Comparison of laparoscopy and laparotomy in endometrial carcinoma

Abstract

Aim: Endometrial carcinoma is the most frequent gynecologic malignancy in Turkey, among United States and Europe. Life time risk of a patient to have endometrial carcinoma is 3-4%. Endometrial carcinoma is staged surgically and the mostly preferred surgical method is open surgery. Aim of this study is to compare open surgery and laparoscopic surgery for treatment and surgical staging of endometrial carcinoma. Materials and Method: We included a total number of 57 patients with the diagnosis of endometrial carcinoma, including 29 operated with laparoscopic surgery and 28 cases operated with open surgery. In this study, we compared the groups in terms of age, body mass index, perioperative and postoperative complications, total lymph node number, operation time, length of hospital stay, pre and post-operative hemoglobin values. Results: There were no significant differences between the two groups among demographic and anthropometric measures. Parity was higher among the open surgery arm and this was statistically significant. There were no significant differences between the two groups in terms of operation time, blood loss, pre and post-operative hemoglobin values, intra and post operative complications. Length of hospital stay was significantly shorter in the laparoscopically managed cases than the open surgery arm. However, total number of lymph nodes dissected were significantly higher in the open surgery group. Conclusion: Laparoscopic surgery is a reliable and a feasible surgical technique in cases with the diagnosis of endometrial carcinoma. Shorter stay at hospital seems to be advantageous in terms of quality of life. Despite that, laparoscopy seems to be disadvantageous for cases with high stage, high grade, agressive type disease, becaouse of lower numbers of dissected lymph nodes. Buna karşı daha agresif lenf nodu disseksiyonu gerektiren ileri evre, yüksek grade, agresif tip kanserlerde, daha az lenf nodu çıkarılması dezavantaj olabilir.

Keywords

• Endometrial carcinoma
• laparoscopy
• laparotomy

ENDOMETRİAL KANSER CERRAHİSİNDE LAPAROSKOPİ İLE LAPAROTOMİNİN KARŞILAŞTIRILMASI

Abstract

Amaç: Endometrium kanseri; Türkiye, Amerika ve Avrupa'da kadınlarda en sık görülen jinekolojik malignensidir. Genel olarak kadınlar yaşamları boyunca endomertium kanserine yakalanma riski %3-4’tür. Tedavi ve evrelemesi cerrahi olarak yapılan endometrium kanserinde cerrahi olarak seçilen genel yöntem açık cerrahidir. Çalışma; endometrium kanserinin evreleme ve tedavisinde laparotomi ile laparoskopiyi karşılaştırmayı amaçlamaktadır. Gereç ve Yöntemler: Endometrium kanseri nedeniyle evreleme cerrahisi yapılan 57 hastanın 29’unda cerrahi laparoskopik olarak, 28’inde cerrahi laparotomik olarak gerçekleştirildi. Laparoskopi grubu ile laparotomi grubunun; yaş, vücut kitle indeksi, perioperatif ve postoperatif komplikasyonları, çıkarılan lenf nodu sayıları, operasyon süresi ve hastanede kalış süresi, cerrahiye giriş ve çıkış hemoglobin değerleri karşılaştırıldı. Bulgular: Gruplar, demografik, maternal ve antropometrik açıdan değerlendirildiğinde homojen yapıda oldukları izlendi. Yalnızca laparotomik grupta parite laparoskopik gruba göre istatiksel olarak anlamlı derecede fazlaydı, gravidalar arasında fark yoktu. Operasyon süreleri, tahmini kan kayıpları, preoperatif, postoperatif hemoglobin düzeyleri, intraoperatif, ve postoperatif komplikasyonlar açısından laparoskopi ve laparotomi arasında fark saptanmadı. Laparoskopi grubunda hastanede kalış süresi anlamlı olarak kısa saptandı. Lenf nodu disseksiyonunda çıkarılan lenf bezi sayısı laparotomik cerrahide daha fazlaydı. Sonuç: Laparoskopik cerrahi endometrium kanserinde güvenilir ve uygulanabilir bir cerrahi yöntemidir. Hastanede kalış süresini azaltması, günlük yaşama çabuk dönüş avantajı olarak gözükmektedir. Buna karşı daha agresif lenf nodu disseksiyonu gerektiren ileri evre, yüksek grade, agresif tip kanserlerde, daha az lenf nodu çıkarılması dezavantaj olabilir.

Keywords

• ENDOMETRİAL KARSİNOM
• LAPAROSKOPİ
• LAPAROTOMİ

References

1. Referans1. İrfan ŞENCAN BK. Türkiye Kanser İstatistikleri. Sağlık Bakanlığı, Türkiye Halk Sağlığı Kurumu. 2015.
2. Referans2. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H, et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer. 2013;49(6):1374-403.
3. Referans3. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. International Journal of Cancer. 2015;136(5):E359-E86.
4. Referans4. SEER Cancer Statistics Factsheets: Endometrial Cancer. National Cancer Institute. Bethesda, MD, 2012. Available from: http://seer.cancer.gov/statfacts/html/corp.html.
5. Referans5. Mourits MJ, Bijen CB, Arts HJ, ter Brugge HG, van der Sijde R, Paulsen L, et al. Safety of laparoscopy versus laparotomy in early-stage endometrial cancer: a randomised trial. The lancet oncology. 2010;11(8):763-71.
6. Referans6. Galaal K, Bryant A, Fisher AD, Al‐Khaduri M, Kew F, Lopes AD. Laparoscopy versus laparotomy for the management of early stage endometrial cancer. The Cochrane Library. 2012.
7. Referans7. Holub Z, Jabor A, Bartos P, Eim J, Kliment L. Laparoscopic pelvic lymphadenectomy in the surgical treatment of endometrial cancer: results of a multicenter study. JSLS : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons. 2002;6(2):125-31.
8. Referans8. TIRAŞ MB, DİLEK TUK, ODABAŞI AR, ONAN MA, ÖKTEM M, GÜNER H. Stage 1 Endometrium Kanseri Tedavisinde Laparoskopik Histerektomi ve Laparoskopik Lenf Nodu Örneklemesi: İki Olgu Sunumu. Turkiye Klinikleri Journal of Gynecology and Obstetrics. 2001;11(2):106-9.

9. Referans9. Hilaris GE, Tsoubis T, Konstantopoulos V, Pavlakis K. Feasibility, safety, and cost outcomes of laparoscopic management of early endometrial and cervical malignancy. JSLS: Journal of the Society of Laparoendoscopic Surgeons. 2009;13(4):489.
10. Referans10. Brinton LA, J. Lacey, J.V., and M.E. Sherman Epidemiology of Gynecologic Cancers, in Principles and Practice of Gynecologic Oncology. In: W.J. Hoskins ea, editor. 4th Edition ed: Lippincott Williams & Wilkins: Philadelphia; 2005. p. p. 3-9.
11. Referans11. McMeekin DS, et al. Corpus: Epithelial Tumors, in Principles and Practice of Gynecologic Oncology. In: R.R. Barakat ea, editor. Chapter 23. 5th ed: Lippincott Williams & Wilkins: Baltimore; 2009. p. 683-6.
12. Referans12. Eltabbakh GH, Shamonki MI, Moody JM, Garafano LL. Hysterectomy for obese women with endometrial cancer: laparoscopy or laparotomy? Gynecologic Oncology. 2000;78(3):329-35.
13. Referans13. Helm CW, Arumugam C, Gordinier ME, Metzinger DS, Pan J, Rai SN. Laparoscopic surgery for endometrial cancer: increasing body mass index does not impact postoperative complications. Journal of gynecologic oncology. 2011;22(3):168-76.
14. Referans14. Eltabbakh GH, Donovan EM, Eltabbakh GD. Comparison of surgical outcome and survival for obese women with endometrial cancer following three surgical approaches: Conventional laparoscopy, robotic laparoscopy and laparotomy. Gynecologic Oncology. 2015;136(2):408.
15. Referans15. Wong CK, Wong YH, Lo LS, Tai CM, Ng TK. Laparoscopy compared with laparotomy for the surgical staging of endometrial carcinoma. The journal of obstetrics and gynaecology research. 2005;31(4):286-90.
16. Referans16. Sobiczewski P, Bidzinski M, Derlatka P, Danska-Bidzinska A, Gmyrek J, Panek G. Comparison of the results of surgical treatment using laparoscopy and laparotomy in patients with endometrial cancer. International journal of gynecological cancer : official journal of the International Gynecological Cancer Society. 2005;15(5):946-51.
17. Referans17 Langebrekke A, Istre O, Hallqvist AC, Hartgill TW, Onsrud M. Comparison of Laparoscopy and Laparotomy in Patients with Endometrial Cancer. The Journal of the American Association of Gynecologic Laparoscopists. 2002;9(2):152-7.
18. Referans18. Malzoni M, Tinelli R, Cosentino F, Perone C, Rasile M, Iuzzolino D, et al. Total laparoscopic hysterectomy versus abdominal hysterectomy with lymphadenectomy for early-stage endometrial cancer: a prospective randomized study. Gynecol Oncol. 2009;112(1):126-33.
19. Referans19. Eltabbakh GH. Effect of surgeon's experience on the surgical outcome of laparoscopic surgery for women with endometrial cancer. Gynecol Oncol. 2000;78(1):58-61.
20. Referans20. Palomba S, Falbo A, Mocciaro R, Russo T, Zullo F. Laparoscopic treatment for endometrial cancer: a meta-analysis of randomized controlled trials (RCTs). Gynecol Oncol. 2009;112(2):415-21.
21. Referans21. Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, et al. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2009;27(32):5331-6.
22. Referans22. Mariani A, Dowdy SC, Cliby WA, Gostout BS, Jones MB, Wilson TO, et al. Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecol Oncol. 2008;109(1):11-8.
23. Referans23. Palomba S, Falbo A, Russo T, La Sala GB. Port-site metastasis after laparoscopic surgical staging of endometrial cancer: a systematic review of the published and unpublished data. J Minim Invasive Gynecol. 2012;19(4):531-7.
24. Referans24. Tozzi R, Malur S, Koehler C, Schneider A. Analysis of morbidity in patients with endometrial cancer: is there a commitment to offer laparoscopy? Gynecol Oncol. 2005;97(1):4-9.
25. Referans25. Sonoda Y, Zerbe M, Smith A, Lin O, Barakat RR, Hoskins WJ. High incidence of positive peritoneal cytology in low-risk endometrial cancer treated by laparoscopically assisted vaginal hysterectomy. Gynecol Oncol. 2001;80(3):378-82.