A COMPARISON OF LAPAROSCOPIC SURGERY WITH CLASSIC OPEN PROCEDURE IN ENDOMETRIAL CANCER
Abstract
Background. Traditional surgical technique applied in the treatment of endometrial carcinoma is total abdominal hysterectomy combined with bilateral salpingooophorectomy. Laparoscopic surgical technique, providing the possibility of simultaneous hysterectomy and lymphadenectomy through the vagina, represents the alternative to laparotomy. The objective of this analysis was to evaluate periand postoperative parameters of both techniques, and the appropriateness of the number of removed nodes.
Methods. This retrospective comparative analysis involved 36 patients (Group LAVH), who underwent laparoscopic surgical treatment for stage I endometrial carcinoma in the period 1995–2003, and 24 randomly chosen patients (Group TELA), in whom the same surgical procedures were performed using abdominal approach. The data for comparison of general clinical parameters, duration of surgery, blood loss, early and late postoperative complications, duration of stay at the intensive care unit and hospital stay, were collected from the operative and anesthesiology records. Histologic findings provided histopathomorphologic data on carcinoma and the number of removed nodes. The comparison of all parameters was evaluated using Student T-test for continuous variables, and Chi-square test and Mann-Whitney test for categorical variables.
Results. General clinical parameters and the patient age were evenly distributed between the groups. The same applies for the distribution of mean blood loss and early postoperative complications. Two patients, treated laparoscopically, were re-admitted to hospital for pelvic abscess. The mean duration of stay at the intensive care unit was longer in the TELA group patients (3.3 ± 1.1) than in the LAVH group patients (2.1 ± 0.45) (F = 30.41; p < 0.0001). Also, most patients from the LAVH group were discharged from hospital on day 8 after surgery (8.47 ± 2.3 days), and on day 11 in the TELA group (11.7 ± 3.4 days) (F = 17.46; p < 0.0001). In the LAVH group mean 18 ± 6 nodes were removed, and in the TELA group 14 ± 8, the difference being statistically significant (p = 0.03).
Conclusions. Although this analysis was retrospective, the obtained results confirm the findings of other authors regarding the advantages offered by the laparoscopic technique, the most important being hysterectomy combined with salpingo-oophorectomy performed through the vagina, quicker postoperative recovery and satisfactory surgical staging for stage I endometrial cancer.
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