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Comparison of laparoscopy and laparotomy for management of endometrial carcinoma: a prospective randomized study with 11-year experience

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Abstract

Purpose

We compared laparoscopic approach with the conventional laparotomy approach for the treatment of patients with endometrial carcinoma in developing country.

Methods

Two hundred and seventy-two patients with endometrial carcinoma were enrolled in a prospective randomized trial and treated with laparoscopic or laparotomy approach.

Results

One hundred and fifty-one patients were treated by laparoscopy, while one hundred and twenty-one patients were treated by laparotomy. The median operative time was 211 min in the laparoscopy group and 231 min in the laparotomy group (P > 0.05). The median blood loss was 86 ml in the laparoscopy group and 419 ml in the laparotomy group (P < 0.05). The median length of hospital stay was 3 days in the laparoscopy group and 6 days in the laparotomy group (P < 0.05). Pelvic lymphadenectomy was performed in all the patients. Para-aortic lymphadenectomy was performed in 15 % of the laparoscopy and 31.4 % of laparotomy group (P < 0.05). The overall survival and 5-year survival rate for the TLH were 94 and 96 % compared with 90.1 and 91 % in the TAH, respectively (P > 0.05).

Conclusions

Laparoscopic surgery is a safe and reliable alternative to laparotomy in the management of endometrial carcinoma patients, with significantly reduced hospital stay and postoperative complications; however, it does not seem to improve the overall survival and 5-year survival rate, although multicenter randomized trials are required to evaluate the overall oncologic outcomes of this procedure.

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References

  • Abu-Rustum NR, Alektiar K, Iasonos A, Lev G, Sonoda Y, Aghajanian C et al (2006) The incidence of symptomatic lower-extremity lymphedema following treatment of uterine corpus malignancies : a 12-year experience at Memorial Sloan-Kettering Cancer Center. Gynecol Oncol 103:714–718

    Article  PubMed  Google Scholar 

  • Abu-Rustum NR, Gomez JD, Alektiar KM et al (2009) The incidence of isolated paraaortic nodal metastasis in surgically staged endometrial cancer patients with negative pelvic lymph nodes. Gynocol Oncol 115:236–238

    Article  Google Scholar 

  • ACOG Practice Bulletin (2005) Clinical management guidelines for obstetrician-gynecologists. Management of endometrial cancer. Obstet Gynecol 106:413–424

    Article  Google Scholar 

  • ASTEC Study Group, Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK (2009) Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomized study. Lancet 373:125–136

    Article  PubMed  CAS  Google Scholar 

  • Benedetti PP, Basile S, Maneschi F, Alberto Lissoni A, Sigorelli M, Scambia G et al (2008) Systematic pelvic lymphadenectomy vs no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 100:1707–1716

    Article  Google Scholar 

  • Chan JK, Cheung MK, Huh WK, Osann K, Husain A, Teng NN et al (2006) Therapeutic role of lymph node resection in endometrioid corpus cancer. a study of 12,333 patients. Cancer 107:1823–1830

    Article  PubMed  Google Scholar 

  • Chiang AJ, Yu KJ, Chao KC, Teng NN (2011) The incidence of isolated paraaortic nodal metastasis in completely staged endometrial cancer patients. Gynecol Oncol 121:122–125

    Article  PubMed  Google Scholar 

  • Childers JM, Surwit EA (1992) Combined laparoscopic and vaginal surgery for the management of two cases of stage I endometrial cancer. Gynecol Oncol 45:46–51

    Article  PubMed  CAS  Google Scholar 

  • Clagett GP, Anderson FA Jr, Geerts W, Heit JA, Knudson M, Lieberman JR et al (1998) Prevention of venous thromboembolism. Chest 114:531S–560S

    Article  PubMed  CAS  Google Scholar 

  • Creasman WT, Odicino F, Maisonneuve P, Quinn MA, Beller U, Benedet JL et al (2006) Carcinoma of the corpus uteri. FIGO 6th annual report on the results of treatment in gynecological cancer. Int J Gynaecol Obstet 95(Suppl 1):S105–S143

    Article  PubMed  Google Scholar 

  • DiSaia PJ, Creasman WT, Boronow RC, Blessing JA (1985) Risk factors and recurrent patterns in stage I endometrial cancer. Am J Obstet Gynecol 151:1009–1015

    PubMed  CAS  Google Scholar 

  • Eltabbakh GH (2002) Analysis of survival after laparoscopy in women with endometrial cnacer. Cancer 95:1894101

    Article  Google Scholar 

  • Eltabbakh GH, Mount SL (2006) Laparoscopic surgery does not increase the positive peritoneal cytology among women with endometrial carcinoma. Gynecol Oncol 100:361–364

    Article  PubMed  Google Scholar 

  • Eltabbakh GH, Shamonki MI, Moody JM, Garafano LL (2000) Hysterectomy for obese women with endometrial cancer: laparoscopy or laparotomy? Gynecol Oncol 78:329–335

    Article  PubMed  CAS  Google Scholar 

  • Holland CM, Latimer JA, Crawford RAF (2004) Vaginal cuff recurrence of endometrial cancer treated by laparoscopic-assisted vaginal hysterectomy. Gynecol Oncol 92:1015–1016

    Article  PubMed  Google Scholar 

  • Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C et al (2006) Cancer statistics. CA Cancer J Clin 56(2):106–130

    Article  PubMed  Google Scholar 

  • Jie J, Zhang Z-Y, Li Z, Liu C, Zhan Y, Qiao B et al (2012) Two mechanical methods for thromboembolism prophylaxis after gynaecological pelvic surgery: a prospective, randomized study. CMJ 125:4259–4263

    Google Scholar 

  • Kalogiannidis Ioannis, Lambrechts Sandrijne, Amant Frederic, Neven Patrick, Van Gorp Toon, Vergote Ignace (2007) Laparoscopy-assisted vaginal hysterectomy compared with abdominal hysterectomy in clinical stage I endometrial cancer: safety, recurrence, and long-term outcome. Am J Obstet Gynecol 196:248.e1–248.e8

    Article  Google Scholar 

  • Magrina JF, Mutone NF, Weaver AL, Magtibay PM, Fowler RS, Cornella JL (1999) Laparoscopic hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer: morbidity and survival. Am J Obstet Gynecol 181:376–381

    Article  PubMed  CAS  Google Scholar 

  • 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 80:239–244

    Article  PubMed  CAS  Google Scholar 

  • Malzoni Mario, Tinelli R, Cosentino F, Perone C, Rasile M, Iuzzolino D, Malzoni C (2009) Harry Reich total laparoscopic hysterectomy versus abdominal hysterectomy with lymphadenectomy for early-stage endometrial cancer: a prospective randomized study. Gynecol Oncol 112:126–133

    Article  PubMed  Google Scholar 

  • May K, Bryant A, Dickinson HO, Kehoe S, Morrison J (2010) Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev 1:CD7585

    Google Scholar 

  • Morrow CP, Bundy BN, Kurman RJ, Creasman WT, Heller P, Homesley HD, Graham JE (1991) Relationship between surgical pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a Gynecologic Oncology Group study. Gynecol Oncol 40:55–65

    Article  PubMed  CAS  Google Scholar 

  • Mourits MJ, Bijen CB, Arts HJ et al (2010) Safety of laparoscopy versus laparotomy in early stage endometrial cancer: a randomized trial. Lancet Oncol 11:763–771

    Article  PubMed  Google Scholar 

  • Muntz HG, Goff BA, Madsen BL, Yon JL (1999) Port-site recurrence after laparoscopic surgery for endometrial carcinoma. Obstet Gynecol 93:807–809

    Article  PubMed  CAS  Google Scholar 

  • Nunns D, Williamson K, Swaney L, Davy M (2000) The morbidity of surgery and adjuvant radiotherapy in the management of endometrial carcinoma. Int J Gynecol Cancer 10:2333–2338

    Google Scholar 

  • Obermair A, Manolitsas TP, Leung Y, Hammond IG, McCartney AJ (2004) Total laparoscopic hysterectomy for endometrial cancer: patterns of recurrence and survival. Gyneco Oncol 92:789–793

    Article  Google Scholar 

  • Palomba S, Falbo A, Mocciaro R, Russo T, Zullo F (2009) Laparoscopic treatment for endometrial cancer: a meta-analysis of randomized controlled trials (RCTs). Gynecol Oncol 112:415–421

    Article  PubMed  Google Scholar 

  • Salani R, Gerardi MA, Barlin JN, Veras E, Bristow RE (2009) Surgical approaches and short-term surgical outcomes for patients with morbid obesity and endometrial cancer. J Gynecol Surg 25:41–48

    Article  Google Scholar 

  • Seracchioli R, Venturoli S, Ceccarini M, Cantarelli M, Ceccaroni M, Pignotti E, De Aloysio D, De Iaco P (2005a) Is total laparoscopic surgery for endometrial carcinoma at risk of local recurrence? Long-term Surviv Anticancer Res 25:2423–2428

    Google Scholar 

  • Seracchioli R, Venturoli S, Ceccarini M, Cantarelli M, Ceccaroni M, Pignotti E, De Aloysio D, De Laco P (2005b) Is total laparoscopic surgery for endometrial carcinoma at risk of local recurrence? A long-term survival. Anticancer Res 25:2423–2428

    PubMed  Google Scholar 

  • Todo Y, Yamamoto R, Minobe S, Suzuki Y, Takeshi U, Nakatani M et al (2010a) Risk factors for postoperative lower-extremity lymphedema in endometrial cancer survivors who had treatment including lymphadenectomy. Gynecol Oncol 119:60–64

    Article  PubMed  Google Scholar 

  • Todo Y, Kato H, Kaneuchi M, Watari H, Takeda M, Sakuragi N (2010b) Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet 375:1165–1172

    Article  PubMed  Google Scholar 

  • Todo Y, Kato H, Kaneuchi I, Watari H, Takeda M, Sakuragi N (2010c) Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet 375:1165–1172

    Article  PubMed  Google Scholar 

  • Tozzi R, Malur S, Koehler C, Schneider A (2005) Analysis of morbidity in patients with endometrial cancer: is there a commitment to offer laparoscopy? Gynecol Oncol 97:4–9

    Article  PubMed  Google Scholar 

  • Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS (2009) Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. J Clin Oncol 27:5331–5336

    Article  PubMed  Google Scholar 

  • Yun-Hyun Cho, Dae-Yeon Kim, Jong-Hyeok Kim, Yong-Man Kim, Young-Tak Kim, Joo-Hyun Nam (2007) Laparoscopic management of early uterine cancer: 10-year experience in Asan Medical Center 106:585–590

    Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Beijing Chao-yang Hospital Affiliated to Capital Medical University, Gongti South Road, No. 8, Chaoyang District, Beijing, 100020, China

    Qi Lu, Chongdong Liu, Shuzhen Wang, Shuhong Li, Shuli Guo, Junli Lu & Zhenyu Zhang

  2. Department of Obstetrics and Gynecology, The First People Hospital of Yangzhou, Yangzhou, 225001, Jiangsu, China

    Haiyan Liu

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  1. Qi Lu
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  2. Haiyan Liu
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  3. Chongdong Liu
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  4. Shuzhen Wang
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  7. Junli Lu
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Correspondence to Zhenyu Zhang.

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Lu, Q., Liu, H., Liu, C. et al. Comparison of laparoscopy and laparotomy for management of endometrial carcinoma: a prospective randomized study with 11-year experience. J Cancer Res Clin Oncol 139, 1853–1859 (2013). https://doi.org/10.1007/s00432-013-1504-3

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  • DOI: https://doi.org/10.1007/s00432-013-1504-3

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