Comparison of laparoscopy and laparotomy in endometrial carcinoma

Öz

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.

Anahtar Kelimeler

• Endometrial carcinoma
• laparoscopy
• laparotomy

ENDOMETRİAL KANSER CERRAHİSİNDE LAPAROSKOPİ İLE LAPAROTOMİNİN KARŞILAŞTIRILMASI

Öz

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.

Anahtar Kelimeler

• ENDOMETRİAL KARSİNOM
• LAPAROSKOPİ
• LAPAROTOMİ

Kaynakça

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