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Perioperative and postoperative outcomes of laparoscopy and open method for surgical staging of endometrial cancer

Year 2019, Volume: 50 Issue: 2, 49 - 53, 15.06.2019
https://doi.org/10.16948/zktipb.556016

Abstract

Objective: The aim of the
study was to compare the safety of the laparoscopic and open method for
endometrial cancer staging.

Methods: Between January
2015 and August 2017, we reviewed 121 women with endometrial cancer treated by
open (n=81) or laparoscopic (n=40) approach, retrospectively. Two groups
were compared in terms of operating times, intraoperative and postoperative
complications, perioperative and postoperative
features
such as
hemoglobin values, the lengths of hospital
stay, and adjuvant therapy.
All of the patients underwent a hysterectomy
and bilateral salpingo-oophorectomy; and when indicated, omentectomy and lymphadenectomy
were performed.

Results: There were no
significant differences between the two groups with regard to the number of parities,
body mass index, menopausal status, age, the American Society of
Anesthesiologists (
ASA) scores,
the requirement of lymphadenectomy, and hospital stay. There were significant
statistical differences between groups in terms of operation time and
difference of hemoglobin (p<0.001, p=0.013; respectively). Laparoscopic surgery
had a longer operative time than laparotomy, and difference of hemoglobin in
the laparotomy group is more than the laparoscopy group. Patients who underwent
staging with laparotomy had bowel injury (1.2%), wound infection (13.6%), and
postop ileus (8.6%) while in the laparoscopy group patients had wound infection
(2.5%) and postop ileus (5%). There were no statistically significant
differences between the two groups in terms of the intraoperative (p=1) and
postoperative complications (p=0.101 for wound infection, p=0.716 for postop
ileus). The groups were similar in terms of the histological grade, FIGO stage,
histologic subtype, the rate of lymphovascular invasion, the depth of
myometrial invasion, the total number of lymph nodes resected in lymph node
dissections, the rate of lymph node metastasis, the location of the tumor,
cervical stromal invasion, and the adjuvant therapy such as chemotherapy and
brachytherapy.
None of the patients
in both groups had a recurrence and long-term lymphatic complication such as
lymphocyst, lymphedema.

























Conclusion: Our
current data demonstrated that the laparoscopic approach can be performed
without loss of safety with similar complication rates in patients with
endometrium cancer. Additionally, the laparoscopy was not inferior to the laparotomy
in terms of efficacy.

References

  • 1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. International journal of cancer. 2010;127(12):2893-917.
  • 2. Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, et al. Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group LAP2 Study. Journal of Clinical Oncology. 2012;30(7):695.
  • 3. Kornblith AB, Huang HQ, Walker JL, Spirtos NM, Rotmensch J, Cella D. Quality of life of patients with endometrial cancer undergoing laparoscopic international federation of gynecology and obstetrics staging compared with laparotomy: a Gynecologic Oncology Group study. Journal of Clinical Oncology. 2009;27(32):5337.
  • 4. Galaal K, Bryant A, Fisher AD, Al‐Khaduri M, Kew F, Lopes AD. Laparoscopy versus laparotomy for the management of early stage endometrial cancer. Cochrane Database of Systematic Reviews. 2012(9).
  • 5. Tozzi R, Malur S, Koehler C, Schneider A. Laparoscopy versus laparotomy in endometrial cancer: first analysis of survival of a randomized prospective study. Journal of minimally invasive gynecology. 2005;12(2):130-6.
  • 6. 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. Gynecologic Oncology. 2009;112(1):126-33.
  • 7. 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.
  • 8. Janda M, Gebski V, Brand A, Hogg R, Jobling TW, Land R, et al. Quality of life after total laparoscopic hysterectomy versus total abdominal hysterectomy for stage I endometrial cancer (LACE): a randomised trial. The lancet oncology. 2010;11(8):772-80.
  • 9. Chu L-H, Chang W-C, Sheu B-C. Comparison of the laparoscopic versus conventional open method for surgical staging of endometrial carcinoma. Taiwanese Journal of Obstetrics and Gynecology. 2016;55(2):188-92.
  • 10. Obermair A, Manolitsas TP, Leung Y, Hammond IG, McCartney AJ. Total laparoscopic hysterectomy for endometrial cancer: patterns of recurrence and survival. Gynecologic oncology. 2004;92(3):789-93.
  • 11. Boosz A, Haeberle L, Renner SP, Thiel FC, Mehlhorn G, Beckmann MW, et al. Comparison of reoperation rates, perioperative outcomes in women with endometrial cancer when the standard of care shifts from open surgery to laparoscopy. Archives of gynecology and obstetrics. 2014;290(6):1215-20.
  • 12. Juhasz-Böss I, Haggag H, Baum S, Kerl S, Rody A, Solomayer E. Laparoscopic and laparotomic approaches for endometrial cancer treatment: a comprehensive review. Archives of gynecology and obstetrics. 2012;286(1):167-72.
  • 13. Lu Q, Liu H, Liu C, Wang S, Li S, Guo S, et al. Comparison of laparoscopy and laparotomy for management of endometrial carcinoma: a prospective randomized study with 11-year experience. Journal of cancer research and clinical oncology. 2013;139(11):1853-9.
  • 14. Terai Y, Tanaka T, Sasaki H, Kawaguchi H, Fujiwara S, Yoo S, et al. Total laparoscopic modified radical hysterectomy with lymphadenectomy for endometrial cancer compared with laparotomy. Journal of Obstetrics and Gynaecology Research. 2014;40(2):570-5.
  • 15. Lutman CV, Havrilesky LJ, Cragun JM, Secord AA, Calingaert B, Berchuck A, et al. Pelvic lymph node count is an important prognostic variable for FIGO stage I and II endometrial carcinoma with high-risk histology. Gynecologic oncology. 2006;102(1):92-7.
  • 16. Lim PC, Kang E, Park DH. A comparative detail analysis of the learning curve and surgical outcome for robotic hysterectomy with lymphadenectomy versus laparoscopic hysterectomy with lymphadenectomy in treatment of endometrial cancer: a case-matched controlled study of the first one hundred twenty two patients. Gynecologic Oncology. 2011;120(3):413-8.
  • 17. Santi A, Kuhn A, Gyr T, Eberhard M, Johann S, Günthert AR, et al. Laparoscopy or laparotomy? A comparison of 240 patients with early-stage endometrial cancer. Surgical endoscopy. 2010;24(4):939-43.
  • 18. Scholz HS, Petru E, Benedicic C, Haas J, Tamussino K, Winter R. Fibrin application for preventing lymphocysts after retroperitonal lymphadenectomy in patients with gynecologic malignancies. Gynecologic oncology. 2002;84(1):43-6.
  • 19. Gallotta V, Fanfani F, Rossitto C, Vizzielli G, Testa A, Scambia G, et al. A randomized study comparing the use of the Ligaclip with bipolar energy to prevent lymphocele during laparoscopic pelvic lymphadenectomy for gynecologic cancer. American journal of obstetrics and gynecology. 2010;203(5):483. e1-. e6.
  • 20. Eisenkop SM. Total laparoscopic hysterectomy with pelvic/aortic lymph node dissection for endometrial cancer—a consecutive series without case selection and comparison to laparotomy. Gynecologic oncology. 2010;117(2):216-23.
  • 21. Muntz HG, Goff BA, Madsen BL, Yon JL. Port-site recurrence after laparoscopic surgery for endometrial carcinoma. Obstetrics & Gynecology. 1999;93(5):807-9.
  • 22. Fanning J, Hossler C. Laparoscopic conversion rate for uterine cancer surgical staging. Obstetrics & Gynecology. 2010;116(6):1354-7.
  • 23. 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. 2009;27(32):5331.
  • 24. Palomba S, Falbo A, Mocciaro R, Russo T, Zullo F. Laparoscopic treatment for endometrial cancer: a meta-analysis of randomized controlled trials (RCTs). Gynecologic oncology. 2009;112(2):415-21.

Endometrium kanseri evrelemesinde laparoskopik yöntem ile laparotomik yöntemin perioperatif ve postoperatif karşılaştırılması

Year 2019, Volume: 50 Issue: 2, 49 - 53, 15.06.2019
https://doi.org/10.16948/zktipb.556016

Abstract

Amaç: Endometrium kanserinin
evreleme cerrahisinde laparoskopik yaklaşımın güvenirliğini laparotomi ile
karşılaştırmak.

Metod: Ocak 2015 ile Ağustos 2017
tarihleri arasında laparoskopik (n=40) ve laparotomik (n=81) yöntemle tedavi
edilen 121 endometrium kanserli hastanın bilgileri geriye dönük olarak
değerlendirildi. İki grup operasyon süreleri, intraoperatif ve postoperatif
komplikasyonlar, hemoglobin değerleri, hastanede kalış süreleri ve postoperatif
ek tedavi gibi preoperatif ve postoperatif özellikleri açısından
karşılaştırıldı. Bütün hastalara histerektomi ve bilateral salpingo-ooferektomi
uygulandı ve gereklilik halinde lenf nodu diseksiyonu ve omentektomi yapıldı.

Bulgular: Gruplar yaş,
doğum sayısı, vücut kütle indeksi, menopozal durum, ASA (
the American Society of Anesthesiologists) skoru, lenfadenektomi
gerekliliği ve hastanede kalış süreleri açısından benzerdi. Preoperatif ve
postoperatif hemoglobin değişim değerleri (p=0.013) ve operasyon süreleri
(p<0.001)
  arasında istatistiksel
olarak anlamlı fark vardı. Laparoskopi yapılan gruptaki hastaların operasyon
süreleri daha fazla bulunurken, hemoglobin değişim değerleri daha az bulundu.
Laparotomi yapılan grupta barsak hasarı (%1,2), yara yeri infeksiyonu (%13,6)
ve postop ileus (%8,6) gelişirken, laparoskopi yapılan grupta yara yeri
infeksiyonu (%2,5) ve postop ileus (%5) gelişti. Gruplar arasında intraoperatif
(p=1) ve postoperatif komplikasyonlar açısından (yara yeri infeksiyonu için
p=0.101; postop ileus için p=0.716) anlamlı fark yoktu. Gruplar histolojik
grade, FIGO evresi, histolojik alt tip, lenfovasküler alan invazyon oranları,
myometrial invazyon, çıkarılan lenf nodu miktarı, nodal metastaz oranları,
tümör yerleşimi, servikal stromal invazyon ve kemoterapi ya da radyoterapi gibi
ek tedavi uygulanmaları açısından benzerdi. Hiçbir hastada lenfokist ya da
lenfödem gibi uzun dönem komplikasyonlar ve rekkürens gelişmedi.

Sonuç: Çalışmamız
laparoskopik yaklaşımın endometrium kanserli hastaların evrelemesinde
laparotomiye benzer komplikasyon oranlarıyla güvenli bir şekilde

uygulanabileceğini gösterdi. Ayrıca laparoskopi endometrium kanserinin
evrelemesinde ve tedavisinde laparotomi kadar etkin bulunmuştur.





 

References

  • 1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. International journal of cancer. 2010;127(12):2893-917.
  • 2. Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, et al. Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group LAP2 Study. Journal of Clinical Oncology. 2012;30(7):695.
  • 3. Kornblith AB, Huang HQ, Walker JL, Spirtos NM, Rotmensch J, Cella D. Quality of life of patients with endometrial cancer undergoing laparoscopic international federation of gynecology and obstetrics staging compared with laparotomy: a Gynecologic Oncology Group study. Journal of Clinical Oncology. 2009;27(32):5337.
  • 4. Galaal K, Bryant A, Fisher AD, Al‐Khaduri M, Kew F, Lopes AD. Laparoscopy versus laparotomy for the management of early stage endometrial cancer. Cochrane Database of Systematic Reviews. 2012(9).
  • 5. Tozzi R, Malur S, Koehler C, Schneider A. Laparoscopy versus laparotomy in endometrial cancer: first analysis of survival of a randomized prospective study. Journal of minimally invasive gynecology. 2005;12(2):130-6.
  • 6. 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. Gynecologic Oncology. 2009;112(1):126-33.
  • 7. 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.
  • 8. Janda M, Gebski V, Brand A, Hogg R, Jobling TW, Land R, et al. Quality of life after total laparoscopic hysterectomy versus total abdominal hysterectomy for stage I endometrial cancer (LACE): a randomised trial. The lancet oncology. 2010;11(8):772-80.
  • 9. Chu L-H, Chang W-C, Sheu B-C. Comparison of the laparoscopic versus conventional open method for surgical staging of endometrial carcinoma. Taiwanese Journal of Obstetrics and Gynecology. 2016;55(2):188-92.
  • 10. Obermair A, Manolitsas TP, Leung Y, Hammond IG, McCartney AJ. Total laparoscopic hysterectomy for endometrial cancer: patterns of recurrence and survival. Gynecologic oncology. 2004;92(3):789-93.
  • 11. Boosz A, Haeberle L, Renner SP, Thiel FC, Mehlhorn G, Beckmann MW, et al. Comparison of reoperation rates, perioperative outcomes in women with endometrial cancer when the standard of care shifts from open surgery to laparoscopy. Archives of gynecology and obstetrics. 2014;290(6):1215-20.
  • 12. Juhasz-Böss I, Haggag H, Baum S, Kerl S, Rody A, Solomayer E. Laparoscopic and laparotomic approaches for endometrial cancer treatment: a comprehensive review. Archives of gynecology and obstetrics. 2012;286(1):167-72.
  • 13. Lu Q, Liu H, Liu C, Wang S, Li S, Guo S, et al. Comparison of laparoscopy and laparotomy for management of endometrial carcinoma: a prospective randomized study with 11-year experience. Journal of cancer research and clinical oncology. 2013;139(11):1853-9.
  • 14. Terai Y, Tanaka T, Sasaki H, Kawaguchi H, Fujiwara S, Yoo S, et al. Total laparoscopic modified radical hysterectomy with lymphadenectomy for endometrial cancer compared with laparotomy. Journal of Obstetrics and Gynaecology Research. 2014;40(2):570-5.
  • 15. Lutman CV, Havrilesky LJ, Cragun JM, Secord AA, Calingaert B, Berchuck A, et al. Pelvic lymph node count is an important prognostic variable for FIGO stage I and II endometrial carcinoma with high-risk histology. Gynecologic oncology. 2006;102(1):92-7.
  • 16. Lim PC, Kang E, Park DH. A comparative detail analysis of the learning curve and surgical outcome for robotic hysterectomy with lymphadenectomy versus laparoscopic hysterectomy with lymphadenectomy in treatment of endometrial cancer: a case-matched controlled study of the first one hundred twenty two patients. Gynecologic Oncology. 2011;120(3):413-8.
  • 17. Santi A, Kuhn A, Gyr T, Eberhard M, Johann S, Günthert AR, et al. Laparoscopy or laparotomy? A comparison of 240 patients with early-stage endometrial cancer. Surgical endoscopy. 2010;24(4):939-43.
  • 18. Scholz HS, Petru E, Benedicic C, Haas J, Tamussino K, Winter R. Fibrin application for preventing lymphocysts after retroperitonal lymphadenectomy in patients with gynecologic malignancies. Gynecologic oncology. 2002;84(1):43-6.
  • 19. Gallotta V, Fanfani F, Rossitto C, Vizzielli G, Testa A, Scambia G, et al. A randomized study comparing the use of the Ligaclip with bipolar energy to prevent lymphocele during laparoscopic pelvic lymphadenectomy for gynecologic cancer. American journal of obstetrics and gynecology. 2010;203(5):483. e1-. e6.
  • 20. Eisenkop SM. Total laparoscopic hysterectomy with pelvic/aortic lymph node dissection for endometrial cancer—a consecutive series without case selection and comparison to laparotomy. Gynecologic oncology. 2010;117(2):216-23.
  • 21. Muntz HG, Goff BA, Madsen BL, Yon JL. Port-site recurrence after laparoscopic surgery for endometrial carcinoma. Obstetrics & Gynecology. 1999;93(5):807-9.
  • 22. Fanning J, Hossler C. Laparoscopic conversion rate for uterine cancer surgical staging. Obstetrics & Gynecology. 2010;116(6):1354-7.
  • 23. 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. 2009;27(32):5331.
  • 24. Palomba S, Falbo A, Mocciaro R, Russo T, Zullo F. Laparoscopic treatment for endometrial cancer: a meta-analysis of randomized controlled trials (RCTs). Gynecologic oncology. 2009;112(2):415-21.
There are 24 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Research
Authors

Doğan Vatansever

Burak Giray 0000-0002-3832-6634

Yasemin Aboalhasan This is me 0000-0002-6231-9223

Publication Date June 15, 2019
Published in Issue Year 2019 Volume: 50 Issue: 2

Cite

APA Vatansever, D., Giray, B., & Aboalhasan, Y. (2019). Perioperative and postoperative outcomes of laparoscopy and open method for surgical staging of endometrial cancer. Zeynep Kamil Tıp Bülteni, 50(2), 49-53. https://doi.org/10.16948/zktipb.556016
AMA Vatansever D, Giray B, Aboalhasan Y. Perioperative and postoperative outcomes of laparoscopy and open method for surgical staging of endometrial cancer. Zeynep Kamil Tıp Bülteni. June 2019;50(2):49-53. doi:10.16948/zktipb.556016
Chicago Vatansever, Doğan, Burak Giray, and Yasemin Aboalhasan. “Perioperative and Postoperative Outcomes of Laparoscopy and Open Method for Surgical Staging of Endometrial Cancer”. Zeynep Kamil Tıp Bülteni 50, no. 2 (June 2019): 49-53. https://doi.org/10.16948/zktipb.556016.
EndNote Vatansever D, Giray B, Aboalhasan Y (June 1, 2019) Perioperative and postoperative outcomes of laparoscopy and open method for surgical staging of endometrial cancer. Zeynep Kamil Tıp Bülteni 50 2 49–53.
IEEE D. Vatansever, B. Giray, and Y. Aboalhasan, “Perioperative and postoperative outcomes of laparoscopy and open method for surgical staging of endometrial cancer”, Zeynep Kamil Tıp Bülteni, vol. 50, no. 2, pp. 49–53, 2019, doi: 10.16948/zktipb.556016.
ISNAD Vatansever, Doğan et al. “Perioperative and Postoperative Outcomes of Laparoscopy and Open Method for Surgical Staging of Endometrial Cancer”. Zeynep Kamil Tıp Bülteni 50/2 (June 2019), 49-53. https://doi.org/10.16948/zktipb.556016.
JAMA Vatansever D, Giray B, Aboalhasan Y. Perioperative and postoperative outcomes of laparoscopy and open method for surgical staging of endometrial cancer. Zeynep Kamil Tıp Bülteni. 2019;50:49–53.
MLA Vatansever, Doğan et al. “Perioperative and Postoperative Outcomes of Laparoscopy and Open Method for Surgical Staging of Endometrial Cancer”. Zeynep Kamil Tıp Bülteni, vol. 50, no. 2, 2019, pp. 49-53, doi:10.16948/zktipb.556016.
Vancouver Vatansever D, Giray B, Aboalhasan Y. Perioperative and postoperative outcomes of laparoscopy and open method for surgical staging of endometrial cancer. Zeynep Kamil Tıp Bülteni. 2019;50(2):49-53.