Laparoscopy without uterine manipulator vs. laparotomy in endometrial cancer: a retrospective study
SUMMARY OBJECTIVE: The objective of the study was to evaluate perioperative and oncologic outcomes of laparoscopy without the use of uterine manipulators and laparotomy in high-grade and serous endometrial cancer. METHODS: Patients with grade III endometrioid adenocarcinoma and serous carcinoma between 2018 and 2022 were included in the study. Preoperative staging with positron emission tomography/computed tomography or thoracoabdominal computed tomography and pelvic magnetic resonance imaging was performed. All patients underwent staging surgery including hysterectomy, bilateral salpingo-oophorectomy, peritoneal washing, omentectomy, and pelvic and paraaortic lymphadenectomy up to the renal vein. No uterine manipulator was used for laparoscopic hysterectomy. Age, CA 125 level, body mass index, accompanying diseases, pathologic data including stage, lymphovascular invasion, number of pelvic and paraaortic lymph nodes, and surgical data including surgical time, surgical complications, and adjuvant therapies were collected from the hospital database retrospectively. RESULTS: Notably, 89 patients were included in the study: 34 underwent laparotomy and 55 underwent laparoscopy. Surgical times were similar between the groups. The mean pelvic lymph node count in the laparotomy and laparoscopy groups was 33 and 34, respectively. The mean paraaortic lymph node counts in the laparotomy and laparoscopy groups were 23 and 22, respectively. Red blood cell transfusion, hemorrhage, urinary tract infection, postoperative fever, bladder atony, bladder injury, and chylous leakage showed no significant differences between the groups. However, ileus, intestinal injury, and evisceration were significantly higher in the laparotomy group. Hospital stay was significantly longer in the laparotomy group compared with the laparoscopy group. Overall and recurrence-free survival were similar between the groups. CONCLUSION: Laparoscopic surgery, performed without manipulators, provides comparable oncologic outcomes to open surgery in the treatment of high-grade endometrial cancer, while also offering improved perioperative results.
