Surgical treatment of endometrioid endometrial carcinoma - laparotomy versus laparoscopy

Abstract

Objective: Recent publications have raised doubts about the oncological safety of a laparoscopic approach in the treatment of endometrial cancer. The aim of this study was to investigate the beneficial aspects of laparoscopy versus laparotomy in patients with endometrial cancer, and present oncological outcomes. Material and Methods: A retrospective study of patients who underwent surgery for the treatment of endometrioid endometrial cancer was performed. Surgical outcomes and complications in patients who were treated by laparoscopy or open surgery were compared. The patients were followed for 5-years. Patients’ characteristics, tumor stage, complications rate and oncologic outcome were analyzed. Results: A total of 151 patients were included. The laparoscopy (n=80) and laparotomy (n=71) groups were homogeneous in regards of demographic data and tumor stage. Median average blood loss (1.31 vs. 1.92 g/dL), the mean duration of hospitalization (5.73 vs. 12.25 days), intraoperative (0 vs. 6%), and severe postoperative complications (5.1 vs. 14.3%) were significantly lower in the laparoscopy group. The numbers of pelvic or para-aortic lymph nodes removed during systematic lymphadenectomy were similar in both groups. Women who underwent laparoscopy and those who underwent laparotomy had similar five-year recurrence-free survival rates (88.7% vs. 91.5%, p=0.864), as well as similar overall five-year survival rates (91.2% vs. 97.2%, p=0.094). Conclusion: The oncological outcome of laparoscopy was similar to that of laparotomy in the treatment of patients with endometrial cancer. However, surgical outcomes and morbidity rates were significantly better in patients treated by laparoscopy. Clinical trials are essential to evaluate the oncological efficacy of laparoscopy in patients with endometrial cancer.

Endometrioid endometrial cancer treated with open or laparoscopic approach: is there a dilemma?

“…The findings were, as expected, in favor of the laparoscopic group regarding the blood loss, hospital stay, intraoperative, and severe postoperative complications. No differences were identified in the nodal yield status, progression free and overall survival between the two groups ( 1 ). The study is in accordance with the findings of a recent metanalysis ( 2 ).…”

“…It was with a great deal of interest, we read the article entitled: “Surgical treatment of endometrioid endometrial carcinoma - laparotomy versus laparoscopy” by Baum et al ( 1 ). The authors present the perioperative outcomes, pathologic findings and long-term oncological findings of their cohort of endometrioid endometrial cancer patients treated either by laparotomy or laparoscopy.…”

Early-stage cervical cancer treatment – what’s new?

“…Cancer antigen is treated through radical hysterectomy, either through conventional laparotomy or laparoscopic surgery (minimally invasive surgery) [ 14 , 15 ]. The latter has been proven to be superior to conventional laparotomy in terms of less intraoperative and postoperative bleeding, lower incidence of lymphocystis, and shorter catheter removal time and hospital stay, while it has equivalent efficacy on complete removal of lymph nodes [ 16 ] and in reducing the levels of circulant biomarkers, such as cancer antigen 125, carcinoembryonic antigen, the soluble form of interleukin 2 receptor (sIL-2R), and tumour necrosis factor α[ 13 , 17 ].…”

Hysterectomy: Let’s Step Up the Ladder of Evidence to Look Over the Horizon

“…The results of the Robot-assisted approach to cervical cancer (RACC) trial could change these findings, confirming the oncologic safety of robot-assisted surgery for early-stage cervical cancer as compared with standard laparotomy [ 23 ]. In addition, the oncological outcomes after laparoscopic and laparotomic hysterectomies are almost overlapping even when we refer to other malignancies, such as endometrioid endometrial cancer [ 24 ].…”