Evaluation of total laparoscopic hysterectomy with lymphadenectomy in surgical treatment of endometrial cancers

Abstract

Objectives: The study was conducted to evaluate the efficacy, feasibility and safety of total laparoscopic hysterectomy (TLH) with lymphadenectomy in the treatment of endometrial cancer. Material and methods: The retrospective study included 31 patients with endometrial cancer who underwent TLH with lymphadenectomy and 42 patients with endometrial cancer who were operated by laparotomy. In both groups the following parameters were analyzed: age, BMI, accompanying diseases, previous surgeries, parity, duration of the surgery, blood loss (complete blood count before and after the operation was compared), necessity of blood transfusion, length of hospital stay, uterine volume, grade, stage of endometrial cancer (FIGO), and intra/postoperative complications. Results: Mean age of patients was lower in the laparoscopic group than in women operated by laparotomy: 54 and 64, respectively (p=0.0001). There were no significant differences between both groups in BMI, uterine volume, grade, staging (FIGO), and parity. The percentage of patients with accompanying chronic diseases in the TLH group was lower than in the laparotomy group: 48.39% and 83.34%, respectively (p=0,032). There were no significant differences between both group in the history of previous laparotomies (p=0.704). Mean duration of surgery was shorter in the case of laparotomy than in case of laparoscopy: 130.6 and 151.77, respectively (p=0.003). Laparotomy was associated with greater blood loss during surgery. Statistically significantly higher decrease in the Hb concentration and Hct values was noted in the group operated by laparotomy when compared to laparoscopy (mean values: Hb-1.17g/dl, Hct-3.49% for the TLH technique and Hb-1.8g/dl Hct-5.47% for laparotomy; p=0.011-Hb; p=0.003-Hct). Mean hospital stay after laparoscopy was shorter than after laparotomy – 4 and 9 days, respectively (p=0,0001). Conclusions: Total laparoscopic hysterectomy with lymphadenectomy in endometrial cancer therapy is a safe and feasible procedure. It is characterized by significantly smaller percentage of complications and shorter hospital stay. This technique offers an alternative for laparotomy when it is performed by a highly experienced surgeon.