Hysterectomy for obese women with endometrial cancer: Laparoscopy or laparotomy?

Objective. The aim of this study was to investigate the feasibility and saf ety of laparoscopic management of obese women with early stage endometrial cancer and to compare the surgical outcome, cost, hospital stay, recall of postoperative pain control, time to return to full activity and to work, an d overall satisfaction among these women and those managed by laparotomy. Methods. We conducted a prospective study over 2 years applying laparoscopi c surgery to all women with clinical stage I endometrial cancer and body ma ss indices (BMIs) between 28.0 and 60.0 who can tolerate such surgery. As a control, we used women with clinical stage I endometrial cancer and simila r BMIs who underwent laparotomy in the previous 2 years. Both groups were c ompared in their characteristics, surgical outcome, cost, and hospital stay , and interviewed regarding time to recovery, recall of postoperative pain control, and overall satisfaction with their management. Results. Forty of 42 obese women who presented with clinical stage I endome trial cancer during the study period were offered laparoscopic surgery. The procedure was converted to laparotomy in 3 (7.5%) patients. Laparoscopic s urgery was thus successful in 88.1% of all obese women. There was no signif icant difference between women who underwent laparoscopy and those who unde rwent laparotomy in patient characteristics, proportion of women who underw ent lymphadenectomy, complications, total cost, patients' recall of postope rative pain, and patients' satisfaction with management. Women who underwen t laparoscopy had a significantly longer operative time, more pelvic lymph nodes removed, a smaller drop in postoperative hematocrit, less pain medica tion, and a shorter hospital stay (194.8 versus 137.7 min, P <0.001; 11.3 v ersus 5.3, P < 0.001; 3.9 versus 5.4, P = 0.029; 32.3 versus 124.1 mg, P < 0.001; and 2.5 versus 5.6 days, P < 0.001, respectively). There was a trend toward earlier resumption of full activity and return to work among women who underwent laparoscopy (23.2 versus 45.0 days, P = 0.073, and 35.3 versu s 67.0 days, P = 0.055, respectively). Conclusions. Most obese women with early stage endometrial cancer can be sa fely managed through laparoscopy with excellent surgical outcome, shorter h ospitalization, and less postoperative pain than those managed through lapa rotomy. (C) 2000 Academic Press.