Does the Type of Surgical Approach and the Use of Uterine Manipulators Influence the Disease-Free Survival and Recurrence Rates in Early-Stage Endometrial Cancer?

Josefa Marcos-Sanmartín, José Antonio López Fernández, José Sánchez-Payá, Óscar Cruz Piñero-Sánchez, María José Román-Sánchez, María Asunción Quijada-Cazorla, María Amparo Candela-Hidalgo, Juan Carlos Martínez-Escoriza, Josefa Marcos-Sanmartín, José Antonio López Fernández, José Sánchez-Payá, Óscar Cruz Piñero-Sánchez, María José Román-Sánchez, María Asunción Quijada-Cazorla, María Amparo Candela-Hidalgo, Juan Carlos Martínez-Escoriza

Abstract

Objective: The purpose of this study was to compare the long-term safety, disease-free survival, and recurrence rate of total laparoscopic hysterectomy using uterine manipulator and abdominal hysterectomy in the surgical treatment in early-stage endometrial cancer.

Study design: This was a cohort study of 147 patients with clinical endometrial cancer (laparoscopic surgery group, 77 women; laparotomy group, 70 women). Data were evaluated and analyzed by intention-to-treat principle, and survival data of stage I endometrial cancer (129 patients; 66 from laparoscopic surgery group and 60 from laparotomy group) were estimated by using the Kaplan-Meier curves.

Results: After a follow-up period of 60 months for both laparoscopic surgery and laparotomy groups, no significant difference in the cumulative recurrence rates (7.4% and 13.1%, P = 0.091) and overall survival (97.1% and 95.1%, P = 0.592) was detected between both groups of stage I endometrial cancer. Conversion to laparotomy occurred in 10.4% (8/77) of the laparoscopic procedures. Laparoscopic hysterectomy was associated with less use of pain medication (P = 0.001) and a shorter hospital stay (P < 0.001), but the procedure took longer than laparotomic hysterectomy (P < 0.001). The proportion of patients with intraoperative and long-term complications was not significantly different between both groups. The use of uterine manipulators did not have increased recurrence rate in patients treated with laparoscopic approach.

Conclusions: The laparoscopic surgery approach to early-stage endometrial cancer using uterine manipulators is as safe and effective as the laparotomic approach.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Disease-free survival of the laparoscopy and laparotomy groups.
FIGURE 2
FIGURE 2
Overall survival of the laparoscopy and laparotomy groups.

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Source: PubMed

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