Endometrial Carcinoma: 178 Patients Treated by Laparoscopy

Abstract

Study Objective: To evaluate results and complications of laparoscopic surgery in patients with cancer of endometrium.Design: Descriptive retrospective study. Patients with incomplete data during the picking up or the follow-up as well as those with other synchronic cancers were excluded.Setting: Unit of Gynecologic Oncology and Endoscopy of the Hospital 12 de Octubre. Madrid. Spain.Patients: 178 patients diagnosed of endometrial cancer during the years 2001 to 2007.Intervention: Laparoscopic total extrafascial hysterectomy with bilateral anexectomy. Pelvic lymphadenectomy. Para-aortic lymphadenectomy. Omentectomy.Measurements and Main Results: Mean age was 63 years. Mean age of menopause was 51 years. Mean value of Body Mass Index was 30. 18 patients had previous treatment with tamoxifen for breast cancer. Mean value of the pre-surgical Ca125 was 31 UI/ml. 18% of the patients had any previous abdominal surgical procedure. Distribution for stages: IA=70,2%, IB=20,8%, IIA=1,7%, IIB=1,1%, IIIA=2,2%, IIIB=0%, IIIC=3,9% and IV=0 %. 51% of tumors were high differentiated, 27% moderate and 22% poorly. 88% of them corresponded to endometrial adenocarcinomas. Lymphadenectomy was practiced to the 58% of the patients. In 48% of the cases uterus was sent to intraoperatory study. Mean pre-surgical hemoglobine was 13.4gr/dl and post-surgical 11.3gr/dl. Ten patients (7,5 %) required blood transfusion. The mean duration of the procedure was 173 minutes (range 60-360 minutes). Intraoperatory complications were: significant hemorrhage in three patients, uterine perforation in three patients and difficulty for the uterine extraction in two cases because of myomas. 3,8% of the cases were reconverted into laparotomy. Postoperative complications were: Fever, haematoma of abdominal wall, paralytic ileus and re-intervention. The mean hospitalization was 5 days (range 2-24).Conclusion: The laparoscopic approach is adequate in the treatment of the cancer of endometrium, with the same level of radicality than laparotomy, and with a fall rate of complications. Study Objective: To evaluate results and complications of laparoscopic surgery in patients with cancer of endometrium. Design: Descriptive retrospective study. Patients with incomplete data during the picking up or the follow-up as well as those with other synchronic cancers were excluded. Setting: Unit of Gynecologic Oncology and Endoscopy of the Hospital 12 de Octubre. Madrid. Spain. Patients: 178 patients diagnosed of endometrial cancer during the years 2001 to 2007. Intervention: Laparoscopic total extrafascial hysterectomy with bilateral anexectomy. Pelvic lymphadenectomy. Para-aortic lymphadenectomy. Omentectomy. Measurements and Main Results: Mean age was 63 years. Mean age of menopause was 51 years. Mean value of Body Mass Index was 30. 18 patients had previous treatment with tamoxifen for breast cancer. Mean value of the pre-surgical Ca125 was 31 UI/ml. 18% of the patients had any previous abdominal surgical procedure. Distribution for stages: IA=70,2%, IB=20,8%, IIA=1,7%, IIB=1,1%, IIIA=2,2%, IIIB=0%, IIIC=3,9% and IV=0 %. 51% of tumors were high differentiated, 27% moderate and 22% poorly. 88% of them corresponded to endometrial adenocarcinomas. Lymphadenectomy was practiced to the 58% of the patients. In 48% of the cases uterus was sent to intraoperatory study. Mean pre-surgical hemoglobine was 13.4gr/dl and post-surgical 11.3gr/dl. Ten patients (7,5 %) required blood transfusion. The mean duration of the procedure was 173 minutes (range 60-360 minutes). Intraoperatory complications were: significant hemorrhage in three patients, uterine perforation in three patients and difficulty for the uterine extraction in two cases because of myomas. 3,8% of the cases were reconverted into laparotomy. Postoperative complications were: Fever, haematoma of abdominal wall, paralytic ileus and re-intervention. The mean hospitalization was 5 days (range 2-24). Conclusion: The laparoscopic approach is adequate in the treatment of the cancer of endometrium, with the same level of radicality than laparotomy, and with a fall rate of complications.