scholarly journals Laparoscopy and laparotomy in endometrial cancer – a meta-analysis

2021 ◽  
Author(s):  
Emilia Tupacz-Mosakowska ◽  
Anna Abacjew-Chmyłko ◽  
Dariusz Wydra
Keyword(s):  
Endometrial Cancer ◽  
Meta Analysis ◽  
Laparoscopic Hysterectomy ◽  
Total Abdominal Hysterectomy ◽  
Developed Countries ◽  
Total Laparoscopic Hysterectomy ◽  
Effective Treatment Option ◽  
Cardiorespiratory Failure ◽  
Less Invasive ◽  
Published Evidence

IntroductionUterine malignancies, the vast majority of which are endometrial cancers, constitute the most common type of gynecological neoplasms in developed countries. The primary treatment for endometrial cancer is hysterectomy and bilateral salpingoophorectomy. Women with endometrial cancer can be subjected to either total abdominal hysterectomy (TAH) or to an increasingly recommended total laparoscopic hysterectomy (TLH). We decided to verify whether published evidence supports TLH as an effective, less invasive than TAH albeit still equally radical treatment for endometrial malignancies.Material and methodsThe systematic review included articles indexed in MEDLINE (PubMed) and EBSCO, published between January 1974 and January 2017. The search was based on the following keywords and combinations thereof: “laparoscopy”, “laparotomy”, “endometrial cancer”, “comparative”. Twenty-six full-text articles were included in the meta-analysis.ResultsA total of 5,996 patients were eligible for the analysis, among them 2,833 (47.2%) women subjected to TLH and 3,163 (52.8%) who underwent TAH. Total laparoscopic hysterectomy is associated with shorter hospital stay, faster recovery, lesser blood loss and fewer intra- and postoperative blood transfusions, reduced pain, and a lower reoperation rate than conventional TAH.ConclusionsAll analyzed studies demonstrated that TLH is a safe and effective treatment option in endometrial cancer patients. This procedure is markedly less invasive than TAH. However, considering several contraindications for laparoscopy, such as peritoneal invasion, cardiorespiratory failure, history of previous surgery and large size of the uterus, qualification for a given procedure needs to be preceded by a detailed evaluation.

Disease-Free and Survival Outcomes for Total Laparoscopic Hysterectomy Compared With Total Abdominal Hysterectomy in Early-Stage Endometrial Carcinoma: A Meta-analysis

2018 ◽  
Vol 28 (3) ◽  
pp. 529-538 ◽  
Author(s):  
Rebecca Asher ◽  
Andreas Obermair ◽  
Monika Janda ◽  
Val Gebski
Keyword(s):  
Overall Survival ◽  
Endometrial Cancer ◽  
Clinical Outcomes ◽  
Early Stage ◽  
Meta Analysis ◽  
Laparoscopic Hysterectomy ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Disease Free ◽  
Early Stage Endometrial Cancer

ObjectivesLaparoscopic hysterectomy is currently offered to a large number of patients, and assessing the noninferiority to abdominal hysterectomy with respect to clinical outcomes is key. We examine rates of recurrence, disease-free survival (DFS), and overall survival, and surgical complications of laparoscopic compared with abdominal hysterectomy for the treatment of early-stage endometrial cancer.MethodsElectronic databases were systematically searched to identify relevant studies, and patient characteristics and clinical outcomes extracted. The primary outcome was 3-year DFS, and estimates were pooled using an inverse-variance weighted meta-analysis.ResultsNine studies (4405 patients) were identified in which DFS was reported in 5 studies. The difference in 3-year DFS was 1.44% (95% confidence interval [CI], −0.65% to 3.53%) in favor of total abdominal hysterectomy, consistent with a noninferiority margin of 5%. Differences in DFS (hazard ratio, 1.10; 95% CI, 0.92–1.32), overall survival (hazard ratio, 1.16; 95% CI, 0.81–1.66), and local recurrence (difference, 0.42%; 95% CI, −0.41% to 1.25%) were not significant. Rates of intraoperative complications showed no difference (0.5%; 95% CI, −1.1% to 2.0%) based on 7 studies. There was a significant reduction in postoperative complications with the laparoscopic procedure (−6.83%; 95% CI, −9.19% to −4.47%).ConclusionsNoninferiority of laparoscopy was demonstrated on clinical outcomes and was associated with a reduction in postoperative complications. These results support continued treatment by laparoscopic hysterectomy for early-stage endometrial cancer.

Total laparoscopic hysterectomy versus total abdominal hysterectomy for obese women with endometrial cancer

2005 ◽  
Vol 15 (2) ◽  
pp. 319-324 ◽  
Author(s):  
A. Obermair ◽  
T. P. Manolitsas ◽  
Y. Leung ◽  
I. G. Hammond ◽  
A. J. Mccartney
Keyword(s):  
Endometrial Cancer ◽  
Blood Loss ◽  
Hospital Stay ◽  
Operating Time ◽  
Laparoscopic Hysterectomy ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Intention To Treat ◽  
Estimated Blood Loss

Obesity is common in endometrial cancer and surgery for these patients is challenging. We compared total laparoscopic hysterectomy (TLH) with total abdominal hysterectomy (TAH) with respect to feasibility (operating time, estimated blood loss, length of hospital stay, and conversion to laparotomy) and safety (perioperative morbidity and mortality) in a retrospective analysis of 78 morbidly obese patients with endometrial cancer. Analysis is based on the intention to treat. The intention to treat was TLH in 47 patients and it could be successfully completed in 42 patients (89.4%). The mean weight for all patients was 118.7 kg, with patients in the TLH group weighing more and having higher ASA scores. Mean operating time and estimated blood loss were similar in both groups. Mean postoperative hospital stay was 4.4 (±3.9) days in the TLH group and 7.9 (±3.0) days in the TAH group (P < 0.0001). Wound infections occurred in 15 of 31 patients (48.4%) in the TAH group and in 1 of 47 patients (2.1%) in the TLH group. All other morbidity, as well as patterns of recurrence and survival were similar in both groups. These data justify a prospective randomized trial comparing TLH with TAH for the treatment of endometrial cancer

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