treatment whenever possible [14]. "
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    ABSTRACT: Background. Laparoscopic hysterectomy has proved to be a safe alternative to open surgery in women with benign indications. Few studies compare laparotomy and laparoscopy in gynecologic oncology, and the objective of this study was to analyze the feasibility and development of laparoscopic surgery in endometrial cancer patients. Material and Methods. Records from all women having a hysterectomy due to premalignant or malignant endometrial changes during the years 2002-2009 were examined retrospectively. Results. A total of 521 hysterectomies were performed during the study period. Laparoscopy was performed in about 20% of the cases in the first two years, increasing to 83% in the last year of the period. Moreover, the laparoscopic technique was increasingly applied in older women, more obese women and in women with high-risk preoperative diagnosis, without increasing the complication rate. Conclusions. As for benign indications, laparoscopic hysterectomy in endometrial cancer patients should be preferred whenever possible.
    Full-text · Article · Jul 2011 · Obstetrics and Gynecology International
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    • "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 others, that this technique offers many advantages compared to the open approach [10] primarily considering the decreased hospital charges and shorter hospital stay as the main benefit [11]; post-operative complications after laparoscopic treatment are reduced or similar [12], likely related to the laparoscopic expertise of the operating surgeons and the patient's co-morbidities. However, long-term risks for recurrence and survival after laparoscopy for endometrial cancer are not well documented; however, this procedure does not seem to modify the incidence of recurrences or the overall survival [13]. "

    Full-text · Article · Apr 2009 · Gynecologic Oncology
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    • "Since Childers and Surwit first proposed laparoscopy as an option for apparently early stage endometrial cancer (1993), several others have published their experience on the feasibility of this approach [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17]. The reported benefits of a laparoscopic approach are lower blood loss and transfusion rates, shorter hospital stay, faster postoperative recovery [3–19], and superior short-term quality of life [10,11], albeit at the expense of longer operative times. "
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    ABSTRACT: To compare outcomes between robotic versus laparoscopic hysterectomy and lymphadenectomy in patients with endometrial cancer. A cohort study was performed by prospectively identifying all patients with clinical stage I or occult stage II endometrial cancer who underwent robotic hysterectomy and lymphadenectomy from 2006-2008 and retrospectively comparing data using the same surgeons' laparoscopic hysterectomy and lymphadenectomy cases from 1998-2005, prior to our robotic experience. Patient demographics, operative times, complications, conversion rates, pathologic results, and length of stay were analyzed. 181 patients (105 robotic and 76 laparoscopic) met inclusion criteria. There was no significant difference between the two groups in median age, uterine weight, bilateral pelvic or aortic lymph node counts, or complication rates in patients whose surgeries were completed minimally invasively. Despite a higher BMI (34 vs. 29, P<0.001), the estimated blood loss (100 vs. 250 mL, P<0.001), transfusion rate (3% vs. 18%, RR 0.18, 95%CI 0.05-0.64, P=0.002), laparotomy conversion rate (12% vs. 26%, RR 0.47, 95%CI 0.25-0.89, P=0.017), and length of stay (median: 1 vs. 2 nights, P<0.001) were lower in the robotic patients compared to the laparoscopic cohort. The odds ratio of conversion to laparotomy based on BMI for robotics compared to laparoscopy is 0.20 (95% CI 0.08-0.56, P=0.002). The mean skin to skin time (242 vs. 287 min, P<0.001) and total room time (305 vs. 336 min, P<0.001) was shorter for the robotic cohort. Robotic hysterectomy and lymphadenectomy for endometrial carcinoma can be accomplished in heavier patients and results in shorter operating times and hospital length of stay, a lower transfusion rate, and less frequent conversion to laparotomy when compared to laparoscopic hysterectomy and lymphadenectomy.
    Full-text · Article · Apr 2009 · Gynecologic Oncology
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