2020 Volume 36 Issue 2 Pages 99-105
Objective: Though the efficacy of laparoscopic surgery including paraaortic lymph node dissection (PAN) for early-stage endometrial cancer patients was demonstrated in the LAP-2 study, the procedure has yet to be widely adopted in Japan. The purpose of this study was to confirm the validity of laparoscopic surgery for intermediate- and high-risk endometrial cancer patients in our hospital.
Methods: The clinical data of preclinical stage I and II endometrial cancer patients who underwent either laparoscopic surgery or laparotomy in our hospital between January 2013 and December 2018 were analyzed. There were 24 cases of laparoscopic surgery including PAN and 36 cases of laparotomy including PAN. Postoperative outcomes, disease-free survival, and sites of recurrence were retrospectively reviewed in this study.
Results: In the laparoscopic group, the hospitalization period was shorter (laparoscopy: 10 days vs. laparotomy: 15 days, p = 0.002), and the volume of intraoperative bleeding was smaller (laparoscopy: 158 ml vs. laparotomy: 901 ml, p < 0.001). On the other hand, there was no difference in the operation time (laparoscopy: 458 min vs. laparotomy: 433 min, p = 0.31) or in the number of lymph nodes harvested (laparoscopy: 58 vs. laparotomy: 66, p = 0.22).
There were three major complication events (12.5%) in the laparoscopic group including one case of venous injury and two cases of compartment syndrome, whereas there were four major complication events (11.2%) in the laparotomy group, which included one case each of urinary tract injury and abdominal incisional hernia and two cases of ileus.
There was no difference between the two groups in the interval of disease-free survival (p = 0.19). There were eight recurrences, three (12.5%) in the laparoscopic group and five (14.0%) in the laparotomy group. In the laparoscopic group, recurrence occurred in one patient in the lung, one in the vaginal stump, and one in the vaginal introitus. In the laparotomy group, recurrence occurred in two patients in the lung, two in the vaginal stump, and one each in the pelvic wall, vaginal wall, and lymph nodes. There was no difference between the two groups in terms of recurrence sites.
Conclusions: Compared to open surgery, laparoscopic surgery including PAN for early-stage endometrial cancer had no greater adverse effect and minimal invasiveness could be achieved in our hospital. Laparoscopic surgery is a useful alternative to laparotomy for early-stage endometrial cancer.
