Comparison of Laparoscopy and Laparotomy in the Treatment of Early Stage Endometrioid Endometrial Adenocarcinoma

Abstract

Objective This study aims to compare the surgical and postoperative outcomes, as well as the safety and efficacy, of laparoscopic surgery and laparotomy in patients diagnosed with early-stage endometrioid endometrial cancer, focusing on operative time, intraoperative blood transfusion requirements, postoperative complications, and recurrence rates. Materials and methods Data were collected on patients who underwent surgery at the Department of Obstetrics and Gynaecology, Ondokuz Mayıs University Faculty of Medicine, with a diagnosis of endometrial cancer between January 2007 and December 2018. Patients were assessed using the staging approach proposed by FIGO in 2009. Patients with endometrioid adenocarcinoma histology in stages IA, IB, and II were chosen; 69 underwent laparoscopic surgery, and 133 underwent laparotomy. Patient survival rates, cancer recurrence, demographic information, and intraoperative and postoperative outcomes were compared. Results There was no significant difference between the groups in terms of survival and disease-free survival. The tumor size was larger in the laparotomy group, which may be attributed to preoperative imaging and clinical assessment guiding the surgical approach. The laparoscopy group had a shorter postoperative hospital stay, required less intraoperative blood transfusion, and experienced fewer postoperative complications. However, the operation time was shorter in the laparotomy group, likely due to the technical complexity of laparoscopy, which typically requires longer preparation and instrument handling times. While laparoscopy provides magnification that enhances visualization and access to lymph nodes, the number of pelvic and total lymph nodes removed was higher in the laparotomy group, possibly reflecting the standard surgical approach used in open procedures. These outcomes were compared and evaluated between the two surgical methods. All surgeries were performed by surgeons with similar levels of expertise in both techniques. Discussion Although the duration of the laparoscopy method is long, it has advantages such as short hospital stay, less intraoperative blood requirement, fewer post-operative complications, and early return to daily activities. There is no difference between both methods in terms of cancer recurrence and survival. The mean, 5-year survival and disease-free survival of the patients were similar. Conclusion Laparoscopic surgery is as safe and effective as laparotomy in the treatment of early-stage endometrial cancer. While this study reinforces an already well-established fact, it is important to acknowledge the continuous advancements in minimally invasive surgical techniques, including robotic surgery and vaginal natural orifice transluminal endoscopic surgery (vNOTES). Future research should focus on comparing these emerging techniques to further refine surgical approaches and optimize patient outcomes.

Keywords: abdominal hysterectomy; early-stage endometrial cancer; laparatomy; laparoscopic hysterectomy; survival.

Figure 1. Kaplan-Meier curve showing overall survival (OS) rates for patients undergoing laparoscopy and laparotomy over a 5-year period. Censored data points are marked for both groups.

Figure 2. Kaplan-Meier curve showing disease-free survival (DFS) rates for patients undergoing laparoscopy and laparotomy over a 5-year period. Censored data points are marked for both groups.