Laparoscopic Approach in Surgical Staging of Endometrial Cancer

Abstract

Objective To compare laparoscopy with laparotomy for surgical staging of endometrial cancer.

Methods 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 A total of 162 patients were analyzed. One-hundred and thirty eight patients met the inclusion criteria, 41 of 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.

Resumo

Objetivo Comparar a abordagem laparoscópica com a laparotômica no estadiamento cirúrgico do carcinoma do endométrio.

Métodos Avaliação retrospectiva de uma coorte de mulheres com diagnóstico pré-operatório de cancro do endométrio submetida a estadiamento cirúrgico. As principais variáveis do estudo foram: morbidade e mortalidade, tempo de internamento hospitalar, eventos adversos peri-operatórios e taxa de recorrência. A análise dos dados foi realizada com o programa SPSS v25 (IBM Corp, Armonk, NY, EUA), para as variáveis categóricas utilizou-se o teste do Qui-quadrado e o teste de Fisher, e para as variáveis contínuas o teste t de Student.

Resultados A amostra foi constituída por 162 pacientes. Cento e trinta e oito pacientes preencheram os critérios de inclusão, 41 das quais foram submetidas a estadiamento por laparoscopia e 97 por laparotomia. As conversões de laparoscopia para laparotomia ocorreram em 2 pacientes (4,9%) e foram secundárias a dificuldades técnicas e má exposição. A laparoscopia teve menos eventos adversos pós-operatórios quando comparada à laparotomia (7,3% versus 23,7%, respectivamente; p = 0,005), mas taxas semelhantes de complicações intraoperatórias, apesar do tempo operatório significativamente maior (mediana 175 a 130 minutos, respetivamente; p < 0,001). A permanência hospitalar foi significativamente menor na abordagem laparoscópica (mediana de 3 versus 7 dias, respectivamente; p < 0,001). Não houve diferenças nas taxas de recorrência ou mortalidade.

Conclusão O estadiamento cirúrgico laparoscópico para carcinoma do endométrio é exequível e seguro. As pacientes apresentam uma menor taxa de complicações pós-operatórias e tempo de internamento mais curto quando comparados aos da abordagem por laparotomia.

Keywords

endometrial neoplasms - laparoscopy - neoplasm staging - hysterectomy - lymph node excision

Palavras-chave

neoplasias do endométrio - laparoscopia - estadiamento de neoplasias - histerectomia - excisão de linfonodo

Contributors

All authors declare to have contributed to the project conception, to the data analysis and interpretation, to the writing of the manuscript, to the relevant critical review of the intellectual content, and to the final approval of the version to be published.

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