Doğan VATANSEVER, Burak GİRAY, Yasemin ABOALHASAN

Endometrium kanseri evrelemesinde laparoskopik yöntem ile laparotomik yöntemin perioperatif ve postoperatif karşılaştırılması

Amaç: Endometrium kanserinin evreleme cerrahisinde laparoskopik yaklaşımın güvenirliğini laparotomi ile karşılaştırmak. Metod: Ocak 2015 ile Ağustos 2017 tarihleri arasında laparoskopik (n=40) ve laparotomik (n=81) yöntemle tedavi edilen 121 endometrium kanserli hastanın bilgileri geriye dönük olarak değerlendirildi. İki grup operasyon süreleri, intraoperatif ve postoperatif komplikasyonlar, hemoglobin değerleri, hastanede kalış süreleri ve postoperatif ek tedavi gibi preoperatif ve postoperatif özellikleri açısından karşılaştırıldı. Bütün hastalara histerektomi ve bilateral salpingo-ooferektomi uygulandı ve gereklilik halinde lenf nodu diseksiyonu ve omentektomi yapıldı.Bulgular: Gruplar yaş, doğum sayısı, vücut kütle indeksi, menopozal durum, ASA (the American Society of Anesthesiologists) skoru, lenfadenektomi gerekliliği ve hastanede kalış süreleri açısından benzerdi. Preoperatif ve postoperatif hemoglobin değişim değerleri (p=0.013) ve operasyon süreleri (p<0.001) arasında istatistiksel olarak anlamlı fark vardı. Laparoskopi yapılan gruptaki hastaların operasyon süreleri daha fazla bulunurken, hemoglobin değişim değerleri daha az bulundu. Laparotomi yapılan grupta barsak hasarı (%1,2), yara yeri infeksiyonu (%13,6) ve postop ileus (%8,6) gelişirken, laparoskopi yapılan grupta yara yeri infeksiyonu (%2,5) ve postop ileus (%5) gelişti. Gruplar arasında intraoperatif (p=1) ve postoperatif komplikasyonlar açısından (yara yeri infeksiyonu için p=0.101; postop ileus için p=0.716) anlamlı fark yoktu. Gruplar histolojik grade, FIGO evresi, histolojik alt tip, lenfovasküler alan invazyon oranları, myometrial invazyon, çıkarılan lenf nodu miktarı, nodal metastaz oranları, tümör yerleşimi, servikal stromal invazyon ve kemoterapi ya da radyoterapi gibi ek tedavi uygulanmaları açısından benzerdi. Hiçbir hastada lenfokist ya da lenfödem gibi uzun dönem komplikasyonlar ve rekkürens gelişmedi.Sonuç: Çalışmamız laparoskopik yaklaşımın endometrium kanserli hastaların evrelemesinde laparotomiye benzer komplikasyon oranlarıyla güvenli bir şekilde uygulanabileceğini gösterdi. Ayrıca laparoskopi endometrium kanserinin evrelemesinde ve tedavisinde laparotomi kadar etkin bulunmuştur.

Anahtar Kelimeler:

endometrium kanseri, cerrahi evreleme, laparoskopi, laparotomi

Perioperative and postoperative outcomes of laparoscopy and open method for surgical staging of endometrial cancer

Objective: The aim of the study was to compare the safety of the laparoscopic and open method for endometrial cancer staging.Methods: Between January 2015 and August 2017, we reviewed 121 women with endometrial cancer treated by open (n=81) or laparoscopic (n=40) approach, retrospectively. Two groups were compared in terms of operating times, intraoperative and postoperative complications, perioperative and postoperative features such as hemoglobin values, the lengths of hospital stay, and adjuvant therapy. All of the patients underwent a hysterectomy and bilateral salpingo-oophorectomy; and when indicated, omentectomy and lymphadenectomy were performed.Results: There were no significant differences between the two groups with regard to the number of parities, body mass index, menopausal status, age, the American Society of Anesthesiologists (ASA) scores, the requirement of lymphadenectomy, and hospital stay. There were significant statistical differences between groups in terms of operation time and difference of hemoglobin (p<0.001, p=0.013; respectively). Laparoscopic surgery had a longer operative time than laparotomy, and difference of hemoglobin in the laparotomy group is more than the laparoscopy group. Patients who underwent staging with laparotomy had bowel injury (1.2%), wound infection (13.6%), and postop ileus (8.6%) while in the laparoscopy group patients had wound infection (2.5%) and postop ileus (5%). There were no statistically significant differences between the two groups in terms of the intraoperative (p=1) and postoperative complications (p=0.101 for wound infection, p=0.716 for postop ileus). The groups were similar in terms of the histological grade, FIGO stage, histologic subtype, the rate of lymphovascular invasion, the depth of myometrial invasion, the total number of lymph nodes resected in lymph node dissections, the rate of lymph node metastasis, the location of the tumor, cervical stromal invasion, and the adjuvant therapy such as chemotherapy and brachytherapy. None of the patients in both groups had a recurrence and long-term lymphatic complication such as lymphocyst, lymphedema. Conclusion: Our current data demonstrated that the laparoscopic approach can be performed without loss of safety with similar complication rates in patients with endometrium cancer. Additionally, the laparoscopy was not inferior to the laparotomy in terms of efficacy.

Keywords:

endometrial carcinoma, laparoscopy, laparotomy, surgical staging,

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