Laparoscopic technology for the treatment of endometrial cancer

The Impact of Obesity on Surgical Outcome in Endometrial Cancer Patients: A Systematic Review

Background: Obesity is a significant public health problem in the United States, and many studies have established obesity as a significant risk factor for endometrial cancer. Surgery is the standard of care in staging and treatment of endometrial cancer, and obesity may influence surgical outcomes because of its attendant comorbid conditions. Therefore, assessment of the impact of obesity on surgical outcome is important for decreasing morbidity and improving survival in patients with endometrial cancer. Objective: The aims of this research were to evaluate and review epidemiologic data systematically on the impact of obesity on surgical outcomes and to assess safety and feasibility of newer surgical techniques in obese patients. Materials and Methods: A systematic search of PubMed was conducted to identify articles between 2004 and 2013 that focused on the impact of obesity on surgical outcome. Reference lists of retrieved articles were also used to identify other relevant articles. Thirteen relevant articles were reviewed. Results: Evidence from epidemiologic studies showed that obesity impacts surgical outcome adversely. On average, obese patients have worse surgical outcomes than their nonobese counterparts. In addition, surgical outcome worsens as level of obesity increases. However, surgical procedure also influences this association. Minimally invasive surgeries are more useful and are accompanied with fewer complications than conventional laparotomy and can be performed safely in obese patients. Conclusions: Obesity is a significant risk in the etiology, treatment, and surgical outcomes of patients with endometrial cancer. Future research will need more randomized controlled trials and prospective studies to identify the best procedures for maximal outcomes. (J GYNECOL SURG 32:149).

Comparative analyses of postoperative complications and prognosis of different surgical procedures in stage II endometrial carcinoma treatment

OBJECTIVE

To investigate the impact of surgical resection extent on the postoperative complications and the prognosis in patients with stage II endometrial cancer.

METHODS

A total of 54 patients were retrospectively reviewed, 35 patients underwent subradical hysterectomy and 19 patients received radical hysterectomy, both with simultaneous bilateral salpingo-oophorectomy and pelvic and paraaortic lymphadenectomy.

RESULTS

Comparing the surgical outcomes in subradical hysterectomy group vs radical hysterectomy group, there were no significant differences in operative time, estimated blood loss, and hospital stay. After surgery, 37.1% vs 36.8% patients received postoperative radiotherapy in the subradical hysterectomy group vs radical hysterectomy group, without statistically significant difference. As for postoperative complications, the early postoperative complication rate in patients who underwent subradical hysterectomy was 14.3%, significantly lower than that in patients submitted to radical hysterectomy (14.3% vs 42.1%), with P=0.043. However, there was no significant difference in late postoperative complication rate between the two surgical procedures. Regarding the clinical prognosis, patients receiving the subradical hysterectomy showed similar survival to their counterparts undergoing the radical procedures. The relapse rate was 5.71% vs 5.26%, respectively, without significant difference. There were no deaths in both surgical groups.

CONCLUSION

For stage II endometrial carcinoma, subradical hysterectomy presented with less early postoperative complications and similar survival duration and recurrence compared with radical hysterectomy and should be advocated in clinical treatment.

Surgical treatment of endometrial cancer and atypical hyperplasia: a trend shift from laparotomy to laparoscopy

Background. Laparoscopic hysterectomy has proved to be a safe alternative to open surgery in women with benign indications. Few studies compare laparotomy and laparoscopy in gynecologic oncology, and the objective of this study was to analyze the feasibility and development of laparoscopic surgery in endometrial cancer patients. Material and Methods. Records from all women having a hysterectomy due to premalignant or malignant endometrial changes during the years 2002–2009 were examined retrospectively. Results. A total of 521 hysterectomies were performed during the study period. Laparoscopy was performed in about 20% of the cases in the first two years, increasing to 83% in the last year of the period. Moreover, the laparoscopic technique was increasingly applied in older women, more obese women and in women with high-risk preoperative diagnosis, without increasing the complication rate. Conclusions. As for benign indications, laparoscopic hysterectomy in endometrial cancer patients should be preferred whenever possible.

Laparoscopy and body mass index: feasibility and outcome in obese patients treated for gynecologic diseases

STUDY OBJECTIVE

To compare feasibility and surgical outcome of laparoscopic gynecologic surgery between obese, overweight, normal-weight, and underweight women.

DESIGN

Retrospective case control study (Canadian Task Force classification II-3).

SETTING

Surgery Unit of Minimally Invasive Gynaecology.

PATIENTS

A total of 503 women who underwent laparoscopic procedures for both benign disease and malignancies.

INTERVENTIONS

Four main categories of gynecologic disease were identified: uterine fibroids, benign adnexal masses, endometriosis, and endometrial cancer (stage I). For each category patients were divided into 4 groups: underweight (BMI <18.5 kg/m(2)), normal-weight (BMI 18.5-24.9 kg/m(2)), overweight (BMI 25-29.9 kg/m(2)), and obese (BMI ≥30 kg/m(2)).

MEASUREMENTS AND MAIN RESULTS

Selected outcomes were duration of surgery, rate of laparotomy conversion, intraoperative and postoperative complications, and duration of hospital stay. No statistical difference regarding demographic data, surgical and medical history, and intraoperative findings was present between groups. No laparotomy conversion occurred. Regarding duration of surgery, we found no statistical difference among the BMI groups with regard to benign diseases, whereas pelvic lymphadenectomy in obese patients with endometrial cancer had a statistically significant longer duration than in the control group (122 +/- 47 min vs 65 +/- 21 min, p <.001). The postoperative complication rate was 0.01%: 3 cases of blood transfusion and 1 case of hemoperitoneum among myomectomies; 1 ureteral fistula in surgery for pelvic endometriosis; and 1 case of postoperative lymphocele in endometrial cancer group. No statistically significant difference was found in duration of hospital stay among the BMI groups in any of the categories of disease. For each category we conducted an analysis to identify any possible risk factors other than BMI in the surgical outcomes.

CONCLUSION

Laparoscopic approach in the various applications of gynecologic surgery does not appear to be significantly influenced by BMI in terms of surgical outcomes, laparotomy conversion rate, intraoperative and postoperative complications rate, and duration of hospital stay. The technical difficulties can be solved if skilled surgeons and anesthetists are available.