Total Laparoscopic Hysterectomy versus Laparoscopic-Assisted Vaginal Hysterectomy in Endometrial Cancer: Surgical and Survival Outcomes

Fader, A. Nickles; Michener, Chad M.; Frasure, Heidi E.; Giannios, N.M.; Belinson, Jerome L.; Zanotti, Kristine

doi:10.1016/j.jmig.2009.02.010

Cited by 19 publications

(8 citation statements)

References 17 publications

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“…Our conversion rate of 18.5% is high in relation to some recent studies (Table 6) but is within the literature range of 0-36.4% [5,8,9,11-13,16,23,25-28,30-35,37,38]. This is almost certainly due to the learning curve since in 6 of the cases (adhesions [n=3], for staging [n=2], inadequate exposure due to subperitoneal fat [n=1]), conversion would probably now be avoided as a result of increased experience.…”

Section: Discussionsupporting

confidence: 85%

Laparoscopic surgery for endometrial cancer: increasing body mass index does not impact postoperative complications

et al. 2011

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ObjectiveTo determine the effect of body mass index on postoperative complications and the performance of lymph node dissection in women undergoing laparoscopy or laparotomy for endometrial cancer.MethodsRetrospective chart review of all patients undergoing surgery for endometrial cancer between 8/2004 and 12/2008. Complications graded and analyzed using Common Toxicity Criteria for Adverse Events ver. 4.03 classification.Results168 women underwent surgery: laparoscopy n=65, laparotomy n=103. Overall median body mass index 36.2 (range, 18.1 to 72.7) with similar distributions for age, body mass index and performance of lymph node dissection between groups. Following laparoscopy vs. laparotomy the percent rate of overall complications 53.8:73.8 (p=0.01), grade ≥3 complications 9.2:34.0 (p<0.01), ≥3 wound complications 3.1:22.3 (p<0.01) and ≥3 wound infection 3.1:20.4 (p=0.01) were significantly lower after laparoscopy. In a logistic model there was no effect of body mass index (≥36 and<36) on complications after laparoscopy in contrast to laparotomy. Para-aortic lymph node dissection was performed by laparoscopy 19/65 (29%): by laparotomy 34/103 (33%) p=0.61 and pelvic lymph node dissection by laparoscopy 21/65 (32.3%): by laparotomy 46/103 (44.7%) p=0.11. Logistic regression analysis revealed that for patients undergoing laparoscopy for stage I disease there was an inverse relationship between the performance of both para-aortic lymph node dissection and pelvic lymph node dissection and increasing body mass index (p=0.03 and p<0.01 respectively) in contrast to the laparotomy group where there was a trend only (p=0.09 and 0.05).ConclusionFor patients undergoing laparoscopy, increasing body mass index did not impact postoperative complications but did influence the decision to perform lymph node dissection.

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Section: Discussionsupporting

confidence: 85%

Laparoscopic surgery for endometrial cancer: increasing body mass index does not impact postoperative complications

et al. 2011

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“…Recent work that has focused on the morbidly obese population with respect to endometrial cancer has shown that total laparoscopic hysterectomy and robotic surgery are feasible and result in fewer perioperative complications [9–11], although these results may not be valid for extremely or “super” obese (BMI ≥50 kg m −2 ) women [12]. Length of hospital stay has not been reported to vary by BMI for some hospitals [7] but has for others [12], with longer stays associated with increasing BMI.…”

Section: Introductionmentioning

confidence: 99%

Endometrial cancer in morbidly obese women: Do racial disparities affect surgical or survival outcomes?

Coté

Ruterbusch

Ahmed

et al. 2014

Gynecologic Oncology

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Objective Endometrial cancer mortality disproportionately affects black women and whether greater prevalence of obesity plays a role in this disparity is unknown. We examine the effect of race on post-surgical complications, length of stay, and mortality specifically in a morbidly obese population. Methods Black and white women with endometrial cancer diagnosed from 1996 to 2012 were identified from the University Pathology Group database in Detroit, Michigan, and records were retrospectively reviewed to obtain clinicopathological, demographic, and surgical information. Analysis was limited to those with a body mass index of 40 kg/m2 or greater. Differences in the distribution of variables by race were assessed by chi-squared tests and t-tests. Kaplan–Meier and Cox regression analyses were performed to examine factors associated with mortality. Results 97 white and 89 black morbidly obese women were included in this analysis. Black women were more likely to have type II tumors (33.7% versus 15.5% of white women, p-value= 0.003). Hypertension was more prevalent in black women (76.4% versus 58.8%, p-value = 0.009), and they had longer hospital stays after surgery despite similar rates of open vs minimally invasive procedures and lymph node dissection (mean days = 5.4) compared to whites (mean days = 3.5, p-value = 0.036). Wound infection was the most common complication (16.5% in whites and 14.4% in blacks, p-value = 0.888). Blacks were more likely to suffer other complications, but overall the proportions did not differ by race. In univariate analyses, black women had higher risk of endometrial cancer-related death (p-value = 0.090). No racial differences were noted in adjusted survival analyses. Conclusion Amore complete investigation, incorporating socio-demographic factors, is warranted to understand the effects of morbid obesity and race on endometrial cancer.

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“…Many studies have compared different types of hysterectomies. To the best of our knowledge, there have been only three studies comparing TLH to LAVH; one involved benign gynecology and two others uterine cancer (10–12).…”

Section: Discussionmentioning

confidence: 99%

Morbidity with total laparoscopic and laparoscopically assisted vaginal hysterectomy

Al-Talib

Sheizaf

Almog

et al. 2010

Acta Obstet Gynecol Scand

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We evaluated the operative and postoperative morbidity among 103 women who underwent total laparoscopic hysterectomy and 107 others who underwent laparoscopically assisted vaginal hysterectomy. Blood loss was significantly greater in the assisted vaginal hysterectomy group (178.0 ± 12.1 ml) than in the total hysterectomy group (130.2 ± 10.7 ml) (p < 0.001). Despite higher uterine weight in the total hysterectomy group, the operative time of both techniques was similar. The complications of both hysterectomies were also comparable. The results from our study suggest that the complication rates of laparoscopically assisted vaginal hysterectomy and total hysterectomy are similar. However, laparoscopically assisted vaginal hysterectomy is associated with increased blood loss.

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Total Laparoscopic Hysterectomy versus Laparoscopic-Assisted Vaginal Hysterectomy in Endometrial Cancer: Surgical and Survival Outcomes

Cited by 19 publications

References 17 publications

Laparoscopic surgery for endometrial cancer: increasing body mass index does not impact postoperative complications

Laparoscopic surgery for endometrial cancer: increasing body mass index does not impact postoperative complications

Endometrial cancer in morbidly obese women: Do racial disparities affect surgical or survival outcomes?

Morbidity with total laparoscopic and laparoscopically assisted vaginal hysterectomy

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