子宫内膜癌腹腔镜手术32例临床分析

目的探讨腹腔镜手术治疗子宫内膜癌的临床效果。方法回顾性分析北京大学人民医院2004年2月至2008年12月具有完整资料的子宫内膜癌腹腔镜手术32例患者,并与同期开腹手术32例比较,观察两组的围手术期指标和近期疗效。结果腹腔镜组术中出血量（345．31±276．60）ml,切除淋巴结数量（20．53±8．35）个,开腹组术中出血量（568．75±345．62）ml,切除淋巴结数量（30．41±11．17）个,差异均有统计学意义（P〈0．05）。两组手术时间比较,差异无统计学意义（P＝0．375）。腹腔镜组和开腹组肛门排气时间分别为（1．91±0．86）d和（2．91±1．67）d（P〈0．05）,平均住院时间分别为（17．22±6．19）d和（21．72±6．84）d（P=0．002）,差异均有统计学意义。腹腔镜组淋巴囊肿形成、切口愈合不良等术后并发症发生率明显低于开腹组（P〈0．05）。两组术后无瘤生存率（P=0．629）、总生存率（P=1．000）及复发率（P=0．629）差异均无统计学意义。结论腹腔镜手术术中出血量少、术后并发症少,近期疗效满意,是治疗早期子宫内膜癌较好的手术方式,但其远期治疗效果及长期预后需进一步研究。     

腹腔镜手术与开腹手术治疗早期子宫内膜癌对比研究

目的探讨腹腔镜手术治疗早期子宫内膜癌的可行性、安全性及近远期疗效。方法回顾性分析中山大学附属第一医院2006年7月至2015年6月209例确诊为早期子宫内膜癌并以腹腔镜治疗的患者为研究对象(腹腔镜组),以同期403例开腹手术治疗的早期子宫内膜癌病例为对照组,两组在手术时间、术中出血量、淋巴结清扫个数、术后排气时间、住院时间及并发症等各方面指标进行比较。结果腹腔镜组术中手术时间(114.7±29.2)min短于开腹组(211.0±45.3)min(P0.05),腹腔镜组出血量(180.6±98.2)mL明显少于开腹组(323.1±167.8)mL(P0.05);与开腹组比较,腹腔镜组术后肛门排气时间和住院时间明显缩短(P0.05)。两组盆腔及腹主动脉淋巴结切除数目、术中及术后并发症及总体生存率上差异无统计学意义(P0.05)。结论子宫内膜癌腹腔镜手术较开腹手术具有出血少、恢复快等优势,其安全可行,可作为早期子宫内膜癌手术选择。     

腹腔镜下腹主动脉旁淋巴结切除在子宫内膜癌诊治中的临床研究

目的:探讨腹腔镜下腹主动脉旁淋巴结切除在子宫内膜癌诊治中的应用价值及安全性、可行性。方法:选择2010年3月至2014年3月子宫内膜癌患者89例,其中,行腹腔镜下腹主动脉旁淋巴结切除手术50例(腹腔镜组),传统开腹腹主动脉旁淋巴结切除手术39例(开腹组),比较两组围手术期情况、术中及术后并发症、预后,统计分析淋巴结转移患者临床病理特征。结果:腹腔镜组和开腹组患者在切除的淋巴结数目上差异无统计学意义(P0.05),腹腔镜组较开腹组腹主动脉旁淋巴结切除出血量少、术后病率低、术后肛门排气时间早、术后住院时间短,但切除腹主动脉旁淋巴结时间长于开腹组,两组比较差异均有统计学意义(P0.01,P0.05)。腹腔镜组与开腹组在术中腔静脉损伤、术后尿潴留、淋巴囊肿、深静脉血栓、肺动脉栓塞发生率比较,差异无统计学意义(P0.05),而开腹组切口裂开4例,腹腔镜组无切口裂开,两组比较差异有统计学意义(P0.05)。术后发现盆腔和(或)腹主动脉旁淋巴结转移共8例,除术前1例患者发现脐部癌转移诊断为ⅣB期和1例患者磁共振成像提示盆腔淋巴结肿大癌转移诊断ⅢC1期与术后病理诊断相同外,其余6例分期均较术前升高。两组术后随访:开腹组复发2例,其中1例死亡;腹腔镜组复发1例后死亡,均为晚期子宫内膜癌患者。结论:腹主动脉旁淋巴结切除是子宫内膜癌规范化诊治的重要组成部分,在对子宫内膜癌患者准确分期、制定精确术后诊治方案,改善预后方面作用是肯定的,腹腔镜下腹主动脉旁淋巴结切除手术安全可行,优于传统开腹手术。     

手术治疗子宫内膜癌术式的选择及对预后的影响

目的分析子宫内膜癌的最佳手术方式及对预后的影响。方法选择2013年1月~2014年1月我院收治的子宫内膜癌患者180例作为研究对象,按手术方式不同随机分成对照组和观察组,对照组给予传统开腹手术;观察组给予腹腔镜手术。观察两组患者的疗效及并发症发生情况。结果两组手术时间、术中出血量、阴道切除长度、宫旁组织切除长度、术后并发症等指标比较,差异有统计学意义(P0.05),盆腔淋巴结切除数目两组比较,差异无统计学意义(P0.05)。结论腹腔镜手术治疗子宫内膜癌较传统开腹手术治疗的疗效更好,并发症更少,预后效果更佳,值得临床广泛推广。     

老年妇科腹腔镜手术148例临床分析

目的探讨腹腔镜手术在65岁以上老年妇女中的应用价值及安全性。方法收集北京协和医院1997年1月至2006年12月间,65岁以上接受全身麻醉下妇科腹腔镜手术的患者148例。回顾性分析其术前合并症、术前检查、手术情况、围手术期并发症及住院时间,并与60～64岁妇科腹腔镜手术组及65岁以上开腹子宫双附件切除组比较。结果患者平均年龄（69．1±3．1）岁。其中妇科良性疾病患者130例（87．8％）,恶性肿瘤患者18例（12．2％）。合并内科疾病患者104例（70．3％）。手术方式：腹腔镜辅助阴式子宫切除及双附件切除术（LAVH＋BSO）60例,腹腔镜下子宫切除及双附件切除术（TLH＋BSO）66例,腹腔镜下双侧附件切除10例,腹腔镜下子宫内膜癌分期手术4例,其他手术8例。平均手术时间（71．7±27．7）min,平均出血量（96．5±88．6）ml。手术中转开腹1例。术后并发症：膀胱损伤1例。平均住院时间（8．8±4．6）d,术后住院时间（4．8±2．2）d。与60－64岁腹腔镜手术组比较,各项指标差异无统计学意义（P〉0．05）。全子宫双附件切除的腹腔镜与开腹手术组比较,出血量及术后住院时间均明显减少（P〈0．05）。结论老龄本身不是妇科腹腔镜手术的禁忌证,经过周密的术前评估和准备,加强围手术期监护,老年女性能够耐受妇科腹腔镜手术。     

腹腔镜与开腹手术治疗子宫肌瘤的临床疗效比较

目的：探讨分析腹腔镜与开腹手术治疗子宫肌瘤的临床疗效。方法：选取我院2012年1月至2013年8月收治的子宫肌瘤患者80例,按照随机分组分为腹腔镜手术组和开腹手术组各40例,观察两组疗效。结果：两组在手术时间方面比较P〉0．05,差异无统计学意义;腹腔镜手术组在术中出血量、术后肛门排气时间及住院时间方面均较开腹手术组少,两组比较P〈0．05,差异具有统计学意义。结论：腹腔镜下子宫肌瘤切除术创伤小、术中出血少,术后恢复快,值得临床推广应用.     

开腹手术与腹腔镜下输卵管妊娠临床对照研究

目的：探讨开腹手术与腹腔镜手术治疗输卵管妊娠的临床疗效。方法回顾性分析我院2007年2月至2010年11月收治的122例输卵管妊娠患者的临床资料,其中采用开腹手术者60例（开腹组）,腹腔镜下手术治疗者62例（腹腔镜组）,观察两组患者术中出血量、手术时间、住院时间以及术后恢复情况,对比临床疗效。结果两组术中出血量比较,腹腔组少于开腹组,差异有统计学意义（P〈0．05）;两组手术时间比较,腹腔镜组较开腹组短,差异无统计学意义（P〉0．05）;两组住院时间比较,开腹组长于腹腔镜组,差异有统计学意义（P〈0．05）;腹腔镜组患者术后排气较早,恢复情况与开腹组比较明显较快。结论腹腔镜手术治疗输卵管妊娠术中出血少、手术创伤小、患者痛苦少,且住院时间短、术后恢复快,其疗效明显优于开腹手术。值得临床推广应用。     

腹腔镜与开腹手术治疗子宫内膜癌效果比较

目的探讨腹腔镜辅助的子宫内膜癌手术与传统开腹手术临床效果的差异。方法回顾性研究2007年1月至2010年3月在上海交通大学附属第一人民医院妇科行子宫内膜癌腹腔镜手术的51例患者临床资料,选择同期同组医生施行的子宫内膜癌传统开腹手术69例作为对照组,比较两组临床效果。结果腹腔镜组与开腹组在手术时间、术中清扫淋巴结数目上差异无统计学意义。腹腔镜组术中失血少、术后发热率低、肠道恢复快、住院时间短,与开腹组差异有统计学意义(P<0.05)。开腹组切口裂开率高于腹腔镜组,而其他并发症组间差异无统计学意义。结论腹腔镜手术是治疗早期子宫内膜癌稳妥可行的选择。     

高频电刀和超声刀在腹腔镜下宫颈癌手术中的应用价值研究

目的探讨高频电刀在腹腔镜下宫颈癌手术中的应用价值。方法河北医科大学第四医院妇科于2006年11月至2015年8月应用高频电刀和超声刀行腹腔镜下根治性子宫切除+盆腔淋巴结切除及(或)腹主动脉旁淋巴结切除共530例,对比分析两组各项手术指标以及并发症之间的差异。结果两种手术器械均能顺利完成手术,两组术中淋巴结切除时间、淋巴结切除个数、根治性子宫切除时间、术中出血量、术后肛门排气时间、住院天数、术后拔除尿管时间、术后拔除引流管时间等差异均无统计学意义(P0.05)。两组血管损伤、输尿管损伤、膀胱损伤、肠道损伤、术后肠梗阻、淋巴囊肿等并发症比较差异均无统计学意义(P0.05)。结论应用高频电刀行腹腔镜下根治性子宫切除+盆腔淋巴结切除及(或)腹主动脉旁淋巴结切除能达到同超声刀相同的手术效果,具有一定临床应用价值。     

腹腔镜联合阴式手术治疗早期子宫恶性肿瘤的临床价值

目的探讨腹腔镜盆腔淋巴切除 阴式广泛全子宫切除术(LPL VRH)治疗早期子宫恶性肿瘤的临床价值。方法2003年8月至2007年12月,选择11例早期子宫颈癌和8例子宫内膜癌的患者行LPL VRH治疗(研究组),选取同时入院接受开腹子宫广泛切除 淋巴切除术治疗早期子宫颈癌11例、子宫内膜癌8例为对照组,对其手术情况、手术时间、术后并发症、术中出血量、淋巴结切除数目、术后病率进行比较。结果研究组19例中18例成功手术,1例因淋巴结切除困难中转开腹。研究组与对照组在术中出血[(321.08±284.36)mL,(513.62±237.23)mL]、术后胃肠恢复时间(1.5d,4.5d)、术后下床活动时间(2d,7d),两组间比较差异有统计学意义(P<0.05)。而两组在手术时间、术中清除淋巴结数、术后尿潴留、尿失禁、淋巴囊肿及术后复发等指标上差异无统计学意义(P>0.05)。结论LPL VRH可作为早期子宫恶性肿瘤手术治疗方法之一,近期效果良好,远期疗效有待进一步观察。     

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.     

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.     

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.     

Laparoscopy compared with laparotomy for the surgical staging of endometrial carcinoma

AIM: To evaluate and compare laparoscopic-assisted surgical staging with conventional laparotomy for the treatment of endometrial carcinoma. METHODS: From July 2001 to December 2003, a retrospective review of patients with endometrial carcinoma was carried out. The medical records of those patients who had undergone surgical staging with hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy (PLN) were evaluated. Primary outcome measures were operating time (OT), estimated blood loss, total number of lymph nodes yielded, intraoperative complications, postoperative complications, and length of hospital stay. RESULT: A total of 64 cases were identified. Two cases were excluded because of incomplete records. Two cases with para-aortic lymphadenectomy and four cases with Wertheim's hysterectomy were excluded from the study. Thirty-six patients underwent laparotomy with total abdominal hysterectomy and bilateral salpingo-oophorectomy and PLN (laparotomy group). Twenty patients underwent the same surgery by laparoscopy, of which 19 were successfully carried out (laparoscopy group). One case was converted to laparotomy. The mean OT in the laparoscopy group was longer when compared with the laparotomy group (211 min vs 94 min, P < 0.001). The mean estimated blood loss in the laparoscopy group was less (200 mL vs 513 mL, P < 0.001). The post-operative hospital stay was shorter in the laparoscopy group (3.6 days vs 7.7 days, P < 0.001). The mean number of lymph nodes yielded was more in the laparoscopy group (26.1 vs 16.7, P = 0.004). Neither group had intraoperative complications and both had similar postoperative complication rates. CONCLUSION: Laparoscopic-assisted surgical staging for endometrial carcinoma is associated with significantly less blood loss, shorter hospital stay, longer OT time, and more lymph nodes yielded when compared with laparotomy.     

Learning curve and surgical outcome for robotic-assisted hysterectomy with lymphadenectomy: case-matched controlled comparison with laparoscopy and laparotomy for treatment of endometrial cancer

Study ObjectiveTo determine the learning curve for robotic-assisted hysterectomy with lymphadenectomy for surgical treatment of endometrial cancer.DesignAn analysis of robotic-assisted hysterectomy with lymphadenectomy vs total laparoscopic hysterectomy with lymphadenectomy and laparotomy with total abdominal hysterectomy with lymphadenectomy (Canadian Task Force classification II-1).SettingSolo, experienced, minimally invasive gynecologic oncology practice in a tertiary hospital.PatientsOne hundred forty-eight patients including 56 patients who underwent robotic-assisted hysterectomy with bilateral pelvic and paraaortic lymph node dissection, 56 patients who underwent total laparoscopic hysterectomy with bilateral pelvic and paraaortic lymph node dissection, and 36 patients who underwent traditional total abdominal hysterectomy with bilateral pelvic and paraaortic lymph node dissection performed by the same surgeon for treatment of endometrial cancer.InterventionsRobotic-assisted hysterectomy with bilateral lymphadenectomy, total laparoscopic hysterectomy with bilateral lymphadenectomy, and traditional total abdominal hysterectomy with bilateral lymphadenectomy were performed. Data were categorized by chronologic order of cases into groups of 20 patients each. The learning curve of the surgical procedure was estimated by measuring operative time with respect to chronologic order of each patient who had undergone the respective procedure.Measurements and Main ResultsFor the 3 surgical procedures, data analyzed included mean age, body mass index, operative time, blood loss, lymph node retrieval, and complications. Mean (SD); 95% confidence interval [CI]) operative time for the 3 procedures was statistically significant: 162.5 (53) minutes (95% CI, 148.6–176.4]), 192.3 (55.5) minutes (95% CI, 177.6–207.0), and 136.9 (32.3) minutes (95% CI, 126.3–147.5), respectively. Analysis of operative time for robotic-assisted hysterectomy with bilateral lymph node dissection with respect to chronologic order of each group of 20 cases demonstrated a decrease in operative time: 183.2 (69) minutes (95% CI; 153.0–213.4) for cases 1 to 20, 152.7 (39.8) minutes (95% CI, 135.3–170.1) for cases 21 to 40, and 148.8 (36.7) minutes (95% CI, 130.8–166.8) for cases 41 to 56. For the groups with laparoscopic hysterectomy with lymphadenectomy and traditional total abdominal hysterectomy with lymphadenectomy, there was no difference in operative time with respect to chronologic group order of cases. There was a difference between the number of lymph nodes retrieved between robotic-assisted hysterectomy with bilateral lymphadenectomy (26.7 [12.8]; 95% CI, 23.3–30.1) compared with laparoscopic hysterectomy with bilateral lymphadenectomy (45.1 [20.9]; 95% CI, 39.6–50.6) and traditional total abdominal hysterectomy with lymphadenectomy (55.8 [23.4]; 95% CI, 48.2–63.4). The rate of intraoperative complications for laparoscopic hysterectomy with bilateral lymphadenectomy was 12.5% (7 of 56) compared with 0 % for robotic-assisted hysterectomy with bilateral lymphadenectomy. The rate of postoperative complications was 14.3% (8 of 56), 21.4% (12 of 56), and 19.4% (7 of 36), respectively, for the 3 groups. There was less blood loss with robotic-assisted hysterectomy with bilateral lymphadenectomy (89.3 [45.4]; 95% CI, 77.4–101.2) compared with laparoscopic hysterectomy with bilateral lymphadenectomy (209.1 [91.8]; 95% CI, 185.1–233.1) and traditional total abdominal hysterectomy with lymphadenectomy (266.0 [145.1]; 95% CI, 218.6–313.4). Duration of hospitalization was shorter in the group with robotic-assisted hysterectomy with bilateral lymphadenectomy (1.6 [0.7]; 95% CI, 1.4–1.8) compared with the groups who underwent laparoscopic hysterectomy with bilateral lymphadenectomy (2.6 [0.9]; 95% CI, 2.4–2.8) or traditional total abdominal hysterectomy with lymphadenectomy (4.9 [1.9]; 95% CI, (4.3–5.5).ConclusionThe learning curve for robotic-assisted hysterectomy with lymph node dissection seems to be easier compared with that for laparoscopic hysterectomy with lymph node dissection for surgical management of endometrial cancer.     

Laparoscopic surgery in women with endometrial cancer: the learning curve

OBJECTIVE: The aim of this study was to assess the effect of increasing surgeons's experience in the laparoscopic surgery of women with endometrial cancer (EC) on the surgical outcome of these patients. STUDY DESIGN: Data were obtained from a prospectively collected database of 108 patients two oncolaparoscopic centers in Czech Republic who underwent laparoscopically assisted surgical staging (LASS) from April 1996 to March 2001. Patients were arranged in chronological order and divided into three groups, based on the date of their surgery. The three groups were compared in patient characteristics and surgical outcome using one-way analysis of variance (ANOVA) and Wilcoxon rank sum test. SETTING: Department of Obstetrics and Gynecology, Endoscopic Training Center, Baby Friendly Hospital Kladno, Czech Republic. RESULTS: The three groups were similar in patient characteristics. Operative times for laparoscopic staging with pelvic lymphadenectomy (LN) decreased significantly from mean of 156.3 min for group 1 to 142.8 min for group 3 (P < 0.05). In cases LASS with pelvic lymphadenectomy was significant increase in the number lymph nodes harvested (12.4 for group 1, 13.9 for group 2, and 15.4 for group 3, P < 0.05). In cases LASS without lymphadenectomy was not significant difference in operating time, estimated blood loss, rate of conversion to laparotomy, operative complications, and length of hospital stay among the compared groups. The number of patients who underwent para-aortic lymphadanectomy was too small (n = 22), and their distribution was asymmetrical for comparison. CONCLUSION: A learning curve is demonstrated in the LASS of women with endometrial cancer. With increasing surgeon's team experience, there is significant decrease in operative time for staging with pelvic lymph node dissection and increase in the number of pelvic lymph nodes removed. The para-aortic lymphadenectomy (PALN) was found to be more challenging than pelvic lymphadenectomy.     

Hysterectomy for Obese Women with Endometrial Cancer: Laparoscopy or Laparotomy?

Objective. The aim of this study was to investigate the feasibility and safety of laparoscopic management of obese women with early stage endometrial cancer and to compare the surgical outcome, cost, hospital stay, recall of postoperative pain control, time to return to full activity and to work, and overall satisfaction among these women and those managed by laparotomy.Methods. We conducted a prospective study over 2 years applying laparoscopic surgery to all women with clinical stage I endometrial cancer and body mass indices (BMIs) between 28.0 and 60.0 who can tolerate such surgery. As a control, we used women with clinical stage I endometrial cancer and similar BMIs who underwent laparotomy in the previous 2 years. Both groups were compared in their characteristics, surgical outcome, cost, and hospital stay, and interviewed regarding time to recovery, recall of postoperative pain control, and overall satisfaction with their management.Results. Forty of 42 obese women who presented with clinical stage I endometrial cancer during the study period were offered laparoscopic surgery. The procedure was converted to laparotomy in 3 (7.5%) patients. Laparoscopic surgery was thus successful in 88.1% of all obese women. There was no significant difference between women who underwent laparoscopy and those who underwent laparotomy in patient characteristics, proportion of women who underwent lymphadenectomy, complications, total cost, patients' recall of postoperative pain, and patients' satisfaction with management. Women who underwent laparoscopy had a significantly longer operative time, more pelvic lymph nodes removed, a smaller drop in postoperative hematocrit, less pain medication, and a shorter hospital stay (194.8 versus 137.7 min, P <0.001; 11.3 versus 5.3, P < 0.001; 3.9 versus 5.4, P = 0.029; 32.3 versus 124.1 mg, P < 0.001; and 2.5 versus 5.6 days, P < 0.001, respectively). There was a trend toward earlier resumption of full activity and return to work among women who underwent laparoscopy (23.2 versus 45.0 days, P = 0.073, and 35.3 versus 67.0 days, P = 0.055, respectively).Conclusions. Most obese women with early stage endometrial cancer can be safely managed through laparoscopy with excellent surgical outcome, shorter hospitalization, and less postoperative pain than those managed through laparotomy.     

Safety of laparoscopy vs laparotomy in the surgical staging of endometrial cancer: a systematic review and metaanalysis of randomized controlled trials

The aim of the current study was to compare the safety of the laparoscopic vs abdominal approach to staging endometrial cancer. A search was conducted for randomized controlled trials that reported data from women with histologically confirmed endometrial cancer who underwent laparoscopic or abdominal surgery. An additional metaanalysis was performed. The primary endpoints were the rates of intraoperative and postoperative complications. A total of 8 original randomized controlled trials were included in the final analysis. No significant difference was observed in the relative risk (RR) for intraoperative complications between laparoscopy and laparotomy (RR, 1.25; 95% confidence interval, 0.99-1.56; P = .062). In contrast, a significant advantage of laparoscopy over laparotomy was obtained in terms of postoperative complications (RR, 0.71; 95% confidence interval, 0.63-0.79; P = .016). In comparison with abdominal surgery, the safety of the laparoscopic approach for surgical staging of endometrial cancer is similar in terms of intraoperative complications but results in fewer postoperative complications.     

Panniculectomy: improving lymph node yield in morbidly obese patients with endometrial neoplasms

OBJECTIVE: Panniculectomy has been used to facilitate pelvic surgery in obese women. The goal of this study was to determine the effect of panniculectomy on staging adequacy and lymph node yield in obese women with endometrial carcinoma undergoing staging laparotomy. METHODS: A retrospective review of patients with endometrial neoplasms who underwent panniculectomy at the time of hysterectomy was performed. For each subject, two control patients were matched by body mass index (BMI). RESULTS: Twenty-seven endometrial cancer patients who underwent panniculectomy at the time of staging were identified. Panniculectomy was successfully performed in all 27 patients. While the mean number of pelvic nodes was statistically similar between the two groups (16.2 vs. 13.7) (P = 0.199), the paraaortic node count was higher in patients who underwent panniculectomy (4.3 vs. 2.9) (P = 0.032). A paraaortic node dissection was not feasible in 3 (11.1%) of the panniculectomy patients and in 11 (20.4%) of the controls (P = 0.365). There were no differences in intraoperative or postoperative complications or in survival between the two groups. CONCLUSION: Among obese women with endometrial cancer, panniculectomy is well tolerated, feasible, and associated with acceptable morbidity. While the clinical significance of an increased paraaortic node count is uncertain, our findings suggest that panniculectomy may enhance operative exposure and facilitate endometrial cancer staging.