Primarily Outcome of Laparoscopic Hysterectomy for Early-Stage Malignant Gynecological Cancer of Unselected Cases in Five Years

Abstract

Objective: To investigate the feasibility and safety of laparoscopic hysterectomy (LH) in early-stage malignant gynecological cancer. Methods: Data from patients who underwent surgical management for early-stage gynecological cancer between 2009 and 2014 were retrospectively reviewed. Each woman gave her informed consent to be included into the study, which was previously approved by the local ethics committee and Institutional Review Board. Inclusion Criteria: All patients presented with stage I or II disease, and underwent comprehensive staging surgery consisting of hysterectomy or radical hysterectomy, with or without bilateral salpingo-oophorectomy, with or without para-aortic lymphadenectomy, with or without omentectomy, and peritoneal cytology. Results: 345 patients who underwent laparoscopic surgery (201 cervical cancer cases, 110 endometrial cancer cases and 34 ovarian cancer cases) were identified. Surgery for none of the patients was converted from laparoscopy to laparotomy. The median patient age for early-stage of gynecological cancer was 48 years (range, 29 - 71 years). 87 (25.22%) of whom were elderly (>60 years); 98 (28.41%) were obese (>30 kg/m2); 164 (62.96%) were postmenopausal; 103 (29.86%) had undergone previous abdominal surgery; 96 (25%) had a history of medical disease. The median operative time and estimated blood loss were 3.5 hours (range, 2.5 - 5.5 hour) and 80 mL (20 - 200 mL), respectively. Intra-operative and postoperative complications occurred in 6 (1.74%) and 34 (9.86%). None of the patients occurred death. The interval to bowel movement and indwelling catheter were 3 days (range, 1 - 5 days) and 7 days (range, 5 - 11 days). The median postoperative hospital stay was 10 days (range, 6 - 18 days). The mean operating time and hospital days for cervical cancer was shorter; the estimated blood loss was lower; and the peri-operative complications were lower in the second stage (July 2012-May 2014) than in the first three years (May 2009-June 2012) in our department (p < 0.05). Conclusion: Based on the data described in our center, laparoscopic surgery seems to be adequate and feasible for the treatment of early-stage gynecological cancer in terms of the surgical outcomes and safety.