Laparoscopic treatment of endometrial cancer: feasibility and results

Obesity and perioperative pulmonary complications in robotic gynecologic surgery

OBJECTIVE

Robotic gynecological surgery is feasible in obese patients, but there remain concerns about the safety of this approach because the positioning required for pelvic surgery can exacerbate obesity-related changes in respiratory physiology. The objective of our study was to evaluate pulmonary and all-cause complication rates in obese women undergoing robotic gynecological surgery and to assess variables that may be associated with complications.

STUDY DESIGN

A retrospective chart review was performed on obese patients (body mass index of ≥30 kg/m(2)) who underwent robotic gynecological surgery at 2 academic institutions between 2006 and 2012. The primary outcome was pulmonary complications and the secondary outcome was all-cause complications. Univariate and multivariate logistic regression analyses were used to determine the associations between patient baseline variables, operative variables, ventilator parameters, and complications.

RESULTS

Of 1032 patients, 146 patients (14%) had any complication, whereas only 33 patients (3%) had a pulmonary complication. Median body mass index was 37 kg/m(2). Only age was significantly associated with a higher risk of pulmonary complications (P = .01). Older age, higher estimated blood loss, and longer case length were associated with a higher rate of all-cause complications (P = .0001, P < .0001, and P = .004, respectively). No other covariates were strongly associated with complications.

CONCLUSION

The vast majority of obese patients can successfully tolerate robotic gynecological surgery and have overall low complications rates and even lower rates of pulmonary complications. The degree of obesity was not predictive of successful robotic surgery and subsequent complications.

The laparoscopic-assisted vaginal approach to early endometrial cancer

INTRODUCTION

For the surgical treatment of endometrial cancer laparotomy still is regarded as the gold standard. Over the past decade, the laparoscopic approach has gained equivalence in FIGO stage I carcinomas.

RESULTS

Laparoscopic-assisted vaginal hysterectomy and bilateral salpingooophorectomy plus pelvic/paraaortic lymphadenectomy have shown short-term advantages such as reduced blood loss and shorter hospitalization without reducing oncological safety or outcome. This has already been confirmed by numerous smaller studies and recent randomized controlled trials with sufficient numbers of patients are being published.

CONCLUSION

Further acceptance of the technique is necessary to enable every gynecological oncologist to individualize treatment by offering minimal access options.

Role of robotic surgery in endometrial cancer

OPINION STATEMENT

Uterine cancer is the most common gynecologic cancer in women in the United States with an estimated number of 40,100 women diagnosed in 2008, the great majority of which belongs to endometrial classification. The traditional approach to treatment of endometrial cancer has been primarily surgery via an open, laparotomy incision. Minimally invasive approaches with smaller incisions, i.e., laparoscopy for the management of endometrial cancer was initially reported in 1992; however, its adoption has been slow due to the prolonged learning curve needed to become proficient in such a technique. Robotic-assisted surgery, a further advancement of traditional laparoscopy, using computer-based controls has been developed enabling the performance of complex procedures that otherwise had been too difficult to accomplish in a minimally invasive fashion. Robotic-assisted laparoscopic radical prostatectomy is one such example that has gained rapid acceptance in recent years. Although the use of robotic-assisted laparoscopy for endometrial cancer is still in its early phase, this approach is anticipated to become similarly, a common approach to the management of endometrial cancer in the future.

Comparison of Laparoscopy and Laparotomy for Management of Endometrial Carcinoma: A Meta-analysis

Background:

This meta-analysis was performed to investigate the outcome of laparoscopic surgery for endometrial carcinoma compared with laparotomy.

Methods:

We searched the MEDLINE (PubMed), EMBASE, and Cochrane Review databases in September 2007. Three independent evaluators selected the articles according to predetermined selection criteria.

Results:

Thirteen comparative studies (5 prospective and 8 retrospective) that met the selection criteria were included. In a fixed-effects meta-analysis, the overall survival and therecurrence rate showed no significant differences between the laparoscopy and the laparotomy groups, with odds ratios of 0.84 (95% confidence interval, 0.64-1.62) and 0.90 (95% confidence interval, 0.49-1.16), respectively. However, the complication rate was lower in the laparoscopy group than in the laparotomy group with an odds ratio of 0.43 (95% confidence interval, 0.32-0.58).

Conclusions:

The survival outcome and recurrence rate after laparoscopic surgery for endometrial carcinoma were similar to those in the laparotomy procedures. However, the complication rate was lower after laparoscopy compared with laparotomy.