Primarily Outcome of Laparoscopic Hysterectomy for Early-Stage Malignant Gynecological Cancer of Unselected Cases in Five Years
Affiliation(s)
1 Department of Obstetrics and Gynecology, MCH of Guiyang, Guiyang, China. 2 ICU, 2nd Affiliated Hospital, Guizhou College of Traditional Chinese Medicine, Guiyang, China.
1 Department of Obstetrics and Gynecology, MCH of Guiyang, Guiyang, China. 2 ICU, 2nd Affiliated Hospital, Guizhou College of Traditional Chinese Medicine, Guiyang, China.
ABSTRACT
Objective: To investigate the feasibility and safety of laparoscopic hysterectomy (LH) in early-stage malignant gynecological cancer. Methods: Data from patients who underwent surgical management for early-stage gynecological cancer between 2009 and 2014 were retrospectively reviewed. Each woman gave her informed consent to be included into the study, which was previously approved by the local ethics committee and Institutional Review Board. Inclusion Criteria: All patients presented with stage I or II disease, and underwent comprehensive staging surgery consisting of hysterectomy or radical hysterectomy, with or without bilateral salpingo-oophorectomy, with or without para-aortic lymphadenectomy, with or without omentectomy, and peritoneal cytology. Results: 345 patients who underwent laparoscopic surgery (201 cervical cancer cases, 110 endometrial cancer cases and 34 ovarian cancer cases) were identified. Surgery for none of the patients was converted from laparoscopy to laparotomy. The median patient age for early-stage of gynecological cancer was 48 years (range, 29 - 71 years). 87 (25.22%) of whom were elderly (>60 years); 98 (28.41%) were obese (>30 kg/m2); 164 (62.96%) were postmenopausal; 103 (29.86%) had undergone previous abdominal surgery; 96 (25%) had a history of medical disease. The median operative time and estimated blood loss were 3.5 hours (range, 2.5 - 5.5 hour) and 80 mL (20 - 200 mL), respectively. Intra-operative and postoperative complications occurred in 6 (1.74%) and 34 (9.86%). None of the patients occurred death. The interval to bowel movement and indwelling catheter were 3 days (range, 1 - 5 days) and 7 days (range, 5 - 11 days). The median postoperative hospital stay was 10 days (range, 6 - 18 days). The mean operating time and hospital days for cervical cancer was shorter; the estimated blood loss was lower; and the peri-operative complications were lower in the second stage (July 2012-May 2014) than in the first three years (May 2009-June 2012) in our department (p < 0.05). Conclusion: Based on the data described in our center, laparoscopic surgery seems to be adequate and feasible for the treatment of early-stage gynecological cancer in terms of the surgical outcomes and safety.
Cite this paper
Qin, J. , Song, G. , Wang, J. and Lu, A. (2014) Primarily Outcome of Laparoscopic Hysterectomy for Early-Stage Malignant Gynecological Cancer of Unselected Cases in Five Years. International Journal of Clinical Medicine, 5, 1345-1351. doi: 10.4236/ijcm.2014.521172.
Qin, J. , Song, G. , Wang, J. and Lu, A. (2014) Primarily Outcome of Laparoscopic Hysterectomy for Early-Stage Malignant Gynecological Cancer of Unselected Cases in Five Years. International Journal of Clinical Medicine, 5, 1345-1351. doi: 10.4236/ijcm.2014.521172.
References
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[1] Gowri, V., Koliyadan, S.V., Al Hamdani, A. and Al Kindy, N. (2012) Successful Term Pregnancies after Laparoscopic Excision of Poorly Differentiated Sertoli Leydig Cell Tumor of the Ovary. Journal of Gynecologic Oncology, 23, 201-204. http://dx.doi.org/10.3802/jgo.2012.23.3.201 [2] Koo, Y.J., Kim, J.E., Kim, Y.H., Hahn, H.S., Lee, I.H., Kim, T.J., Lee, K.H., Shim, J.U. and Lim, K.T. (2014) Comparison of Laparoscopy and Laparotomy for the Management of Early-Stage Ovarian Cancer: Surgical and Oncological Outcomes. Journal of Gynecologic Oncology, 25, 111-117. http://dx.doi.org/10.3802/jgo.2014.25.2.111 [3] Yoon, A., Kim, T.J., Lee, W.S., Kim, B.G. and Bae, D.S. (2011) Single-Port Access Laparoscopic Staging Operation for a Borderline Ovarian Tumor. Journal of Gynecologic Oncology, 22, 127-130.
http://dx.doi.org/10.3802/jgo.2011.22.2.127 [4] Nam, J.H., Park, J.Y., Kim, D.Y., Kim, J.H., Kim, Y.M. and Kim, Y.T. (2012) Laparoscopic versus Open Radical Hysterectomy in Early-Stage Cervical Cancer: Long-Term Survival Outcomes in a Matched Cohort Study. Annals of Oncology, 23, 903-911. http://dx.doi.org/10.1093/annonc/mdr360 [5] Nezhat, F.R., Ezzati, M., Chuang, L., Shamshirsaz, A.A., Rahaman, J. and Gretz, H. (2009) Laparoscopic Management of Early Ovarian and Fallopian Tube Cancers: Surgical and Survival Outcome. American Journal of Obstetrics and Gynecology, 200, 1-6. http://dx.doi.org/10.1016/j.ajog.2008.08.013 [6] Nam, J.H., Kim, J.H. and Kim, D.Y. (2004) Comparative Study of Laparoscopico Vaginal Radical Hysterectomy and Abdominal Radical Hysterectomy in Patients with Early Cervical Cancer. Gynecologic Oncology, 92, 277-283.
http://dx.doi.org/10.1016/j.ygyno.2003.09.003 [7] Park, J.Y., Kim, D.Y. and Kim, J.H. (2012) Laparoscopic versus Open Radical Hysterectomy for Elderly Patients with Early-Stage Cervical Cancer. American Journal of Obstetrics and Gynecology, 207, 1-8.
http://dx.doi.org/10.1016/j.ajog.2012.06.081 [8] Park, J.Y., Kim, D.Y. and Kim, J.H. (2012) Laparoscopic Compared with Open Radical Hysterectomy in Obese Women with Early-Stage Cervical Cancer. Gynecologic Oncology, 119, 1201-1209. [9] Eltabbakh, G.H., Shamonki, M.I., Moody, J.M. and Garafano, L.L. (2001) Laparoscopy as the Primary Modality for the Treatment of Women with Endometrial Carcinoma. Cancer, 91, 378-387.
http://dx.doi.org/10.1002/1097-0142(20010115)91:2<378::AID-CNCR1012>3.0.CO;2-F [10] Nezhat, F.R., Ezzati, M., Chuang, L., Shamshirsaz, A.A., Rahaman, J. and Gretz, H. (2009) Laparoscopic Management of Early Ovarian and Fallopian Tube Cancers: Surgical and Survival Outcome. American Journal of Obstetrics and Gynecology, 200, 1-6. http://dx.doi.org/10.1016/j.ajog.2008.08.013 [11] Medeiros, L.R., Rosa, D.D., Bozzetti, M.C., Rosa, M.I., Edelweiss, M.I., Stein, A.T., Zelmanowicz, A., Ethur, A.B. and Zanini, R.R. (2008) Laparoscopy versus Laparotomy for FIGO Stage I Ovarian Cancer. Cochrane Database of Systematic Reviews, 4, Article ID: CD005344. [12] Walker, J.L., Piedmonte, M.R., Spirtos, N.M., Eisenkop, S.M., Schlaerth, J.B., Mannel, R.S., et al. (2012) 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, 30, 695-700.
http://dx.doi.org/10.1200/JCO.2011.38.8645 [13] Koo, Y.J., Kim, J.E., Kim, Y.H., Hahn, H.S., Lee, I.H., Kim, T.J., Lee, K.H., Shim, J.U. and Lim, K.T. (2014) Comparison of Laparoscopy and Laparotomy for the Management of Early-Stage Ovarian Cancer: Surgical and Oncological Outcomes. Journal of Gynecologic Oncology, 25, 111-117. http://dx.doi.org/10.3802/jgo.2014.25.2.111 [14] Einarsson, J.I., Matteson, K.A., Schulkin, J., Chavan, N.R. and Sangi-Haghpeykar, H. (2010) Minimally Invasive Hysterectomies—A Survey on Attitudes and Barriers among Practicing Gynecologists. Journal of Minimally Invasive Gynecology, 17, 167-175. http://dx.doi.org/10.1016/j.jmig.2009.12.017 [15] Park, J.Y. and Nam, J.H. (2014) Laparotomy Conversion Rate of Laparoscopic Radical Hysterectomy for Early-Stage Cervical Cancer in a Consecutive Series without Case Selection. Annals of Surgical Oncology, 21, 3030-3035.
http://dx.doi.org/10.1245/s10434-014-3707-5 [16] Puntambekar, S.P., Palep, R.J., Puntambekar, S.S., Wagh, G.N., Patil, A.M., et al. (2007) Laparoscopic Total Radical Hysterectomy by the Technique: Our Experience of 248 Cases. Journal of Minimally Invasive Gynecology, 14, 682-689. http://dx.doi.org/10.1016/j.jmig.2007.05.007 [17] Pellegrino, A., Signorelli, M., Fruscio, R., Villa, A., Buda, A., Beretta, P., Garbi, A. and Vitobello, D. (2009) Feasibility and Morbidity of Total Laparoscopic Radical Hysterectomy with or without Pelvic Limphadenectomy in Obese Women with Stage I Endometrial Cancer. Archives of Gynecology and Obstetrics, 279, 655-660.
http://dx.doi.org/10.1007/s00404-008-0790-5 [18] Pomel, C., Atallah, D., Le Bouedec, G., Rouzier, R., Morice, P., Castaigne, D. and Dauplat, J. (2003) Laparoscopic Radical Hysterectomy for Invasive Cervical Cancer: 8-Year Experience of a Pilot Study. Gynecologic Oncology, 91, 534-539. http://dx.doi.org/10.1016/j.ygyno.2003.08.035 [19] Hwang, J.H., Yoo, H.J., Joo, J., Kim, S., Lim, M.C., Song, Y.J. and Park, S.Y. (2012) Learning Curve Analysis of Laparoscopic Radical Hysterectomy and Lymph Node Dissection in Early Cervical Cancer. European Journal of Obstetrics and Gynecology and Reproductive Biology, 163, 219-223. http://dx.doi.org/10.1016/j.ejogrb.2012.05.005 [20] Reade, C., Hauspy, J., Schmuck, M.L. and Moens, F. (2011) Characterizing the Learning Curve for Laparoscopic Radical Hysterectomy: Buddy Operating as a Technique for Accelerating Skill Acquisition. International Journal of Gynecological Cancer, 21, 930-935. http://dx.doi.org/10.1097/IGC.0b013e3182157a44 [21] Chong, G.O., Park, N.Y., Hong, D.G., Cho, Y.L., Park, I.S. and Lee, Y.S. (2009) Learning Curve of Laparoscopic Radical Hysterectomy with Pelvic and/or Para-Aortic Lymphadenectomy in the Early and Locally Advanced Cervical Cancer: Comparison of the First 50 and Second 50 Cases. International Journal of Gynecological Cancer, 19, 1459-1464. http://dx.doi.org/10.1111/IGC.0b013e3181b76640