The role of laparoscopic hysterectomy and lymph node dissection in treatment of endometrial cancer

Background: The development of new diagnostic and surgical methods has brou ght a differentiated approach to surgery of endometrial cancer. The aim of this study was to verify the peri-and postoperative differences between lap aroscopic and open procedure and prepare protocol for a second phase follow -up multicentric study. Methods: The study includes 133 women with indications for surgery of endom etrial cancer. A prospective multicentric study was undertaken at four cent res in the Czech Republic. We evaluated differences in the peri-and postope rative outcomes. Sixty-eight patients treated laparoscopically were compare d with 65 patients treated by an open procedure of hysterectomy and lymphad enectomy. Results: Three patients with conversion were withdrawn from the study and a nother 65 patients (97%) from the laparoscopic group successfully completed the procedures. Laparoscopic and abdominal hysterectomy with lymphadenecto my were performed based on the grade of the tumor and depth of myometrial i nvasion. Out of both groups, 75 patients underwent pelvic lymphadenectomy a nd 21 women underwent para-aortic lymph node dissection or sampling. Eleven patients had metastases in the pelvic or para-aortic nodes (11.7% versus 4 .7% in the open procedure group). Deep myoinvasion over 50% was more freque ntly present in the group of abdominally-treated women. The rate of major c omplications (18 versus 14 cases) was higher in the laparoscopic group, but more wound infections were seen in the open procedure group. Conclusion: The study illustrates that the laparoscopic approach to surgery is feasibile and it also may be considered for endometrial cancer which ty pically occurs in at risk and obese women. Recovery time is reduced by avoi ding an abdominal incision. Laparoscopic surgery was performed successfully in 65 women and in 8 cases (11.7%) malignant spread outside to the regiona l lymph nodes was found. However, the selection of patients for laparoscopy should be done considering optimal benefit and safety.