%0 Journal Article
%T Surgical Treatment of Endometrial Cancer and Atypical Hyperplasia: A Trend Shift from Laparotomy to Laparoscopy
%A Erik Qvigstad
%A Marit Lieng
%J Obstetrics and Gynecology International
%D 2011
%I Hindawi Publishing Corporation
%R 10.1155/2011/829425
%X 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¨C2009 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. 1. Introduction Endometrial cancer is the most common gynecological malignancy [1, 2]. The main treatment of early-stage endometrial cancer is surgery, including total hysterectomy, bilateral salping oophorectomy, and pelvic and aortic lymph-node dissection and removal if indicated [3]. Although total abdominal hysterectomy with vertical midline incision is still the standard treatment for early-stage endometrial cancer, laparoscopic approach has been in increasing use since Reich et al. published the first laparoscopic assisted vaginal hysterectomy in 1989 [4]. For benign indications, like fibroids and bleeding disorders, several prospective controlled studies have shown total laparoscopic hysterectomy as a safe alternative to open surgery [5, 6]. Endometrial cancer patients are, however, usually older, quite often obese, and a substantial number of them present with comorbidity at the time of surgery. 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¨C13]. 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
%U http://www.hindawi.com/journals/ogi/2011/829425/