At Principe De Asturias Hospital in Madrid, Spain, between January 1997 and December 2003, 75 women with stage I or II endometrial cancer were treated either with laparoscopic-assisted vaginal hysterectomy and pelvic lymphadenectomy (n = 38) or with total abdominal hysterectomy and pelvic lymphadenectomy (n = 37). This article presents a comparison of these two groups. Patients were not randomized to treatment; abdominal surgeries were more frequent in the early years, and laparoscopic procedures more common in the later years. All patients underwent initial pelvic and abdominal washing and inspection followed by pelvic lymphadenectomy. Paraaortic lymphadenectomy was performed after hysterectomy if there were positive pelvic lymph nodes. In laparoscopic procedures, a 10-mm umbilical and another inter-xipho-umbilical port and two 5-mm punctures in each lower abdominal quadrant were used. Lymph nodes were collected in a bag that was placed in the pouch of Douglas at the beginning of the procedure and then removed through the 10-mm umbilical trocar. The uterine vessels were sutured by either the laparoscopic or vaginal route. A midline incision was used for abdominal procedures. Patients were seen at a follow-up visit every 6 months for 5 years and then once a year. The mean operating time for the laparoscopic vaginal hysterectomy (LPS) group was 165 minutes (range, 77-240 minutes) compared with 130 minutes (range, 60-180 minutes) for the abdominal hysterectomy (LPM) group (P <0.05). There were seven (19%) intraoperative complications in the LPM group, including blood loss greater than 1000 mL in three patients and bladder and bowel injury in two patients each. In the LPS group, two patients had excessive bleeding, two patients with an uncontrollable hypercapnia were converted to laparotomy, and one patient with a ureteral abnormality had a double-J catheter inserted to maintain patency (five total intraoperative complications; 13%). Postoperative complications were seen in 39% of the LPM group compared with 18% of the LPS group. Overall, nine women had an abscess or hematoma, which was in the abdominal incision in five LPM and one LPS patient and in the vaginal vault in three LPS patients. There were five instances of fever in the LPM group and three in the LPS group. One LPM patient had a deep vein thrombosis and three LPM patients had postoperative ileus greater than 3 days. Four women who had laparotomy required postoperative blood transfusion. Three patients in this group were readmitted to the hospital for treatment of abscess or fever. No patient in the laparoscopically treated group required transfusion or readmission. There were no differences between the two groups in the number or location of lymph nodes removed or in the pathologic results. Postoperative adjuvant radiotherapy was given to all patients with a pathologic diagnosis of stage IB,G2 or greater. After a mean follow up of 53 months (range, 5-90 months) in patients who had laparotomy, 30(81%) are free of disease, two (5%) are alive with recurrence, three (8%) are dead, and two have been lost to follow up. The mean follow up for women who underwent laparoscopy was 36 months (range, 9-65 months). Thirty-one (82%) of these women are alive, two (5%) are alive with disease, four (10.5%) are dead, and one has been lost to follow up. A total of four patients developed recurrent disease. There was one recurrence in the retroperitoneum, one in the lung (LPM group), one in the vaginal vault, and one bone metastasis (LPS group). All were alive at the time of publication.
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Jan 1, 2019
Bv Sunil + 4
