Laparoscopic management of early uterine cancer: 10-year experience in Asan Medical Center

Abstract

Objective: To assess the feasibility of laparoscopic surgery in the treatment of patients with early uterine cancer and to compare their outcomes with those of patients treated with laparotomy.

Methods: The records of 388 patients with clinical stage I or II uterine cancer treated by laparoscopic-assisted vaginal hysterectomy (LAVH) or total abdominal hysterectomy (TAH) between January 1997 and April 2006 were retrospectively reviewed. After excluding 39 patients with uterine sarcoma and 40 with upstaging or conversion to laparotomy procedures, the case-controlled study was performed.

Results: Laparoscopic procedures were converted to laparotomy in 10 of 188 patients (5.3%), whereas laparoscopic surgery was successful in 178 (94.7%). Histopathologic results led to upstaging of 32 of 349 patients (9.2%), including 15 of 188 (8.0%) in laparoscopy group and 17 of 161 (10.6%) in laparotomy group. The two groups were similar in age, parity, BMI, surgical stage, histological grade, tumor size, operating time and number of lymph nodes removed. Fewer complications and shorter hospital stay were observed in laparoscopy group. Between groups, recurrence rate did not differ significantly. Four recurrences in vaginal stump occurred in the only laparoscopy group, but the difference was not statistically significant. There were no significant differences between the two groups in progression-free and overall survival.

Conclusion: Laparoscopy is a valid alternative to conventional laparotomy and does not worsen the prognosis of patients with early endometrial carcinoma. Efforts should be made during laparoscopic procedures to minimize the risk of vaginal recurrence.