Use of Laparoscopy in the Treatment of Endometrial and Cervical Cancer – Results of a 2012 Germany-wide Survey

Abstract

Introduction: Endoscopy has begun to play an increasingly important role in the surgical therapy of uterine cancers. To date, there is no data on the use of laparoscopy to treat endometrial cancer (EC) and cervical cancer (CC). Method: A Germany-wide, anonymised survey was done of all gynaecological clinics/endoscopy clinics, using a standardised questionnaire. Results: A total of 128 clinics responded: 16 university clinics (12.5 %), 30 hospitals offering maximum care (23.4 %), 66 general hospitals (51.5 %), 5 outpatient clinics (3,9 %), 4 physicians in private practice affiliated to hospitals (3.1 %) and 7 hospitals (5.4 %) which did not indicate status. Laparoscopy was used in the treatment of 82 % of all EC and 54 % of CC. Surgery for EC was done completely laparoscopically in 58 % of cases and with laparoscopic assistance using a vaginal approach in 32 % of cases. If lymphadenectomy (LNE) was additionally performed, this was done abdominally in 42 % of cases and laparoscopically in 53 %. Cervical cancer was treated by laparoscopic radical hysterectomy (HE) in 44 % of cases and by radical HE using a vaginal approach in 14 %. 4 % of hospitals reported the use of other endoscopic methods (e.g. DaVinci). While the majority of hospitals (43.3 %) treated more than 75 % of EC patients using laparoscopy, in many clinics (38.3 %) less than 25 % of CC patients were treated using endoscopy. Discussion: Laparoscopy is used more often in EC surgery as compared to surgery for CC. However, there are still major differences between hospitals with regard to case numbers, the number of uterine cancers treated using endoscopic surgery, and the type of endoscopic surgery.

Zusammenfassung

Einleitung: Die Endoskopie nimmt eine zunehmende Bedeutung in der operativen Therapie der Uteruskarzinome ein. Es gibt bis dato keine Daten, wie verbreitet der Einsatz der Laparoskopie (LSK) in der Therapie der Endometrium- (EC) und Zervixkarzinome (CC) ist. Methode: Deutschlandweite anonymisierte Klinikumfrage unter allen gynäkologisch/endoskopisch operierenden Kliniken mittels standardisiertem Fragebogen. Ergebnisse: 128 Klinikantworten: 16 Unikliniken (12,5 %), 30 Kliniken der Maximalversorgung (23,4 %), 66 Kliniken der Regelversorgung (51,5 %), 5 Tageskliniken (3,9 %), 4 Belegärzte (3,1 %) und 7 Kliniken (5,4 %) ohne Statusangabe. Die LSK kommt in 82 % aller EC- und in 54 % aller CC zum Einsatz. EC werden in 58 % der Fälle komplett laparoskopisch und in 32 % der Fälle vaginal assistiert laparoskopisch operiert. Im Falle einer Lymphonodektomie (LNE) erfolgt diese in 42 % der Fälle abdominal und in 53 % laparoskopisch. Beim CC erfolgt in 44 % eine laparoskopische radikale Hysterektomie (HE) und in 14 % eine radikale HE in Kombination mit vaginalem Vorgehen. 4 % der Kliniken geben an, weitere endoskopische Methoden (z. B. DaVinci) anzuwenden. Während die meisten Kliniken (43,3 %) mehr als 75 % der EC laparoskopisch behandeln, ist die Rate der endoskopisch operierten CC in den meisten Kliniken (38,3 %) unter 25 %. Diskussion: EC werden häufiger als CC laparoskopisch operiert. Zwischen den Kliniken gibt es jedoch noch große Unterschiede bez. Fallzahl, der Anzahl der endoskopisch operierten Uteruskarzinome und der Art der endoskopischen OP.

Key words

endometrial cancer - cervical cancer - surgical therapy - laparoscopy - endoscopy - epidemiology - gynaecology

Schlüsselwörter

Endometriumkarzinom - Zervixkarzinom - operative Therapie - Laparoskopie - Endoskopie - Epidemiologie - Frauenheilkunde

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