Abstract
After minimally invasive surgery gained popularity in gynecology, laparoscopic operations became widespread among oncologic operations. However, more studies evaluating experiences of oncologic surgeons during the learning period of laparoscopy are needed. To compare the surgical outcomes and perioperative complications of laparoscopic surgery and laparotomy in the treatment of early-stage endometrioid endometrial cancer patients, we retrospectively investigated patients who underwent surgery due to endometrial cancer at our institution between 2014 and 2018. Early-stage (stage I) endometrioid endometrial cancer patients were included in the study. Operative times, length of hospital stay, extracted pelvic lymph nodes, perioperative complications, and blood loss were compared. A total of 128 patients were treated for stage I endometrial cancer during the study period. Sixty-two patients (48.4%) underwent laparoscopic surgery, and 66 (51.6%) patients underwent laparotomy. Median operation time and pelvic lymph node count in the laparotomy and laparoscopy groups did not demonstrate statistically significant differences. However, the length of hospital stay, estimated blood loss, and perioperative complication rate were lower in the laparoscopic surgery group. Laparoscopic surgery in early-stage endometrial cancer may be performed with less blood loss, shorter duration of hospital stays, and similar lymph node counts compared to laparotomic surgery.
Highlights
Endometrial cancer (EC) is the most common type of gynecological malignancy among women in developed countries [1] and the second most common in developing countries [2]
We reviewed the records of 321 patients who underwent surgical staging due to endometrial cancer in our gynecologic oncology department between 2014 and 2018
While lymph node dissection is controversial, paraaortic lymphadenectomy is performed at our institution to the level of the inferior mesenteric artery in patients with greater than 50% myometrial invasion (MI) grade I-II endometrioid adeno cancer; this is because adjuvant therapy after surgery is influenced by the stage of the disease
Summary
Endometrial cancer (EC) is the most common type of gynecological malignancy among women in developed countries [1] and the second most common in developing countries [2]. Studies evaluating oncologic outcomes including rates of recurrence, disease-free survival (DFS), and overall survival demonstrated noninferiority of laparoscopy for patients with early-stage endometrial cancer [12,13,14]. More studies are required which evaluate early experiences of oncologic surgeons during the learning period of laparoscopy. Accessing minimally invasive surgery for gynecologic cancer patients could have significant impacts on morbidity, mortality, and quality of life in low- and middle-income countries compared to developed countries [16, 18]. More research from developing countries is required to establish the surgical and oncologic outcomes of the laparoscopic surgery in treatment of gynecologic malignancies. E aim of the present study is to compare a single center experience of laparoscopic and laparotomic approaches for the treatment of early-stage endometrioid EC in a developing country
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