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

Abstract

We compared laparoscopic approach with the conventional laparotomy approach for the treatment of patients with endometrial carcinoma in developing country. Two hundred and seventy-two patients with endometrial carcinoma were enrolled in a prospective randomized trial and treated with laparoscopic or laparotomy approach. 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). 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.