Laparoscopia frente a laparotomía para el tratamiento quirúrgico del cáncer de endometrio

Objective

To compare overall survival and disease-specific survival for endometrial cancer with the laparoscopic and laparotomy approaches.

Subjects and methods

We performed a retrospective cohort study that included 235 patients with a diagnosis of endometrial carcinoma who were surgically treated between 2001 and 2010 either by the laparoscopic approach (104 patients) or by laparotomy (131 patients) in our hospital.

Results

Overall survival, disease-specific survival and the disease-free interval were similar in the two groups. In the laparoscopic group, disease-free survival was 85.5% and survival was 80.2%, while in the laparotomy group, disease-free survival was 77.9% and survival was 82.3%, with no statistically significant differences. In the laparoscopy group, operating time was longer and hospital stay was shorter. Except for organ injury, surgical and postoperative complications were similar.

Conclusions

There were no differences in survival or the disease-free interval between the laparoscopy and laparotomy groups. Considering the risks of surgery, laparoscopy is a good alternative to traditional surgery.     

Clinical outcome and complications of laparoscopic surgery compared with traditional surgery in women with endometrial cancer

Introduction The purpose of this study was to evaluate the feasibility, clinical outcome and complications of laparoscopic surgery in women with endometrial cancer and to compare surgical outcome and postoperative early and late complications with results of traditional laparotomy. Methods Forty women with endometrial cancer underwent laparoscopic hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy. Each patient operated by laparoscopy was matched by age, preoperative clinical stage and histology of the endometrial cancer with a patient treated by the same operation but using traditional laparotomy. Half of these patients underwent total pelvic lymphadenectomy and half had pelvic lymph node sampling. The groups were compared in clinical characteristics, surgical outcomes, recoveries and early and late postoperative complications. Results The patients in the laparoscopy group had less blood loss, more lymph nodes removed, shorter hospital stay but longer operation time than those treated by laparotomy. Only one (2.5%) laparoscopy was converted to laparotomy due to pelvic adhesions. There were no intraoperative complications in either group. Postoperative complications were more common (55.0%) in the laparotomy than in the laparoscopy group (37.5%). Only one major complication (2.5%) occurred among patients undergoing laparoscopy as compared with three (7.5%) major complications in the laparotomy group. Superficial wound infection was the most common (20%) infection in laparotomy patients while vaginal cuff cellulitis occurred in 10% of laparoscopy patients. Late (>42 days) postoperative complications were almost equally frequent (20.0 and 22.5%) in both groups. Lower extremity lymph edema or pelvic lymph cyst was found in 12.5% of all cases. As a result of surgical staging the disease of 6 women (15%) in both groups was upgraded. Conclusions Laparoscopic surgery is a viable alternative to traditional surgery in the management of endometrial cancer. The surgical outcome is similar in both cases. In laparoscopic procedures the operation time is longer but the postoperative recovery time shorter than in laparotomy. Severe complications were limited in both groups, while wound infections can be avoided using laparoscopy.     

腹腔镜手术与开腹手术治疗早期子宫内膜癌的临床对比分析

目的　探讨腹腔镜用于早期子宫内膜癌手术治疗的可行性。方法　回顾性分析 1998年 1月至 2 0 0 3年 8月间用腹腔镜完成手术治疗的子宫内膜癌患者 2 4例作为研究组 ,随机选择同期经过开腹手术治疗的患者 41例作为对照组 ,对两组围手术期的情况和生存情况决定是否进行比较。结果　两组患者术前情况 ,如体重、病情严重程度、病理分化程度和肌层浸润深度比较 ,差异均无显著性 (P >0 0 5)。研究组平均手术时间 97min ,对照组为 13 4min ,差异有极显著性 (P <0 0 0 1) ;平均手术出血量分别为 163和 2 59ml,差异无显著性 (P =0 0 59) ;平均切除盆腔淋巴结数量分别为 13 6和19 6个 ,差异无显著性 (P >0 0 5) ;术后并发症发生率分别是 12 %和 2 4% ,差异有显著性 (P <0 0 5) ;术后平均住院天数分别为 6 3和 9 6d ,差异有极显著性 (P <0 0 0 1)。两组病理类型和手术病理分期比较 ,差异无显著性 (P >0 0 5) ;术后放疗、化疗和生物治疗等辅助治疗比较 ,差异无显著性(P >0 0 5) ;剔除失访病例后 ,两组生存率分别为 10 0 %和 97% ,差异无显著性 (P >0 0 5)。结论　小样本量的临床研究表明 ,在严格掌握指征的条件下腹腔镜治疗早期子宫内膜癌是可行的 ,并且有手术创伤小、恢复快的优点 ,值得进行多中心、前瞻     

Laparoscopy versus laparotomy in endometrial cancer: first analysis of survival of a randomized prospective study

STUDY OBJECTIVE: Laparoscopy has been proved to be safe and reliable in staging of patients with endometrial cancer. It has definite advantages over laparotomy, but a comparable survival outcome is still to be verified in prospective randomized trials. DESIGN: Prospective, randomized clinical trial. SETTING: Department of Gynecology, Friedrich Schiller University, Jena, Germany. PATIENTS: One hundred twenty-two women with uterine cancer. INTERVENTIONS: Laparotomy and laparoscopy. MEASUREMENTS AND MAIN RESULTS: Sixty-three patients were allocated to the laparoscopy arm, and 59 were allocated to the laparotomy arm. Median follow-up for all patients was 44 months (range 5-96 months). Eight patients (12.6%) in the laparoscopy group had a recurrence versus five patients (8.5%) in the laparotomy group (p = .65). At median follow-up, disease-free survival (DFS) and overall survival (OS) in the laparoscopy group and laparotomy group were 87.4% versus 91.6% and 82.7% versus 86.5%, respectively. Cause-specific survival (CSS) was 90.5% in the laparoscopy group versus 94.9% in the laparotomy group. In patients with International Federation of Gynecology and Obstetrics stage I, DFS was 91.2% in the laparoscopy group versus 93.8% in the laparotomy group, OS was 86.5% versus 89.7%, and CSS was 93.4% versus 95.9%. CONCLUSION: Laparoscopic vaginal treatment of patients with endometrial cancer provides a survival outcome comparable with laparotomy. If these data are confirmed, laparoscopic procedures should be included in routine therapy for patients with endometrial cancer.     

Laparoscopic management of early uterine cancer: 10-year experience in Asan Medical Center

OBJECTIVE: To assess the feasibility of laparoscopic surgery in the treatment of patients with early uterine cancer and to compare their outcomes with those of patients treated with laparotomy. METHODS: The records of 388 patients with clinical stage I or II uterine cancer treated by laparoscopic-assisted vaginal hysterectomy (LAVH) or total abdominal hysterectomy (TAH) between January 1997 and April 2006 were retrospectively reviewed. After excluding 39 patients with uterine sarcoma and 40 with upstaging or conversion to laparotomy procedures, the case-controlled study was performed. RESULTS: Laparoscopic procedures were converted to laparotomy in 10 of 188 patients (5.3%), whereas laparoscopic surgery was successful in 178 (94.7%). Histopathologic results led to upstaging of 32 of 349 patients (9.2%), including 15 of 188 (8.0%) in laparoscopy group and 17 of 161 (10.6%) in laparotomy group. The two groups were similar in age, parity, BMI, surgical stage, histological grade, tumor size, operating time and number of lymph nodes removed. Fewer complications and shorter hospital stay were observed in laparoscopy group. Between groups, recurrence rate did not differ significantly. Four recurrences in vaginal stump occurred in the only laparoscopy group, but the difference was not statistically significant. There were no significant differences between the two groups in progression-free and overall survival. CONCLUSION: Laparoscopy is a valid alternative to conventional laparotomy and does not worsen the prognosis of patients with early endometrial carcinoma. Efforts should be made during laparoscopic procedures to minimize the risk of vaginal recurrence.     

Laparoscopic-assisted vaginal hysterectomy versus abdominal hysterectomy in patients with stage I and II endometrial cancer

The purpose of this study was to evaluate and compare the outcomes of laparoscopic surgery with those of conventional abdominal surgery in patients with early endometrial cancer. From 1997 to 2003, 79 patients underwent laparoscopic-assisted vaginal hysterectomy with or without lymphadenectomy. Laparoscopy was performed on patients deemed clinical stage I in preoperative studies. Of the 79 patients, 74 found to be surgical stage I or II were enrolled in the comparative study. As a control group, we selected 168 laparotomy cases at the same disease stage as the laparoscopy group. Operation time, amount of blood transfusion, and hemoglobin changes were similar for both groups. In the laparoscopy group, the number of lymph nodes obtained was significantly higher, and the number of postoperative complications was lower compared to the laparotomy group. The hospital stay was significantly shorter for laparoscopy group. Three-year recurrence-free survival rates were similar, being 97.5% for the laparoscopy group and 98.6% for the laparotomy group. We conclude that laparoscopic surgery for treatment of early endometrial cancer is a safe and effective alternative to laparotomy in terms of perioperative complications. Three-year recurrence-free survival did not differ significantly between the groups. However, long-term survival and risk of recurrence have yet to be determined.     

Laparoscopic-assisted vaginal versus abdominal surgery in patients with endometrial cancer--a prospective randomized trial

OBJECTIVE: We compared a laparoscopic-vaginal approach with the conventional abdominal approach for treatment of patients with endometrial cancer. METHOD: Between July 1995 and August 1999, 70 patients with endometrial cancer FIGO stage I-III were randomized to laparoscopic-assisted simple or radical vaginal hysterectomy or simple or radical abdominal hysterectomy with or without lymph node dissection. RESULTS: Thirty-seven patients were treated in the laparoscopic versus 33 patients in the laparotomy group. Lymph node dissection was performed in 25 patients by laparoscopy and in 24 patients by laparotomy. Blood loss and transfusion rates were significantly lower in the laparoscopic group. Yield of pelvic and para-aortic lymph nodes, duration of surgery, and incidence of postoperative complications were similar for both groups. Overall and recurrence-free survival did not differ significantly for both groups. CONCLUSION: The laparoscopic-vaginal approach for treatment of endometrial cancer is associated with lower perioperative morbidity compared with the conventional abdominal approach.     

Impact of initial surgical access on staging and survival of patients with stage I ovarian cancer

The aim of this study was to compare staging by laparoscopy and laparotomy, and to compare survival in patients with laparoscopy versus laparotomy as the first surgical access. We conducted a retrospective analysis of patients with stage I ovarian cancer treated surgically between 1985 and 2001, and we included those patients with stage I epithelial cancer for whom follow-up data were available. For each patient, we recorded whether initial surgical staging was by laparoscopy or by laparotomy, the procedures done at initial staging surgery, and the outcomes. The data were evaluated by analysis of variance, Chi-square test or Fisher's exact test, logistic regression, Cox model, and log-rank test, using SPSS 7.5 and STATA. Initial staging was by laparoscopy in 34 patients, laparotomy in 114 patients, and laparoscopy converted to laparotomy in 30 patients. In the laparotomy group, patient age was significantly greater and tumor size significantly larger, as compared to the laparoscopy group. Staging after first surgery was often inadequate; most notably para-aortic lymph node dissection was done in 0% of laparoscopy patients, 18% of laparotomy patients, and 33% of conversion patients. Restaging surgery has been indicated in 88% of laparoscopy patients, 48% of laparotomy patients, and 46% of conversion ones. After a mean follow-up of 40 months, survival rates were not significantly different among the three patient groups. No deleterious influence of laparoscopy as first surgical access was detected by univariate or multivariate analysis. Despite of inaccurate radicality and staging during initial laparoscopy, this study found no harmful influence of laparoscopy as first initial access on outcomes of patients with stage I ovarian cancer.     

Laparoscopy for the management of early-stage endometrial cancer: from experimental to standard of care

We performed a search of PUBMED and MEDLINE for articles concerning surgical management of early stage endometrial cancer from 1950 to 2011. From the articles collected we extracted data such as estimated blood loss, operating room time, complications, conversion to laparotomy, and length of hospital stay. Forty-seven relevant sources were analyzed. The patients in the laparoscopy group had less blood loss, fewer complications, longer operating room times, and a shorter length of stay. Lymph node count was similar in both groups. Although obesity is not a contraindication to laparoscopy, it does lead to a higher conversion rate. Route of surgical treatment had no impact on recurrence or survival. Robotic surgery has significant advantages over laparotomy, but advantages over laparoscopy are not as distinct. Laparoscopic hysterectomy offers several advantages over laparotomy. These advantages relate to improvements in patient care with comparable clinical outcome. After careful analysis we believe laparoscopy should be the standard of care for surgical management of early stage endometrial cancer.     

Analysis of survival after laparoscopic management of endometrial cancer

STUDY OBJECTIVE: To assess the effect of laparoscopic surgery on the survival of women with early-stage endometrial cancer and to analyze the factors that affect survival. DESIGN: Retrospective cohort study (Canadian Task Force classification II-2). SETTING: Tertiary teaching hospital. PATIENTS: Women with clinical stage I and II endometrial cancer (International Federation of Gynecology and Obstetrics staging, 1971) from January 1993 through June 2003. INTERVENTION: Demographic, surgical, perioperative, and pathologic characteristics of women treated with laparoscopy or laparotomy were compared by use of Fisher's exact test or the Student t test. Recurrence-free and overall survival was calculated by use of the Kaplan-Meier method. Stratified analyses were performed with the log-rank test for factors affecting survival (surgical stage, histologic study, and grade). MEASUREMENTS AND MAIN RESULTS: Sixty-seven and 127 women were treated with laparoscopy and laparotomy, respectively. Median follow-up was 36.3 months for the laparoscopy group and 29.6 months for the laparotomy group. The complication rates in the 2 groups were comparable. Women undergoing laparoscopy had shorter hospital stay and less morbidity related to infection. The 2- and 5-year estimated recurrence-free survival rates for the laparoscopy and laparotomy groups (93 % vs 91.7% and 88.5% vs 85%, respectively), as well as the overall 2- and 5-year survival rates (100% vs 99.2% and 100% vs 97%, respectively) were similar. CONCLUSIONS: Laparoscopic surgery in women with early-stage endometrial carcinoma resulted in survival rates similar to laparotomy, although a small sample size precludes definitive conclusions. A larger randomized comparison of the 2 techniques is needed to validate these findings.     

腹腔镜手术与开腹手术治疗Ⅰ期子宫内膜癌的临床分析

目的探讨腹腔镜手术及开腹手术治疗工期子宫内膜癌的临床效果和并发症的处理及预防对策。方法回顾分析中国医科大学附属盛京医院自2010年8月至2012年8月Ⅰ期子宫内膜癌54例,其中腹腔镜手术22例,开腹手术32例。比较两组手术时间、术中出血量、淋巴结切除数量、手术并发症、术后肠道功能恢复时间等以评价二者差异。结果两组患者术前临床资料,如年龄、体重、婚育史、内科合并症及深静脉血栓风险评估差异均无统计学意义（P〉0．05）。术中出血量、术后排气时间、术后住院时间三方面差异有统计学意义（P〈0．05）。手术时间、淋巴结切除数量、腹主动脉淋巴结切除或取样完成的病例数、腹腔引流量等术中及术后资料差异无统计学意义（P〉0．05）。结论对于子宫内膜癌患者术前应注意重视相关风险评估,给予全面的预防措施以降低术中及术后并发症的发生,腹腔镜手术为早期子宫内膜癌的较优治疗方式。     

Laparoscopic-assisted vaginal hysterectomy versus abdominal hysterectomy in stages I and II endometrial cancer. Operating data, follow up and survival

OBJECTIVE: To assess the feasibility of laparoscopy in the treatment of early stage endometrial carcinoma and follow up outcomes compared to classic laparotomy. METHODS: A retrospective review of 90 consecutive patients with endometrial cancer managed between January 1997 and December 2003. Two groups were defined whether they had been treated by laparoscopy (N = 38; LPS group) or by laparotomy (N = 37; LPM group). Nine patients treated by vaginal hysterectomy and 6 cases with stages III-IV were excluded from the study. RESULTS: Both groups were comparable in mean age and mean BMI. Mean operating time was longer for LPS group, 164.91 +/- 5.60 (77-240) vs. 129.97 +/- 5.08 (60-180) min (P < 0.05). Intraoperative complications were seen in 7 patients (18.9%) from LPM and in 5 cases (13.2%) in the laparoscopic group. Two patients (5.2%) initially evaluated by laparoscopy were converted into laparotomy due to an increasing and uncontrollable hypercapnia. There were more post-operative complications in patients managed by laparotomy (14 cases; 38.8%), than by laparoscopy (7 cases; 18.4%) (P < 0.05). Blood transfusion was necessary in 4 patients (10.8%) in LPM group while none was required in LPS group (P < 0.01). Hospital readmission was only recorded in 3 patients treated by laparotomy (6.7%) (P < 0.05). Hospital stay was longer in LPM group 7.06 +/- 0.58 (4-21) vs. LPS 5.04 +/- 0.73 (2-17) days (P < 0.05). With a median follow up of 53.21 +/- 4.32 months for LPM (5-90) and 36.31 +/- 2.75 months for LPS (9-65) there was no significant difference in disease recurrence between the two groups. CONCLUSION: Laparoscopic staging combined with vaginal hysterectomy appears to be a feasible alternative to classical surgical approach in patients with early stage I or II endometrial carcinoma.     

Stage I ovarian cancer: comparison of laparoscopy and laparotomy on staging and survival

OBJECTIVE: The aim of this study was to compare staging accurateness as well as survival when managing early ovarian cancers by laparoscopy or laparotomy. MATERIAL AND METHODS: We have conducted a retrospective and multicentric study in France. Only Stage I ovarian epithelial cancers operated on from January 1, 1985 to December 31, 1999 were taken into account. Respondents had to fill in a form detailing in each case the surgical access; the surgical acts performed during the initial intervention as well as data on the patient's follow-up. Lack of follow-up or final Stage > I were considered as exclusion criteria. Data were recorded and analysed with SPSS 7.5 and STATA (Stata statistical sofware 7.0). (ANOVA, chi-square test or Fisher's exact test and log-rank test). RESULTS: 105 cases were included: 14 patients were exclusively operated on by laparoscopy (group 1), 13 other patients were subjected to a conversion from laparoscopy to laparotomy (group 2) and 78 patients exclusively underwent laparotomy (group 3). Patients in group 3 were significantly more frequently postmenopausal and had larger lesions. Cyst rupture was rare during laparoscopy (21%) and the use of an endobag was achieved in only 21% of the patients in group 1. Radical treatment was significantly more frequent in group 3 when compared to group 1 (67% vs 23%, p < 0.05). Laparoscopy was not adequate for staging since no lymphadenectomy was carried out by this approach. However, only 27% of patients subjected to an open approach underwent lymphadenectomy and omentectomy. The outcome in terms of survival was similar in the three groups with a mean follow-up period of 1,221 days (+/- 832) (p = 0.1). CONCLUSION: Laparoscopic management of early ovarian cancer is poorly efficient in staging although disease-free survival does not seem to be affected. Further evaluation of laparoscopy in this indication is needed.     

Laparoscopic surgery for endometrial cancer: long-term results of a multicentric study

PURPOSE OF INVESTIGATION: Surgical treatment of endometrial cancer was traditionally done by laparotomy, however the laparoscopic approach has gained wider acceptance by gynecologic surgeons.The primary aim of the study was to report the perioperative and postoperative outcomes of laparoscopic surgery in a major group of patients with endometrial cancer. The second aim was to study the long-term results of laparoscopic surgery in patients with endometrial cancer. MATERIAL AND METHOD: A prospective multicentric study was conducted at three oncolaparoscopic centres; 221 women who had undergone laparoscopic (177 women) or abdominal (44 women) hysterectomy with bilateral salpingo-oophorectomy and lymphadenectomy were included in the study. Women with stage IA, grade I did not undergo lymphadenectomy unless they had a high risk histologic tumor type. Lymph node dissection was performed in 145 women with disease greater than IA or grades other than 1. RESULTS: The mean age and weight were similar in the compared laparoscopic and open groups. Perioperative blood loss was comparable in both groups (211.2 ml vs 245.7 ml, respectively) without any significant consecutive changes in serum hemoglobin values. Although the length of operating time for the laparoscopic surgery was significantly longer than the time for the laparotomy procedure (163.3 min vs 114.7 min, p < 0.0001), the laparoscopic patients were discharged from hospital much earlier at 3.9 days (range 2-16) after the laparoscopic procedure compared with 7.3 days (range 5-16) after the abdominal procedure (p < 0.0001). The difference in surgical complications between groups was statistically insignificant (p = 0.58). Similar long-term results were noted in both groups. With a median follow-up of 33.6 months for the laparoscopy group and 45.2 months for the open group, there were no significant differences in tumor recurrence (p = 0.99] or recurrence-free survival (p = 0.86) between the two groups. CONCLUSION: The study illustrates that laparoscopically assisted surgical staging of endometrial cancer is safe as an open procedure.The laparoscopic approach may also be considered for endometrial malignancy which typically occurs in obese and elderly, high-risk women. Our analysis showed no difference with respect to recurrence or survival between the compared laparoscopic and the open group.     

Comparison of perioperative outcomes and cost of robotic-assisted laparoscopy,laparoscopy and laparotomy for endometrial cancer

Objective

To analyze the perioperative outcomes and cost of three surgical approaches in the treatment of endometrial cancer: robotic, laparoscopy and laparotomy.

Study design

We studied 347 patients with endometrial cancer treated in a single institution: 71 patients were operated by robotics, 84 by conventional laparoscopy and 192 by laparotomy. All patients underwent total hysterectomy, bilateral salpingoophorectomy and pelvic and para-aortic lymphadenectomy depending on the pathological features.

Results

Operative time was longer in the laparoscopy group as compared to robotics and laparotomy (218.2 min, 189.2 min, and 157.4 min respectively, p = 0.000). The estimated blood loss was lower in the robotic group relative to the other groups (99.4 ml in robotic, 190.0 ml in laparoscopy and 231.5 ml in laparotomy, p = 0.000). Similar findings were observed for the pre- and post-operative mean hemoglobin levels (−1.3 g/dl, −2.3 g/dl and −2.5 g/dl respectively, p = 0.000), and transfusion rate (4.2%, 7.1% and 14.1% respectively, p = 0.036). The length of hospital stay was higher in the laparotomy group compared to robotics and laparoscopy (8.1, 3.5 and 4.6 days respectively; p = 0.000). The conversion rate to laparotomy was lower for robotics (2.4% for robotics and 8.1% for laparoscopy, p = 0.181). Overall complications were similar for robotics and laparoscopy (21.1%, 28.5%) (p = 0.079). Robotic complications were significantly lower as compared to laparotomy (21.2 vs 34.9% (p = 0.036). No differences were found relative to disease-free or overall survival among the three groups. The global costs were similar for the three approaches (p = 0.566).

Conclusion

Robotics is a safe alternative to laparoscopy and laparotomy for endometrial cancer patients, offering improved perioperative outcomes and similar cost as compared to the other two surgical approaches.     

Outcomes of laparoscopic treatment for endometrial cancer

PURPOSE OF REVIEW: Laparoscopy has become the standard approach for the surgical management of a variety of benign gynecological conditions. Numerous studies have reported their findings on the laparoscopic approach for the treatment of patients with endometrial cancer. It is timely and relevant to provide a review of these findings. RECENT FINDINGS: Comparison analysis of recurrence and survival rates for patients treated by laparoscopy and laparotomy have found similar results. A similar or reduced cost is noted for the laparoscopic approach. Numerous patient advantages are indicated for the laparoscopic approach. This information is detailed in this review. SUMMARY: The open abdominal approach is an alternative to laparoscopy for the surgical treatment of patients with early endometrial cancer.     

Role of laparoscopy in the treatment of patients with endometrial cancer

Patients with endometrial cancer (EC) are conventionally staged by surgery. Depending on the tumor risk factors and the surgical findings, adjuvant treatment is indicated in the form of radiotherapy or chemotherapy. The FIGO guidelines on surgical staging are clear on the importance of assessing the presence of extra-uterine spread of disease, but are elusive on how extensive the surgical staging should be. Also, the role of lymphadenectomy and adjuvant radiotherapy in these patients is the object of controversy, as confirmed by recent results of clinical trials. With surgery remaining the cornerstone of treatment, the surgical approach associated with the least complications should be pursued, particularly since the association of surgery and radiotherapy can escalate the overall treatment morbidity. Therefore, in the last 15 years, laparoscopy has slowly been replacing the traditional midline laparotomy. The results of the few clinical trials and several retrospective studies are unanimous. The laparoscopic approach is feasible, safe and effective and has a lower complication rate as compared to laparotomy in all patients. The number of patients with endometrial cancer included in published studies so far is too low to achieve statistical significance with respect to survival outcomes. However, for some groups of patients, there are results from clinical trials showing that laparoscopy is the method of choice in view of the outstanding reduced surgical morbidity.     

Sentinel lymph node identification and radical hysterectomy with lymphadenectomy in early stage cervical cancer: laparoscopy versus laparotomy

STUDY OBJECTIVE: To estimate the feasibility and results of sentinel lymph node identification and radical hysterectomy with pelvic lymphadenectomy entirely completed by laparoscopy versus laparotomy in early stage cervical cancer. DESIGN: Retrospective, nonrandomized clinical study (Canadian Task Force classification II-2). SETTING: Acute care, teaching hospital. PATIENTS: From September 2000 through January 2005, 50 consecutive patients with International Federation of Gynecology and Obstetrics stage IA(2), IB(1), and IIA disease less than 4 cm underwent radical hysterectomy and lymphadenectomy with intraoperative sentinel lymph node biopsy. INTERVENTIONS: The operation was performed entirely by laparoscopy in 20 patients and using the conventional abdominal approach in 30. Feasibility of sentinel lymph node identification, surgical morbidity, overall survival, and recurrence rate-free survival in both groups were compared. MEASUREMENTS AND MAIN RESULTS: The overall detection rate of the sentinel lymph node was 100% (false negative 0%). A mean of 2.50 sentinel nodes/patient was detected in the laparotomy group compared with a mean of 2.55 nodes in the laparoscopic group (p = .874). Bifurcation of the right common iliac artery was the most frequent nodal location. Blood loss and length of stay were significantly lower in the laparoscopic group, but surgical time was significantly longer. The median follow-up was 35 months (range 5-57) in the laparotomy group and 22.5 (range 2-52) in the laparoscopic group. Differences in overall survival and disease-free survival were not observed. CONCLUSION: Sentinel lymph node identification and radical hysterectomy in the initial treatment of early stage cervical cancer can be performed safely by laparoscopy with lower morbidity and overall survival and recurrence-free survival similar to standard laparotomy.     

Laparoscopic management of early endometrial cancer: current status

Endometrial cancer is the most common form of gynaecological cancer. Laparotomy has traditionally been the surgical treatment of choice, but the laparoscopic approach is gaining wider acceptance by gynaecologic surgeons, and an abundance of clinical information is currently available on all aspects of this approach. Whether in combination with laparoscopic-assisted vaginal or total laparoscopic hysterectomy, laparoscopic staging, including salpingo-oophorectomy and regional lymph-node dissection, is a major component of the treatment of patients with early endometrial cancer. This review examines the various options to treating endometrial cancer and proposes that laparoscopically assisted surgical staging of endometrial cancer is both a feasible and safe option. Comparative analyses of survival and recurrence rates for patients treated by laparoscopy and laparotomy have shown similar survival results. It remains to be proven if these laparoscopic techniques are associated with greater benefits.     

A prospective trial of progesterone therapy for malignant peritoneal cytology in patients with endometrial carcinoma.

From February 1982 to February 1991, 45 patients with endometrial carcinoma confined to the uterus except for malignant peritoneal cytology were treated with 1 year of progesterone therapy. Thirty-six patients have undergone planned second-look laparoscopy with repeat peritoneal washings and the remaining 9 patients either refused second-look laparoscopy or the procedure was medically contraindicated. Of the 36 who underwent second-look laparoscopy, 34 (94.5%) were NED (no evidence of disease) and had negative repeat peritoneal cytology and 2 (5.5%) had persistent malignant cytology. The latter two patients, after an additional year of progesterone therapy, were found to be NED and had negative peritoneal cytology at third-look laparoscopy. Of the 45 women enrolled in this protocol, no patient has developed recurrent endometrial cancer, and the expected 5-year disease-free survival was 88.6%.