Öz
Aim: The aim of the study is to compare the results of total laparoscopic hysterectomy and total abdominal hysterectomy in obese women with endometrial cancer (EC).
Materials and Methods: Patients with endometrial cancer whose BMI ≥30 kg/m2 and who were undergone total laparoscopic hysterectomy (n=68) or total abdominal hysterectomy (n=161) were included in the study. Demographic and histopathological features, disease-free survival and overall survival of the patients were recorded. All these data of laparoscopy and laparotomy patients were compared with each other.
Results: No significant difference was observed between two groups in terms of stage, tumor grade, histology, lymph node dissection rate and number of removed lymph nodes. Cardiovascular diseases were more common in laparotomy group (p=0.002). ASA (American Society of Anesthesiologists) score was higher in laparotomy group (p=0.001). Perioperative and postoperative complications were similar in both groups. The operation time was significantly longer and postoperative hospital stay was significantly shorter in the laparoscopy group (p<0.0001). There was no significant difference between two groups in disease-free survival and overall survival. The overall survival rate was 90.7% in the laparoscopy group and 95.1% in the laparotomy group (p = 0.789).
Conclusion: Our results showed that in obese patients with EC, laparoscopy had similar oncological outcomes with laparotomy and was also more beneficial for patients in terms of a shorter hospital stay.
Anahtar Kelimeler
Kaynakça
- 2014 Cancer Incidences in Turkey. Avaliable from: https://hsgm.saglik.gov.tr/tr/kanser-istatistikleri/yillar/495-2014-yili-turkiye-kanser-istatistikleri.html
- Tangjitgamol S, Manusirivithaya S, Srijaipracharoen S, et al. Endometrial cancer in Thai women: clinico-pathological presentation and survival. Asian Pac J Cancer Prev. 2010; 11 (5):1267-72.
- Saso S, Chatterjee J, Georgiou E, Ditri AM, Smith JR, Ghaem-Maghami S. Endometrial cancer. BMJ. 2011 Jul 6; 343:d3954.
- Salani R, Backes FJ, Fung MF, et al. Posttreatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncologists recommendations. Am J Obstet Gynecol. 2011 Jun; 204 (6): 466-78.
- Hacker NF. Uterine cancer. In: Berek JS, Hacker NF, eds. Practical gynecologic oncology. Philadelphia: Lippincott Williams & Wilkins, 2000: 407–55.
- Mikuta JJ. International Federation of Gynecology and Obstetrics. Staging of endometrial cancer 1988. Cancer 1993; 71: 1460–63.
- Krebs HB, Helmkamp F. Transverse periumbilical incision in the massively obese patient. Obstet Gynecol 1984; 63: 241–5.
- Pitkin RM. Abdominal hysterectomy in obese women. Surg Gynecol Obstet 1976; 142:532–6.
- Gomel V, Taylor PJ. Indications and contraindications of diagnostic laparoscopy. In: Gomel V, Taylor PJ, editors. Diagnostic and operative gynaecologic laparoscopy. 1st ed. St. Louis (MO): Mosby-Year Book; 1995. p. 68–70.
- Puri KS, Suresh KR, Gogtay NJ, Thatte UM. Declaration of Helsinki, 2008: implications for stake- holders in research. J Postgrad Med. 2009; 55 (2):131-4.
- FIGO stages—1988 revision (Announcement). Gynecol Oncol 1989; 135: 125-6.
- Reich, Harrya,b Total laparoscopic hysterectomy: indications, techniques and outcomes, Current Opinion in Obstetrics and Gynecology: August 2007; 19 (4): 337-44.
- Wang HL, Ren YF, Yang J, Qin RY, Zhai KH. Total laparoscopic hysterectomy versus total abdominal hysterectomy for endometrial cancer: a meta-analysis. Asian Pac J Cancer Prev. 2013; 14(4):2515-9.
- Bouwman F, Smits A, Lopes A, et al. The impact of BMI on surgical complications and outcomes in endometrial cancer surgery--an institutional study and systematic review of the literature. Gynecol Oncol. 2015 Nov; 139 (2): 369-76.
- Gehrig PA, Cantrell LA, Shafer A, Abaid LN, Mendivil A, Boggess JF. What is the optimal minimally invasive surgical procedure for endometrial cancer staging in the obese and morbidly obese woman? Gynecol Oncol 2008; 111: 41–5.
- Eltabbakh GH, Piver MS, Hempling RE, Recio FO. Laparoscopic surgery in obese women. Obstet Gynecol 1999; 94 (5 Pt 1): 704–8.
- Obermair A, Manolitsas TP, Leung Y, Hammond IG, McCartney AJ. Total laparoscopic hysterectomy versus total abdominal hysterectomy for obese women with EC. Int J Gynaecol Cancer 2005; 15: 319-24.
- Eltabbakh GH, Shamonki MI, Moody JM, Garafano LL. Hysterectomy for obese women with EC: laparoscopy or laparotomy? Gynecol Oncol 2000; 78: 329-35.
- Helm CW, Arumugam C, Gordinier ME, et al. Laparoscopic surgery for EC: increasing body mass index does not impact postoperative complications. J Gynecol Oncol 2011; 22: 168-76.
- Santi A, Kuhn A, Gyr T. Laparoscopy or laparotomy? A comparison of 240 patients with early-stage EC. Surg Endosc 2010; 24: 939-43.
- Manolitsas TP, McCartney AJ. Total laparoscopic hysterectomy in the management of endometrial carcinoma. J Am Assoc Gynecol Laparosc 2002; 9: 54-62.
- Corrado G, Vizza E, Cela V, et al. Laparoscopic versus robotic hysterectomy in obese and extremely obese patients with endometrial cancer: A multi-institutional analysis. Eur J Surg Oncol. 2018 Dec; 44 (12): 1935-41.
- Barnett JC, Judd JP, Wu JM, Scales CD Jr, Myers ER, Havrilesky LJ. Cost comparison among robotic, laparoscopic and open hysterectomy for endometrial cancer. Obstet Gynecol. 2010 Sep; 116 (3): 685-93.
- Seamon LG, Cohn DE, Henretta MS, et al. Minimally invasive comprehensive surgical staging for endometrial cancer: Robotics or laparoscopy? Gynecol Oncol. 2009 Apr; 113 (1): 36-41.
- Gala RB, Margulies R, Steinberg A, et al; Society of Gynecologic Surgeons Systematic Review Group. Systematic review of robotic surgery in gynecology: robotic techniques compared with laparoscopy and laparotomy. J Minim Invasive Gynecol. 2014 May-Jun; 21 (3):353-61.
- Chan JK, Gardner AB, Taylor K, et al. Robotic versus laparoscopic versus open surgery in morbidly obese endometrial cancer patients - a comparative analysis of total charges and complication rates. Gynecol Oncol. 2015 Nov; 139 (2): 300-5.
- Shemshedini T, Pradhan TS, Pua TL, Tedjarati SS. The roles and limitations of robotic surgery for obese endometrial cancer patients: a common challenge in gynecologic oncology. J Robot Surg. 2015 Jun; 9 (2): 109-16.
- Bijen CB, Briët JM, de Bock GH, Arts HJ, Bergsma-Kadijk JA, Mourits MJ. Total laparoscopic hysterectomy versus abdominal hysterectomy in the treatment of patients with early stage endometrial cancer: a randomized multicenter study. BMC Cancer. 2009 Jan15; 9: 23.
- Mourits MJ, Bijen CB, Arts HJ, et al. Safety of laparoscopy versus laparotomy in early-stage endometrial cancer: a randomised trial. Lancet Oncol. 2010 Aug; 11 (8): 763-71.
Öz
Amaç: Çalışmanın amacı endometrial kanserli obez hastalarda total laparoskopik histerektomi ve total abdominal histerektomi sonuçlarının karşılaştırılmasıdır.
Gereç ve Yöntem: Vücut kitle oranı ≥30 kg/m2 olan endometrial kanserli hastalardan total laparoskopik histerektomi (n=68) ve total abdominal histerektomi (n=161) uygulanmış olanlar çalışmaya dahil edildi. Hastaların demografik ve histopastolojik özellikleri, hastalıksız sağ kalım ve toplam sağ kalım süreleri kaydedildi. Laparoskopi ve laparotomi grubunun verileri birbirleri ile karşılaştırıldı.
Bulgular: k grup arasında, evre, tümör derecesi, histoloji, lenf nodu diseksiyonu yapılma oranı ve çıkarılan lenf nodu sayısı açısından anlamlı fark görülmedi. ard yovasküler hastalıklar laparotom grubunda belirgin fazla izlendi (p=0,002). ASA (Amerikan Anestezistler Derneği) skoru laparotomi grubunda daha yüksek idi (p=0,001). Peroperatif ve postoperatif komplikasyonlar laparotomi ve laparoskopi gruplarında benzer idi. Laparatomi grubunda; operasyon süresi belirgin kısa iken, postoperatif hastanede yatış süres laparoskop grubuna göre belirgin artmış idi (p<0,0001). ki grup arasında hastalıksız sağ kalım ve genel sağ kalım süreler açısından bel rg n fark saptanmadı. Laparoskop grubunda genel sağ kalım %90,7 iken, laparotomi grubunda %95,1 saptandı (p=0,789).
Sonuç: Sonuçlarımız endometrial kanserli obez hastalarda laparoskopinin laparotomi ile benzer onkolojik sonuçlara sahip olmakla birlikte hastanede kalış süresindeki kısalık ile hastalar için daha konforlu olduğunu gösterdi.
Anahtar Kelimeler
Kaynakça
- 2014 Cancer Incidences in Turkey. Avaliable from: https://hsgm.saglik.gov.tr/tr/kanser-istatistikleri/yillar/495-2014-yili-turkiye-kanser-istatistikleri.html
- Tangjitgamol S, Manusirivithaya S, Srijaipracharoen S, et al. Endometrial cancer in Thai women: clinico-pathological presentation and survival. Asian Pac J Cancer Prev. 2010; 11 (5):1267-72.
- Saso S, Chatterjee J, Georgiou E, Ditri AM, Smith JR, Ghaem-Maghami S. Endometrial cancer. BMJ. 2011 Jul 6; 343:d3954.
- Salani R, Backes FJ, Fung MF, et al. Posttreatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncologists recommendations. Am J Obstet Gynecol. 2011 Jun; 204 (6): 466-78.
- Hacker NF. Uterine cancer. In: Berek JS, Hacker NF, eds. Practical gynecologic oncology. Philadelphia: Lippincott Williams & Wilkins, 2000: 407–55.
- Mikuta JJ. International Federation of Gynecology and Obstetrics. Staging of endometrial cancer 1988. Cancer 1993; 71: 1460–63.
- Krebs HB, Helmkamp F. Transverse periumbilical incision in the massively obese patient. Obstet Gynecol 1984; 63: 241–5.
- Pitkin RM. Abdominal hysterectomy in obese women. Surg Gynecol Obstet 1976; 142:532–6.
- Gomel V, Taylor PJ. Indications and contraindications of diagnostic laparoscopy. In: Gomel V, Taylor PJ, editors. Diagnostic and operative gynaecologic laparoscopy. 1st ed. St. Louis (MO): Mosby-Year Book; 1995. p. 68–70.
- Puri KS, Suresh KR, Gogtay NJ, Thatte UM. Declaration of Helsinki, 2008: implications for stake- holders in research. J Postgrad Med. 2009; 55 (2):131-4.
- FIGO stages—1988 revision (Announcement). Gynecol Oncol 1989; 135: 125-6.
- Reich, Harrya,b Total laparoscopic hysterectomy: indications, techniques and outcomes, Current Opinion in Obstetrics and Gynecology: August 2007; 19 (4): 337-44.
- Wang HL, Ren YF, Yang J, Qin RY, Zhai KH. Total laparoscopic hysterectomy versus total abdominal hysterectomy for endometrial cancer: a meta-analysis. Asian Pac J Cancer Prev. 2013; 14(4):2515-9.
- Bouwman F, Smits A, Lopes A, et al. The impact of BMI on surgical complications and outcomes in endometrial cancer surgery--an institutional study and systematic review of the literature. Gynecol Oncol. 2015 Nov; 139 (2): 369-76.
- Gehrig PA, Cantrell LA, Shafer A, Abaid LN, Mendivil A, Boggess JF. What is the optimal minimally invasive surgical procedure for endometrial cancer staging in the obese and morbidly obese woman? Gynecol Oncol 2008; 111: 41–5.
- Eltabbakh GH, Piver MS, Hempling RE, Recio FO. Laparoscopic surgery in obese women. Obstet Gynecol 1999; 94 (5 Pt 1): 704–8.
- Obermair A, Manolitsas TP, Leung Y, Hammond IG, McCartney AJ. Total laparoscopic hysterectomy versus total abdominal hysterectomy for obese women with EC. Int J Gynaecol Cancer 2005; 15: 319-24.
- Eltabbakh GH, Shamonki MI, Moody JM, Garafano LL. Hysterectomy for obese women with EC: laparoscopy or laparotomy? Gynecol Oncol 2000; 78: 329-35.
- Helm CW, Arumugam C, Gordinier ME, et al. Laparoscopic surgery for EC: increasing body mass index does not impact postoperative complications. J Gynecol Oncol 2011; 22: 168-76.
- Santi A, Kuhn A, Gyr T. Laparoscopy or laparotomy? A comparison of 240 patients with early-stage EC. Surg Endosc 2010; 24: 939-43.
- Manolitsas TP, McCartney AJ. Total laparoscopic hysterectomy in the management of endometrial carcinoma. J Am Assoc Gynecol Laparosc 2002; 9: 54-62.
- Corrado G, Vizza E, Cela V, et al. Laparoscopic versus robotic hysterectomy in obese and extremely obese patients with endometrial cancer: A multi-institutional analysis. Eur J Surg Oncol. 2018 Dec; 44 (12): 1935-41.
- Barnett JC, Judd JP, Wu JM, Scales CD Jr, Myers ER, Havrilesky LJ. Cost comparison among robotic, laparoscopic and open hysterectomy for endometrial cancer. Obstet Gynecol. 2010 Sep; 116 (3): 685-93.
- Seamon LG, Cohn DE, Henretta MS, et al. Minimally invasive comprehensive surgical staging for endometrial cancer: Robotics or laparoscopy? Gynecol Oncol. 2009 Apr; 113 (1): 36-41.
- Gala RB, Margulies R, Steinberg A, et al; Society of Gynecologic Surgeons Systematic Review Group. Systematic review of robotic surgery in gynecology: robotic techniques compared with laparoscopy and laparotomy. J Minim Invasive Gynecol. 2014 May-Jun; 21 (3):353-61.
- Chan JK, Gardner AB, Taylor K, et al. Robotic versus laparoscopic versus open surgery in morbidly obese endometrial cancer patients - a comparative analysis of total charges and complication rates. Gynecol Oncol. 2015 Nov; 139 (2): 300-5.
- Shemshedini T, Pradhan TS, Pua TL, Tedjarati SS. The roles and limitations of robotic surgery for obese endometrial cancer patients: a common challenge in gynecologic oncology. J Robot Surg. 2015 Jun; 9 (2): 109-16.
- Bijen CB, Briët JM, de Bock GH, Arts HJ, Bergsma-Kadijk JA, Mourits MJ. Total laparoscopic hysterectomy versus abdominal hysterectomy in the treatment of patients with early stage endometrial cancer: a randomized multicenter study. BMC Cancer. 2009 Jan15; 9: 23.
- Mourits MJ, Bijen CB, Arts HJ, et al. Safety of laparoscopy versus laparotomy in early-stage endometrial cancer: a randomised trial. Lancet Oncol. 2010 Aug; 11 (8): 763-71.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 13 Haziran 2022 |
| Gönderilme Tarihi | 1 Mayıs 2021 |
| Yayımlandığı Sayı | Yıl 2022 |