Endometriyal Kanser Cerrahisinde Laparoskopiden Laparotomiye Geçiş: Tersiyer Bir Merkezde İntraoperatif Faktörlerin 10 Yıllık Retrospektif Analizi

Öz

Özet Amaç: Minimal invaziv cerrahi (MİC), endometriyal kanserde cerrahi evreleme için standart yaklaşım olup laparotomiye kıyasla daha az kan kaybı, daha düşük perioperatif morbidite ve daha kısa hastanede kalış süresi sağlamaktadır. Bununla birlikte, intraoperatif olarak açık cerrahiye geçiş, MİC’in avantajlarını azaltabilecek ve altta yatan cerrahi ya da hastalığa bağlı zorlukları yansıtan klinik açıdan önemli bir durumdur. Bu çalışmanın amacı, tersiyer bir merkezde konversiyon sıklığını ve intraoperatif ilişkili faktörleri değerlendirmektir. Yöntem: Bu retrospektif kohort çalışmaya, Ocak 2015 – Aralık 2024 tarihleri arasında laparoskopik cerrahi evreleme planlanan, histolojik olarak doğrulanmış 181 endometriyal kanser hastası dahil edildi. Konversiyon, laparoskopiden laparotomiye plansız geçiş olarak tanımlandı. Demografik, klinik ve intraoperatif veriler analiz edildi ve konversiyon ile ilişkili faktörler araştırıldı. Bulgular: Toplam konversiyon oranı %7,2 (n = 13) olarak saptandı ve literatürle uyumlu bulundu. En sık konversiyon nedeni intraoperatif kanama (%30,8) olup bunu ileri evre hastalık veya beklenmeyen metastatik yayılım (%23,1), yoğun adezyonlar gibi teknik zorluklar (%23,1) ve anesteziye bağlı komplikasyonlar (%23,1) izledi. Konversiyon gelişen hastalarda vücut kitle indeksi (VKİ) anlamlı derecede daha yüksek bulundu (p < 0,05). İleri FIGO evresi ve artmış intraoperatif kompleksite de konversiyon ile ilişkili görünmektedir. Sonuç: Laparoskopik cerrahi endometriyal kanser evrelemesinde güvenli ve etkili bir yöntemdir. Konversiyon çoğunlukla kanama, hastalık yaygınlığı ve obezite gibi hasta faktörlerine bağlı intraoperatif zorluklardan kaynaklanmaktadır. Konversiyon, cerrahi başarısızlık olarak değil, hasta güvenliği ve optimal onkolojik sonuçlar için alınan klinik bir karar olarak değerlendirilmelidir.

Anahtar Kelimeler

• Laparotomiye konversiyon
• Endometriyal kanser
• İntraoperatif faktörler
• Laparoskopi

Conversion from Laparoscopy to Laparotomy in Endometrial Cancer Surgery: A 10-Year Retrospective Analysis of Intraoperative Factors in a Tertiary Center

Öz

Conversion from Laparoscopy to Laparotomy in Endometrial Cancer Surgery: A 10-Year Retrospective Analysis of Intraoperative Factors in a Tertiary Center Abstract Background: Minimally invasive surgery (MIS) is the standard approach for surgical staging in endometrial cancer (EC), offering reduced blood loss, lower perioperative morbidity, and shorter hospital stay compared with laparotomy. Despite these advantages, intraoperative conversion to open surgery remains a clinically significant event that may compromise the benefits of MIS and reflect underlying surgical or disease-related challenges. This study aimed to evaluate the incidence and intraoperative factors associated with conversion in a tertiary referral center. Methods: This retrospective cohort study included 181 patients with histologically confirmed EC who underwent planned laparoscopic surgical staging between January 2015 and December 2024. Conversion was defined as any unplanned transition from laparoscopy to laparotomy. Demographic, clinical, and intraoperative variables were analyzed, and factors associated with conversion were explored. Results: The overall conversion rate was 7.2% (n = 13), consistent with previously reported rates in the literature. The leading cause of conversion was intraoperative hemorrhage (30.8%), followed by advanced disease or unexpected metastatic spread (23.1%), technical difficulties including dense adhesions (23.1%), and anesthesia-related complications such as respiratory intolerance (23.1%). Patients requiring conversion had significantly higher body mass index (BMI) values compared with those who completed laparoscopy (p < 0.05). Advanced FIGO stage and increased intraoperative complexity appeared to be associated with conversion. Conclusions: Conversion is primarily driven by intraoperative challenges related to bleeding, disease extent, and patient-specific factors such as obesity. Importantly, conversion should be regarded as a safety-oriented clinical decision aimed at optimizing surgical and oncologic outcomes rather than a surgical failure. Keywords: Conversion to laparotomy, Endometrial cancer, Intraoperative factors, Laparoscopy

Anahtar Kelimeler

• Conversion to laparotomy
• Endometrial cancer
• Intraoperative factors
• Laparoscopy

Kaynakça

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