Feasibility and morbidity of total laparoscopic radical hysterectomy with or without pelvic limphadenectomy in obese women with stage I endometrial cancer

  • Antonio Pellegrino
  • Mauro Signorelli
  • Robert Fruscio
  • Annalisa Villa
  • Alessandro Buda
  • Pietro Beretta
  • Annalisa Garbi
  • Domenico Vitobello
Original Article

Abstract

Objective

The aim of this study was to describe the feasibility and morbidity rates associated with total laparoscopic radical hysterectomy (TLRH) with or without pelvic lymphadenectomy for stage I endometrial cancer in obese women.

Patients and methods

Obese patients with stage I endometrial cancer who underwent total laparoscopic radical surgery at the Department of Obstetrics and Gynecology of San Gerardo Hospital were compared to nonobese patients. The same group of obese patients was compared with patients who underwent radical laparotomic surgery. Obesity was defined as a body mass index more than 30 kg/m2.

Results

Between September 2003 and September 2007, 75 women underwent TLRH. Median age was 54 years and median body mass index was 28 kg/m2. Thirty-seven women were obese.

There were no differences between nonobese and obese women in operative, time length of parametria and pelvic nodes removed and operative or late complications. Blood loss was significantly higher in obese patients.

Comparing retrospectively laparoscopy and laparotomy in obese women treated in our center, laparotomy was associated with decreased operative time, but also with increased blood loss, transfusion rate, duration of hospitalization and frequency of post surgical complications.

Conclusions

Total laparoscopic radical hysterectomy (with pelvic lymphadenectomy) is a safe option in patients with endometrial cancer. Obesity is not a contraindication to perform a TRLH with no differences in surgical parameters between obese and nonobese population. TLRH show a significant decrease of complications compared to laparotomic radical surgery in obese women.

Keywords

Laparoscopy Endometrial cancer Obesity TLRH 

References

  1. 1.
    Ries LA, Eisner MP, Kosary CL et al (2001) SEER cancer statistics review, 1973–1998. Bethesda National Cancer InstituteGoogle Scholar
  2. 2.
    Boronow RC, Morrow CP, Creasman WT, Disaia PJ, Silverberg SG, Miller A et al (1984) Surgical staging in endometrial cancer: clinical-pathologic findings of a prospective study. Obstet Gynecol 63(6):825–832PubMedGoogle Scholar
  3. 3.
    Eltabbakh GH (2002) Analysis of survival after laparoscopy in women with endometrial cancer. Cancer 95:1894–1901. doi:10.1002/cncr.10928 PubMedCrossRefGoogle Scholar
  4. 4.
    Magrina JF, Mutone NF, Weaver AL et al (1999) Laparoscopic lymphadenectomy and vaginal or laparoscopic hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer: morbidity and survival. Am J Obstet Gynecol 181:376–381. doi:10.1016/S0002-9378(99)70565-X PubMedCrossRefGoogle Scholar
  5. 5.
    Magrina JF, Weaver AL (2004) Laparoscopic treatment of endometrial cancer: five year recurrence and survival rates. Eur J Gynaecol Oncol 25:439–441PubMedGoogle Scholar
  6. 6.
    Spirtos NM, Schlaerth JB, Bross GM, Spirtos TW (1996) Cost and quality-of-life analysis of surgery for early endometrial cancer: laparotomy vs laparoscopy. Am J Obstet Gynecol 174:1795–1800. doi:10.1016/S0002-9378(96)70212-0 PubMedCrossRefGoogle Scholar
  7. 7.
    Zullo F, Palomba S, Russo T, Falbo A, Costantino M, Tolino A 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. Am J Obstet Gynecol 193(4):1344–1352. doi:10.1016/j.ajog.2005.02.131 PubMedCrossRefGoogle Scholar
  8. 8.
    Piver MS, Rutledge F, Smith JP (1974) Five classes of extended hysterectomy for women with cervical cancer. Obstet Gynecol 44:265–272PubMedGoogle Scholar
  9. 9.
    Spirtos NM, Eisenkop SM, Schlaerth JB, Ballon SC (2002) Laparoscopic radical hysterectomy (type III) with aortic and pelvic lymphadenectomy in patients with stage I cervical cancer: surgical morbidity and intermediate follow-up. Am J Obstet Gynecol 187(2):340–348. doi:10.1067/mob.2002.123035 PubMedCrossRefGoogle Scholar
  10. 10.
    Hsieh YY, Lin WC, Chang CC, Yeh LS, Hsu TY, Tsai HD (1998) Laparoscopic radical hysterectomy with low paraaortic, subaortic and pelvic lymphadenectomy. Results of short-term follow-up. J Reprod Med 43:528–534PubMedGoogle Scholar
  11. 11.
    Gemignani ML, Curtin JP, Zelmanovich J, Patel DA, Venkatraman E, Barakat RR (1999) Laparoscopic-assisted vaginal hysterectomy for endometrial cancer: clinical outcomes and hospital charges. Gynecol Oncol 73:5–11. doi:10.1006/gyno.1998.5311 PubMedCrossRefGoogle Scholar
  12. 12.
    Holub Z, Voracek J, Shomani A (1998) A comparison of laparoscopic surgery with open procedure in endometrial cancer. Eur J Gynec Oncol 9:294–296Google Scholar
  13. 13.
    Holub Z (2003) The role of laparoscopy in the surgical treatment of endometrial cancer. Clin Exp Obstet Gynecol 30(1):7–12 ReviewPubMedGoogle Scholar
  14. 14.
    Magrina JF (2005) Outcomes of laparoscopic treatment for endometrial cancer. Curr Opin Obstet Gynecol 17(4):343–346. doi:10.1097/01.gco.0000175350.18308.73 PubMedGoogle Scholar
  15. 15.
    La Vecchia C, Parazzini F, Negri E, Fasoli M, Gentile A, Franceschi S (1991) Anthropometric indicators of endometrial cancer risk. Eur J Cancer 27(4):487–490PubMedCrossRefGoogle Scholar
  16. 16.
    Shoff SM, Newcomb PA (1998) Diabetes, body size, and risk of endometrial cancer. Am J Epidemiol 148(3):234–240PubMedGoogle Scholar
  17. 17.
    Pitkin RM (1976) Abdominal hysterectomy in obese women. Surg Gynecol Obstet 142:532–536PubMedGoogle Scholar
  18. 18.
    Obermair A, Manolitsas TP, Leung Y, Hammond IG, McCartney AJ (2005) Total laparoscopic hysterectomy versus total abdominal hysterectomy for obese women with endometrial cancer. Int J Gynecol Cancer 15(2):319–324. doi:10.1111/j.1525-1438.2005.15223.x PubMedCrossRefGoogle Scholar
  19. 19.
    Ostrzenski A (1999) Laparoscopic total abdominal hysterectomy in morbidly obese women. J Reprod Med 44:853–858PubMedGoogle Scholar
  20. 20.
    Holub Z, Bartos P, Jabor A, Eim J, Fischlova D, Kliment L (2002) Laparoscopic surgery in obese women with endometrial cancer. J Am Assoc Gynecol Laparosc 7:83–88. doi:10.1016/S1074-3804(00)80014-6 CrossRefGoogle Scholar
  21. 21.
    Kuoppala T, Tomas E, Heinonen PK (2004) Clinical outcome and complications of laparoscopic surgery compared with traditional surgery in women with endometrial cancer. Arch Gynecol Obstet 270(1):25–30. doi:10.1007/s00404-003-0488-7 PubMedCrossRefGoogle Scholar
  22. 22.
    Abu-Rustum NR, Gemignani ML, Moore K, Sonoda Y, Venkatraman E, Brown C et al (2003) Total laparoscopic radical hysterectomy with pelvic lymphadenectomy using the argon-beam coagulator: pilot data and comparison to laparotomy. Gynecol Oncol 91(2):402–409. doi:10.1016/S0090-8258(03)00518-3 PubMedCrossRefGoogle Scholar
  23. 23.
    Childers JM, Brzecheffa PR, Hatch KD, Surwit EA (1993) Laparoscopically assisted surgical staging (LASS) of endometrial cancer. Gynecol Oncol 51:33–38. doi:10.1006/gyno.1993.1242 PubMedCrossRefGoogle Scholar
  24. 24.
    Pelosi MA (1994) Laparoscopically-assisted hysterectomy in women weighing 200 lb or more. Gynaecol Endosc 3:159–162Google Scholar
  25. 25.
    Eltabbakh GH, Piver MS, Hempling RE, Recio FO (1999) Laparoscopic surgery in obese women. Obstet Gynecol 94:704–708. doi:10.1016/S0029-7844(99)00406-8 PubMedCrossRefGoogle Scholar
  26. 26.
    Kadar N (1995) Laparoscopic pelvic lymphadenectomy in obese women with gynecologic malignancies. J Am Assoc Gynecol Laparosc 2:163–167. doi:10.1016/S1074-3804(05)80011-8 PubMedCrossRefGoogle Scholar
  27. 27.
    Eltabbakh GH, Shamonki MI, Moody JM, Garafano LL (2000) Hysterectomy for obese women with endometrial cancer: laparoscopy or laparotomy? Gynecol Oncol 78:329–335. doi:10.1006/gyno.2000.5914 PubMedCrossRefGoogle Scholar
  28. 28.
    Yu CK, Cutner A, Mould T, Olaitan A (2005) Total laparoscopic hysterectomy as a primary surgical treatment for endometrial cancer in morbidly obese women. BJOG 112(1):115–117. doi:10.1111/j.1471-0528.2004.00335.x PubMedCrossRefGoogle Scholar
  29. 29.
    Ghezzi F, Cromi A, Bergamini V, Uccella S, Beretta P, Franchi M et al (2006) Laparoscopic-assisted vaginal hysterectomy versus total laparoscopic hysterectomy for the management of endometrial cancer: a randomized clinical trial. J Minim Invasive Gynecol 13(2):114–120. doi:10.1016/j.jmig.2005.11.013 PubMedCrossRefGoogle Scholar
  30. 30.
    Malur S, Possover M, Michels W, Schneider A (2001) Laparoscopic-assisted vaginal versus abdominal surgery in patients with endometrial cancer—a prospective randomized trial. Gynecol Oncol 80(2):239–244. doi:10.1006/gyno.2000.6069 PubMedCrossRefGoogle Scholar
  31. 31.
    Tozzi R, Malur S, Koehler C, Schneider A (2005) Laparoscopy versus laparotomy in endometrial cancer: first analysis of survival of a randomized prospective study. J Minim Invasive Gynecol 12(2):130–136. doi:10.1016/j.jmig.2005.01.021 PubMedCrossRefGoogle Scholar
  32. 32.
    Holub Z, Jabor A, Bartos P et al (2003) Laparoscopic surgery in women with endometrial cancer: the learning curve. Eur J Obstet Gynecol 107:195–200. doi:10.1016/S0301-2115(02)00373-1 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Antonio Pellegrino
    • 1
  • Mauro Signorelli
    • 1
  • Robert Fruscio
    • 1
  • Annalisa Villa
    • 1
  • Alessandro Buda
    • 1
  • Pietro Beretta
    • 1
  • Annalisa Garbi
    • 1
  • Domenico Vitobello
    • 1
  1. 1.Clinica Ostetrica e Ginecologica, Division of Gynecologic Oncology, Ospedale San GerardoUniversity of Milan-BicoccaMonza, MilanItaly

Personalised recommendations