Cœlioscopie et cancer en gynécologie : le point en 2005

Standardised Registration of Surgical Complications in Laparoscopic-Gynaecological Therapeutic Procedures Using the Clavien-Dindo Classification

Introduction: The registration of complications represents an important component in the evaluation of surgical therapeutic procedures. The aim of the present study was to examine the frequency of occurrence as well as the severity of surgical complications after laparoscopic-gynaecological operations in a standardised manner using the Clavien-Dindo system. Material and Methods: Altogether 7438 treatment courses after laparoscopic-gynaecological interventions by 9 working groups were evaluated. Covariates recorded were the technical complexity of the operation, type of study cohort, study size, data acquisition as well as study centre. Target variables recorded were the surgical morbidity rate, subdivided into mild (Clavien-Dindo grade I-II) and severe complications (Clavien-Dindo grade III-V). In addition, a binary logistic regression analysis for the mentioned covariates and the occurrence of surgical complication was carried out. Results: 946 complications were recorded (overall complication rate: 13 %). These included 664 mild complications (8.9 %) and 305 severe complications (4.1 %). A correlation was found between the covariates technical complexity (relative risk [rR] 1.37; p < 0.01), study size (rR: 0.35; p < 0.01) and study centre (rR 0.19; p < 0.01) and the occurrence of surgical complications. Conclusion: By means of a standardised registration of complications using the Clavien-Dindo classification it appears to be possible to limit the methodologically caused underestimation of surgical morbidity in the retrospective evaluation of gynaecological-endoscopic therapeutic procedures. Factors decisively influencing the surgical morbidity of gynaecological-laparoscopic therapeutic procedures are the respective operative experience of the treating facility as well as the technical complexity of the intervention.

Two-Port Access Laparoscopic Surgery in Gynecologic Oncology

Purpose

The purpose of this study was to evaluate the feasibility and safety of 2-port access (TPA) laparoscopy in gynecologic oncology.

Methods

This was a retrospective review of 81 consecutive patients who underwent TPA laparoscopic surgery for various gynecologic cancers from March 2009 to September 2011. The TPA system consisted of a single multichannel port at the umbilicus and an ancillary 5-mm port in the suprapubic area.

Results

The surgical procedures included comprehensive ovarian cancer staging (33 patients), radical hysterectomy with pelvic lymph node dissection (19 patients), and endometrial cancer staging (29 patients). All surgical procedures were completed laparoscopically with no conversion to laparotomy. Two cases required 1 or 2 additional ports. The mean operating time, estimated blood loss, and number of lymph nodes were 253.8 minutes, 170.7 mL, and 34.9, respectively. Three patients (9.1%) with ovarian cancer and 4 patients (13.8%) with endometrial cancer were upstaged after surgery. The mean postoperative hospital stay was 6.6 days, and the mean postoperative pain scores (0–10 scale) were 3.4 at 6 hours, 3.0 at 24 hours, and 2.5 at 48 hours. Postoperative complications occurred at a low incidence (4.9%) and included one umbilical hernia, one vault dehiscence, and one lumbosacral nerve injury.

Conclusions

Two-port access laparoscopic surgery using a single multichannel port system is a feasible and safe procedure in selected patients with gynecologic cancers. Prospective randomized trials will permit the evaluation of the potential benefits of this minimally invasive surgical technique.

[Laparoscopy for surgical treatment for uterine and ovarian cancer in France: a national practice survey]

AIM

The aim of this study was to describe the use of laparoscopy in gynecologic malignancies (cervical, endometrial and ovarian cancer, borderline included) in France during year 2005.

PATIENTS AND METHODS

We have carried out a retrospective national practice survey during 12 months. Each university hospital (45 centers) and each cancer center (20 centers) received a questionnaire to evaluate their practice in laparoscopy. Centers performing less than ten cases per year in this indication were excluded.

RESULTS

Among 65 centers, 31 answered and 19 were included. A total of 1397 surgical procedures for gynaecologic cancer was analysed. Laparoscopy was performed in 714 cases. In these cases, 51.1% (675 cases) of patients were treated by laparoscopy in France during year 2005. Seventy-four surgical procedures for cancer were performed each year per center and among them 38 by laparoscopy. The average cases number is 9.4 per surgeon.

CONCLUSION

We found that 51.1% of cases of gynaecologic cancer surgery were performed by laparoscopy in France during 2005, representing 38 cases per centers and 9.4 per surgeon per year. This suggests that access to training for surgeons and care for patients is difficult.