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

Yıl 2019, , 49 - 53, 15.06.2019

Doğan Vatansever , Burak Giray , Yasemin Aboalhasan

https://doi.org/10.16948/zktipb.556016

Öz

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.

Anahtar Kelimeler

endometrial carcinoma, laparoscopy, laparotomy, surgical staging

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

Öz

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.

 

Anahtar Kelimeler

endometrium kanseri, cerrahi evreleme, laparoskopi, laparotomi

Kaynakça

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