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. 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 [7–13]. 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
References
[1]
W. T. Creasman, F. Odicino, P. Maisonneuve, et al., “Carcinoma of the corpus uteri. FIGO 6th annual report on the results of treatment in gynecological cancer,” International Journal of Gynaecology and Obstetrics, vol. 95, supplement 1, pp. 105–143, 2006.
[2]
A. Jemal, R. Siegel, E. Ward, Y. Hao, J. Xu, and M. J. Thun, “Cancer statistics, 2009,” CA: Cancer Journal for Clinicians, vol. 59, no. 4, pp. 225–249, 2009.
[3]
C. Holland and H. Kitchener, “The modern management of endometrial cancer,” Oncology Reviews, vol. 1, pp. 103–119, 2007.
[4]
H. Reich, J. DeCaprio, and F. McGlynn, “Laparoscopic hysterectomy,” Journal of Gynecologic Surgery, vol. 5, no. 2, pp. 213–216, 1989.
[5]
K. B. Kluivers, J. C. M. Hendriks, B. W. J. Mol et al., “Quality of life and surgical outcome after total laparoscopic hysterectomy versus total abdominal hysterectomy for benign disease: a randomized, controlled trial,” Journal of Minimally Invasive Gynecology, vol. 14, no. 2, pp. 145–152, 2007.
[6]
R. Garry, J. Fountain, S. Mason et al., “The eVALuate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy,” British Medical Journal, vol. 328, no. 7432, pp. 129–135, 2004.
[7]
M. Malzoni, R. Tinelli, F. Cosentino et al., “Total laparoscopic hysterectomy versus abdominal hysterectomy with lymphadenectomy for early-stage endometrial cancer: a prospective randomized study,” Gynecologic Oncology, vol. 112, no. 1, pp. 126–133, 2009.
[8]
S. Malur, M. Possover, W. Michels, and A. Schneider, “Laparoscopic-assisted vaginal versus abdominal surgery in patients with endometrial cancer—a prospective randomized trial,” Gynecologic Oncology, vol. 80, no. 2, pp. 239–244, 2001.
[9]
K. M. Fram, “Laparoscopically assisted vaginal hysterectomy versus abdominal hysterectomy in stage I endometrial cancer,” International Journal of Gynecological Cancer, vol. 12, no. 1, pp. 57–61, 2002.
[10]
C. G. Zorlu, T. Simsek, and E. S. Ari, “Laparoscopy or laparotomy for the management of endometrial cancer,” Journal of the Society of Laparoendoscopic Surgeons, vol. 9, no. 4, pp. 442–446, 2005.
[11]
F. Zullo, S. Palomba, T. Russo et al., “A prospective randomized comparison between laparoscopic and laparotomic approaches in women with early stage endometrial cancer: a focus on the quality of life,” American Journal of Obstetrics and Gynecology, vol. 193, no. 4, pp. 1344–1352, 2005.
[12]
M. J. E. Mourits, C. B. Bijen, H. J. Arts et al., “Safety of laparoscopy versus laparotomy in early-stage endometrial cancer: a randomised trial,” The Lancet Oncology, vol. 11, no. 8, pp. 763–771, 2010.
[13]
M. Janda, V. Gebski, A. Brand et al., “Quality of life after total laparoscopic hysterectomy versus total abdominal hysterectomy for stage I endometrial cancer (LACE): a randomised trial,” The Lancet Oncology, vol. 11, no. 8, pp. 772–780, 2010.
[14]
J. Hauspy, W. Jiménez, B. Rosen, W. H. Gotlieb, M. Fung-Kee-Fung, and M. Plante, “Laparoscopic surgery for endometrial cancer: a review,” Journal of Obstetrics and Gynaecology Canada, vol. 32, no. 6, pp. 570–579, 2010.
[15]
O. Istre, A. Langebrekke, and E. Qvigstad, “Changing hysterectomy technique from open abdominal to laparoscopic: new trend in Oslo, Norway,” Journal of Minimally Invasive Gynecology, vol. 14, no. 1, pp. 74–77, 2007.
[16]
J. L. Walker, M. R. Piedmonte, N. M. Spirtos et al., “Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: gynecologic oncology group study LAP2,” Journal of Clinical Oncology, vol. 27, no. 32, pp. 5331–5336, 2009.
[17]
J. C. Barnett, J. P. Judd, J. M. Wu, C. D. Scales, E. R. Myers, and L. J. Havrilesky, “Cost comparison among robotic, laparoscopic, and open hysterectomy for endometrial cancer,” Obstetrics and Gynecology, vol. 116, no. 3, pp. 685–693, 2010.
[18]
A. Obermair, T. P. Manolitsas, Y. Leung, I. G. Hammond, and A. J. Mccartney, “Total laparoscopic hysterectomy versus total abdominal hysterectomy for obese women with endometrial cancer,” International Journal of Gynecological Cancer, vol. 15, no. 2, pp. 319–324, 2005.
[19]
D. R. Scribner, J. L. Walker, G. A. Johnson, D. S. McMeekin, M. A. Gold, and R. S. Mannel, “Laparoscopic pelvic and paraaortic lymph node dissection in the obese,” Gynecologic Oncology, vol. 84, no. 3, pp. 426–430, 2002.
[20]
A. S. Kueck, G. Gossner, W. M. Burke, and R. K. Reynolds, “Laparoscopic technology for the treatment of endometrial cancer,” International Journal of Gynecology and Obstetrics, vol. 93, no. 2, pp. 176–181, 2006.
[21]
M. Janda, V. Gebski, P. Forder, D. Jackson, G. Williams, and A. Obermair, “Total laparoscopic versus open surgery for stage 1 endometrial cancer: the LACE randomized controlled trial,” Contemporary Clinical Trials, vol. 27, no. 4, pp. 353–363, 2006.
[22]
M. Camanni, L. Bonino, E. M. Delpiano, G. Migliaretti, P. Berchialla, and F. Deltetto, “Laparoscopy and body mass index: feasibility and outcome in obese patients treated for gynecologic diseases,” Journal of Minimally Invasive Gynecology, vol. 17, pp. 576–582, 2010.
