Laparoscopic radical hysterectomy and lymphadenectomy for endometrial cancer

Abstract

The development of laparoscopic surgery to its current status wherein the most complex procedures can be performed laparoscopically today has completely changed the connotations of surgery in the modern world including that of many cancer surgeries. The key to surgical management of endometrial cancer is identification of patients at risk of retroperitoneal nodal metastasis. Even in stage I disease this can be as high as 45%. The relevance of lymphadenectomy is the improved survival in patients as well as the informed tailoring of post-operative adjuvant radiotherapy. On the other hand, it spares unnecessary radiation exposure to the bowel and abdomen in node negative patients. The author's experience is described where the last 5 cases of conventional radical hysterectomy with pelvic and para-aortic lymphadenectomy are compared retrospectively with the first five cases performed laparoscopically for the surgical management of endometrial cancer. The advantages of laparoscopic management of endometrial cancer is that it usually has a similar or a shorter operating time which in occasional series has been reported to be longer. It improves with surgical experience of the operating surgeon. Laparoscopy has a shorter hospitalization period. It results in less blood loss. It has similar financial cost though sometimes the costs may be higher from use of disposable instruments. Laparoscopy is feasible even in obese women. It results in improved quality of life. Moreoever, the lower perioperative morbidity with similar or better yield of pelvic and para aortic lymph nodes, similar or less complications and similar recurrence free survival are obvious endearing benefits of the laparoscopic approach.