Laparoscopic Approach in Surgical Staging of Endometrial Cancer

A cohort of women with preoperative diagnosis of endometrial cancer who underwent surgical staging was retrospectively evaluated. The main study end points were: morbidity and mortality, hospital length of stay, perioperative adverse events and recurrence rate. Data analysis was performed with the software SPSS v25 (IBM Corp., Armonk, NY, USA), categorical variables using a Chi-square and Fisher test, and continuous variables using the Student t-test.

Results

Atotal of 162 patientswere analyzed. 138 patientsmet the inclusion criteria, 41of whom underwent staging by laparoscopy and 97 by laparotomy. Conversions from laparoscopy to laparotomy happened in 2 patients (4.9%) and were secondary to technical difficulties and poor exposure. Laparoscopy had fewer postoperative adverse events when compared with laparotomy (7.3% vs 23.7%, respectively; p = 0.005), but similar rates of intraoperative complications, despite having a significantly longer operative time (median, 175 vs 130 minutes, respectively; p < 0.001). Hospital stay was significantly lower in laparoscopy versus laparotomy patients (median, 3 vs 7 days, respectively; p < 0.001). No difference in recurrence or mortality rates were observed.

Conclusion

Laparoscopic surgical staging for endometrial cancer is feasible and safe. Patients have lower postoperative complication rates and shorter hospital stays when compared with the approach by laparotomy.

Keywords:
endometrial neoplasms; laparoscopy; neoplasm staging; hysterectomy; lymph node excision

	Laparotomy (n= 97)	Laparoscopy (n= 41)	P-value
Age (years)	66 (59.0–74.0)	68 (62.0–76.0)	0.32
BMI (Kg/cm²)	30.5 (27.0–35.4)	29.9 (25.0–32.3)	0.26
Obesity (n)	55 (56.7%)	20 (48.8%)	0.25
Anterior surgery (n)	25 (25.8%)	4 (9.8%)	0.04

	Laparotomy (n= 97)	Laparoscopy (n= 41)	P-value
Surgical stage (n)			0.92
IA	51 (52.6%)	25 (61%)
IB	22 (22.7%)	8 (19.5%)
II	4 (4.1%)	1 (2.5%)
III	17 (17.5%)	6 (14.5%)
IV	3 (3.1%)	1 (2.5%)
Histologic grade (n)			0.44
Grade 1	34 (35.1%)	15 (36.6%)
Grade 2	39 (40.2%)	20 (48.8%)
Grade 3	24 (24.7%)	6 (14.6%)
Histologic type (n)
Endometrioid adenocarcinoma	78 (80.4%)	36 (87.8%)	0.64
Serous carcinoma	9 (9.3%)	3 (4.1%)
Clear cell carcinoma	2 (2.1%)	0 (0%)
Carcinosarcoma	3 (3.1%)	3 (4.1%)
Mixed carcinoma	4 (4.1%)	3 (4.1%)
Undifferentiated	1 (1%)	0 (0%)

	Laparotomy (n= 97)	Laparoscopy (n= 41)	P-value
Surgery type (n)			0.24
Total hysterectomy + bilateral salpingo-oophorectomy^a with or without omentectomy.	61 (62.9%)	30 (73.2%)
Total hysterectomy + bilateral salpingo-oophorectomy + pelvic and para-aortic lymphadenectomy^a with or without omentectomy.	32 (34.8%)	8 (19.5%)
Total hysterectomy + bilateral salpingo-oophorectomy + pelvic lymphadenectomy^a with or without omentectomy.	4 (2.3%)	3 (7.3%)
Pelvic nodes dissected	9 (6–12)	9 (7–11)	0.22
Aortic nodes dissected	3 (2–4)	4 (1–6)	0.06
Uterus weight (gr)	98.0 (67.0–161.0)	88.0 (74.3–125)	0.24
Staging (n)			0.28
Complete	77 (79.4%)	30 (73.2%)
Incomplete	20 (20.6%)	11 (26.8%)

	Laparotomy (n= 97)	Laparoscopy (n= 41)	P-value
Intraoperative complications (n)
None	93 (95.9%)	36 (87.8%)	0.88
Hemorrhagic shock	1 (1%)	0 (0%)
Visceral injurie	2 (2.1%)	1 (2.4%)
Vasculo-nerve injurie	1 (1%)	1 (2.4%)
Uterus laceration	0 (0%)	2 (4.9%)
Vaginal laceration	0 (0%)	1 (2.4%)
Postoperative complication (n)			0.005
None	74 (76.3%)	38 (92.8%)
Wound dehiscence ^a with need for reintervention (reoperation or readmission).	10 (10.3%)	1 (2.4%)
Wound or abdominal infection ^a with need for reintervention (reoperation or readmission).	4 (4.1%)	1(2.4%)
Hemoperitoneum ^a with need for reintervention (reoperation or readmission).	1 (1.0%)	0 (0%)
Thromboembolic events	2 (2.1%)	0 (0%)
Neuropathy	0 (0%)	1 (2.4%)
Ileus/bowel obstruction	2 (2.1%)	0 (0%)
Incisional hernia	4 (4.1%)	0 (0%)
Blood transfusion (n)	4 (4.1%)	1 (2.4%)	0.63

	Laparoscopy (n= 97)	Laparotomy (n= 41)	P-value
Clinical and imaging surveillance only	51 (52.6%)	27 (65.8%)	0.28
Radiation	22 (22.7%)	6 (14.6%)
Radiation plus chemotherapy	12 (12.4%)	6 (14.6%)
Chemotherapy	11 (11.3%)	1 (2.5%)
Hormonal therapy	1 (1%)	1 (2.5%)

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[1] Address for correspondence
Mariana Mouraz, MD, Departamento de Ginecologia e Obstetrícia, Hospital Dr. José de Almeida, Praceta Filinto Elísio, N 10, RC B. 2790-069 Carnaxide, Portugal (e-mail: mariana_mouraz@hotmail.com).