Total laparoscopic hysterectomy versus total abdominal hysterectomy for obese women with endometrial cancer

Abstract

Obesity is common in endometrial cancer and surgery for these patients is challenging. We compared total laparoscopic hysterectomy (TLH) with total abdominal hysterectomy (TAH) with respect to feasibility (operating time, estimated blood loss, length of hospital stay, and conversion to laparotomy) and safety (perioperative morbidity and mortality) in a retrospective analysis of 78 morbidly obese patients with endometrial cancer. Analysis is based on the intention to treat. The intention to treat was TLH in 47 patients and it could be successfully completed in 42 patients (89.4%). The mean weight for all patients was 118.7 kg, with patients in the TLH group weighing more and having higher ASA scores. Mean operating time and estimated blood loss were similar in both groups. Mean postoperative hospital stay was 4.4 (+/-3.9) days in the TLH group and 7.9 (+/-3.0) days in the TAH group (P < 0.0001). Wound infections occurred in 15 of 31 patients (48.4%) in the TAH group and in 1 of 47 patients (2.1%) in the TLH group. All other morbidity, as well as patterns of recurrence and survival were similar in both groups. These data justify a prospective randomized trial comparing TLH with TAH for the treatment of endometrial cancer.

Feasibility and Safety of Laparoscopic Surgery for Obese Korean Women with Endometrial Cancer: Long-Term Results at a Single Institution

“…The rate of conversion to laparotomy in laparoscopic surgery was 1.04% to 10.6% in previous studies (18,19,27,37). In contrast, Walker et al (36) and Scribner et al (38) reported the conversion rate in their studies as 25.8% and 36.4%, respectively.…”

“…In contrast, Farthing et al (19) performed lymphadenectomy in 3.1% of all of their patients. Eltabbakh et al performed pelvic lymphadenectomy in 77.5% of their patients and para-aortic lymphadenectomy in 17.5% of the patients in his earlier study, and with 75.7% for pelvic and 21.1% for para-aortic lymphadenectomy in his later study, while Obermair et al performed lymphadenectomy in 67.8% of their patients (18,27,37). In our study, 98.8% and 95.7%, respectively, underwent lymphadenectomy, and 26.8% and 31.4% underwent para-aortic lymphadenectomy in the overweight group and the obese group.…”

Laparoscopy in the treatment of cancer of the corpus uteri in patients with metabolic syndrome. A case report

“…Данные литературы свидетельствуют, что лапароскопия выполнима у 88-97 % больных [1][2][3]. У пациентов с ожирением выше частота конверсии, которая составляет 7,5-36 % и возрастает по мере ро-ста ИМТ [2,3].…”

Laparoscopy in Gynecology - How Why When

“…Laparoscopic approach is a longer operation but involves less blood loss, a shorter hospitalization, and fewer intraoperative and postoperative complications. [21][22][23] Cervical cancer Early cervical cancers are treated surgically, by radical abdominal hysterectomy and pelvic lymphadenectomy (RAH). The main difference between RAH and TAH is that during RAH, lymphatic tissue is removed lateral to the uterus.…”