Laparoscopic Versus Conventional Open Method for the Surgical Staging of Endometrial Carcinoma: A Comparative Study

Abstract

Introduction: Before the advancement and improvement of techniques of using laparoscopy in total hysterectomy, it was considered as a procedure that carried a high risk of injury to the ureters but now with improvement of the experience, training and novel equipment, there is increase in the use of such procedure with lower incidence of ureteric injury. Recently, in surgical staging of endometrial carcinoma (EC); the laparoscopy role has been considered more beneficial. Many previous reports proved fewer complications, lower morbidity, shorter duration of postoperative hospitalization, and rabid recovery. But, the therapeutic benefits and drawbacks of using laparoscopy are not confirmed yet. Aim: The aim of current study was to assess the benefits and drawbacks of using laparoscopy in surgical staging of EC and comparing them with open surgical staging (laparotomy). Materials and Methods: the current study included 50 patients diagnosed with EC were included and were divided in to two groups the first group included 20 patients and was managed by laparoscopic staging, while the second group included 30 patients and was managed by laparotomy. We compared between using laparoscopy in surgical staging of EC with open surgical staging (laparotomy) regarding operative and postoperative outcomes. Results: laparoscopic method of staging had a significantly longer time of the operation than laparotomy (p=0.04), but it had lesser amount of blood loss intra-operatively (p<0.002). There were fewer number of resected lymph nodes (p=0.004) in the laparoscopic technique in contrast to laparotomy. Patients who underwent laparoscopy has a shorter time of postoperative staying in hospital in comparison to those who underwent laparotomy (p=0.012). More number of patients in the open group than the laparoscopy group underwent para-aortic lymphadenectomy (p<0.001). Conclusion: we have proved the benefits, disadvantages and the essential role of laparoscopy in treatment and surgical staging of EC. Laparoscopy is proved to be safe and effective technique with lower rates of blood loss and less rates of intra-and post-operative morbidity. Experienced surgeon could perform hysterectomy and lymphadenectomy with perfect cancer excision and staging as equally good to laparotomy.