Laparoscopy as the primary modality for the treatment of women with endometrial carcinoma

Abstract

BACKGROUND The current study was conducted to assess the feasibility of laparoscopy in the treatment of women with early stage endometrial carcinoma and to compare the surgical outcome, cost, and quality of life among these patients with those treated with laparotomy. METHODS A prospective study was conducted over 2 years in which all women with early stage endometrial carcinoma who could tolerate laparoscopic surgery were treated with laparoscopically assisted vaginal hysterectomy (LAVH), bilateral salpingo‐oophorectomy (BSO), and lymphadenectomy. Women with a similar disease stage who underwent similar surgical procedures through laparotomy in the previous 2 years were used as the control group. Both groups were compared with regard to their characteristics, surgical outcome, and cost and were interviewed regarding their quality of life. RESULTS Eighty‐six of 90 women with endometrial carcinoma underwent LAVH. The procedure was converted to laparotomy in 5 patients (5.8%). Laparoscopic surgery thus was successful in 90% of the women. There were no significant differences noted between those women who underwent LAVH and those who underwent total abdominal hysterectomy (TAH) (n = 57) with regard to patient characteristics, type of surgical procedure, preoperative and postoperative hematocrit, complications, patient recall of postoperative pain, and tumor recurrence. LAVH patients had significantly smaller body mass indices, a longer surgical time, more pelvic lymph nodes, a smaller decrease in postoperative hematocrit, received less pain medication, had a shorter hospital stay, an earlier return to full activity and work, and a higher level of satisfaction with their treatment, although their procedures had a higher cost compared with TAH patients. CONCLUSIONS The majority of women with early stage endometrial carcinoma can be treated with laparoscopy with an excellent surgical outcome, shorter hospitalization, earlier recovery, and improved quality of life, but with a higher financial cost. Cancer 2001;91:378–87. © 2001 American Cancer Society.

Evaluation of quality of life after laparoscopic surgery: evidence-based guidelines of the European Association for Endoscopic Surgery

“…Follow-up was 6 weeks. In the only study comparing QoL after open and laparoscopic hysterectomy for endometraial carcinoma, Eltabbakh et al [31] followed 143 patients over a period of 17 months (2b). The laparoscopic group reported higher satisfaction with the procedure and returned earlier to full activity.…”

Added Value of Perfusion in Gynaecological Imaging

“…This requires a specialized center with gynecologic-oncology surgeon [24]. Over-treating low risk patients results in increasing their morbidity, Furthermore, the recent introduction of laparoscopic techniques offers an alternative approach for these patients [25,30,31]. Accordingly preoperative MRI may play an important role owing to its ability to accurately detect the depth of myometrial invasion as well as the local and distant spread of endometrial tumors [24].…”

Robotic Surgery in the Management of Endometrial Cancer

“…Later studies have included multiple variables such as description of feasibility reports of the standard laparoscopic method, outcome analysis of open surgical versus laparoscopic techniques, analysis of cost-effectiveness, and even development of laparoendoscopic single-site surgery (LESS). [37][38][39][40][41][42][43][44][45][46] …”