OJOG  Vol.3 No.4 , June 2013
Laparoscopic versus laparotomy approach to endometrial cancer: A prospective study

Objective: The aim of this study was to compare laparoscopic (LPS) and laparotomy (LPT) approaches for endometrial cancer, and to assess intraoperative and postoperative results, disease-free survival and overall survival. Methods: We designed a prospective observational study, every patient diagnosed of endometrial cancer and subsidiary to surgical staging was included. Total hysterectomy, bilateral adnexectomy, pelvic lymphadenectomy were performed in every case. Paraaortic lymphadenectomy was performed depending on tumor histology. Results: 70 patients with endometrial cancer were enrolled, 49 (70%) were treated laparoscopically and 21 (30%) laparotomically. There was not statistical significant difference in the mean operative time, it was 183.06 ± 21.03 min (range 120 - 230) in the LPS group and 195.24 ± 28.39 min (range 130 - 240) in the LPT group, mean difference 12.16 (95% CI 0.2 - 24). There was no difference in the number of lymph nodes resected. Mean blood loss was lower in the LPS group. There were less postoperative complications, 3 (6.12%) in the LPS group and 7 (33.3%) in the LPT group (p < 0.01). Mean hospital stay was significantly shorter in the LPS group 4.29 ± 1.62 days vs 8.81 ± 3.37 days in the LPT group (p < 0.01), mean difference 4.52 (95% CI 3.3 - 5.7). Overall survival was similar in both groups. Conclusion: Laparoscopic approach for endometrial cancer offers similar results in terms of survival and oncological radicality as the laparotomic approach and a lower rate of complications, a quicker convalescence time and a shorter hospital stay.

Cite this paper
López-De la Manzanara C, Martín-Francisco C, Luengo-Tabernero A, Garrido-Esteban RA, León-Martín A , Haya-Palazuelos J. (2013) Laparoscopic versus laparotomy approach to endometrial cancer: A prospective study. Open Journal of Obstetrics and Gynecology, 3, 422-426. doi: 10.4236/ojog.2013.34077.
[1]   Siegel, R., Naishadham, D. and Jemal, A. (2012) Cancer statistics, 2012. CA: A Cancer Journal for Clinicians, 62, 10-29. doi:10.3322/caac.20138

[2]   Van den Bosch, T., Coosemans, A., Morina, M., et al. (2012) Screening for uterine tumours. Best Practice & Research Clinical Obstetrics & Gynaecology, 26, 257-266. doi:10.1016/j.bpo bgyn.2011.08.002

[3]   Creasman, W.T., Odicino, F., Maisonneuve, P., et al. (2006) Carcinoma of the corpus uteri. FIGO 26th annual report on the results of treatment in gynecological cancer. International Journal of Gynecology & Obstetrics, 95, S105-S143. doi:10.1016/S0020-7292(06)60031-3

[4]   Kornblith, A.B., Huang, H.Q., Walker, J.L., et al. (2009) 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, 27, 5337-5342. doi:10.1200/JCO.2009.22.3529

[5]   Janda, M., Gebski, V., Brand, A., et al. (2010) Quality of life after total laparoscopic hysterectomy versus total abdominal hysterectomy for stage I endometrial cancer (LACE): A randomised trial. The Lancet Oncology, 11, 772-780. doi:10.1016/S1470-2045(10)70145-5

[6]   Mourits, M.J., Bijen, C.B., Art, H.J., et al. (2010) Safety of laparoscopy versus laparotomy in early-stage endometrial cancer: A randomised trial. The Lancet Oncology, 11, 763-771. doi:10.1016/S1470-2045(10)70143-1

[7]   Walker, J.L., Piedmonte, M.R., Spirtos, N.M., et al. (2009) Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic oncology group study LAP2. Journal of Clinical Oncology, 27, 5331-5336. doi:10.1200/JCO.2009.22.3248

[8]   Carter, J.R. (2011) Laparoscopy or laparotomy for endometrial cancer? A review of three prospective randomised trials. Australian and New Zealand Journal of Obstetrics and Gynaecology, 51, 387-392. doi:10.1111/j.1479-828X.2011.01306.x

[9]   Zullo, F., Falbo, A. and Palomba, S. (2012) Safety of laparoscopy vs laparotomy in the surgical staging of endometrial cancer: A systematic review and metaanalysis of randomized controlled trials. American Journal of Obstetrics and Gynaecology, 13, 94-100. doi:10.1016/j.ajog.2012.01.010

[10]   Pecorelli, S. (2009) Revised FIGO staging for carcinoma of de vulva, cervix and endometrium. International Journal of Obstetrics and Gynaecology, 105, 103-104. doi:10.1016/j.ijgo.2009.02.012

[11]   Palomba, S., Falbo, A., Mocciaro, R., et al. (2009) Laparoscopic treatment for endometrial cancer: A meta-analysis of randomized controlled trials (RCTs). Gynecologic Oncology, 112, 415-421. doi:10.1016/j.ygyno.2008.09.014

[12]   Malzoni, M., Tinelli, R., Cosentino, F., et al. (2009) Total laparoscopic hysterectomy versus abdominal hysterictomy with lymphadenectomy for early-stage endometrial cancer: A prospective randomized study. Gynecologic Oncology, 112, 126-133. doi:10.1016/j.ygyno.2008.08.019

[13]   Coronado, P.J., Herraiz, M.A., Magrina, J.F., et al. (2012) Comparison of perioperative outcomes and cost of robotic-assisted laparoscopy, laparoscopy and laparotomy for endometrial cancer. European Journal of Obstetrics & Gynecology and Reproductive Biology, 165, 289-294. doi:10.1016/j.ejo grb.2012.07.006

[14]   Fram, K.M. (2002) Laparoscopically assisted vaginal hysterectomy versus abdominal hysterectomyin stage I endometrial cancer. International Journal of Gynecological Cancer, 12, 57-61. doi:10.1046/j.1525-1438.2002.01038.x

[15]   Zorlu, C.G., Simsek, T. and Ari, E.S. (2005) Laparoscopy or laparotomy for the management of endometrial cancer. Journal of the Society of Laparoendoscopic Surgeons, 9, 442-446.

[16]   Tozzi, R., Malur, S., Koehler, C., et al. (2005) Laparoscopy versus laparotomy in endometrial cancer: First analysis of survival of a randomized prospective study. Journal of Minimally Invasive Gynecology, 12, 130-136. doi:10.1016/j.jmig.2005.01.021

[17]   Zullo, F., Palomba, S., Russo, T., et al. (2005) A prospective randomized comparison between laparoscopic and laparotomic approaches in women with early stage endometrial cancer: A focus on the quality of life. American Journal of Obstetrics & Gynecology, 193, 1344-1352. doi:10.1016/j.aj og.2005.02.131

[18]   Zhang, H., Cui, J., Jia, L., et al. (2012) Comparison of laparoscopy and laparotomy for endometrial cancer. International Journal of Obstetrics & Gynecology, 116, 185-191. doi:10.1016/j.ij go.2011.10.022

[19]   Malur, S., Possover, M., Michels, W., et al. (2001) Laparoscopic-assisted vaginal versus abdominal surgery in patients with endometrial cancer a prospective randomized trial. Obstetrics & Gynecology, 80, 239-244. doi:10.1006/gyno.2000.6069

[20]   Pignotti, E., De Aloysio, D. and De Iaco, P. (2005) Is total laparoscopic surgery for endometrial carcinoma at risk of local recurrence? A long-term survival. Anticancer Research, 25, 2423-2428.

[21]   Fader, A., Seamon, L., Escobar, P., et al. (2012) Minimally invasive surgery versus laparotomy in women with high grade endometrial cancer: A multi-site study performed at high volume cancer centers. Obstetrics & Gynecology, 126, 180-185. doi:10.1016/j.ygyno.2012.04.028

[22]   Reed, B.G., Lowery, W.J., Keyser, E.A., et al. (2011) Surgically managed stage I endometrial cancer in a lowvolume center: Outcomes and complications in a military residency program. American Journal of Obstetrics & Gynecology, 205, e1-e5.

[23]   Diaz-Montes, T.P., Zahurak, M.L., Giuntoli, R.L., et al. (2007) Concentration of uterine cancer surgical care among the elderly: A population-based perspective. Gynecologic Oncology, 107, 436-440. doi:10.1016/j.ygyno.2007.07.060