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Laparoscopic Surgery vs Laparotomy : Radical Hysterectomy and Lymphadenectomy for Endometrial Cancer
Hazim.W.A, Shahril.A.B, Yong.C.M. Pavani. N, Hafiz M.B, Siti N.M
Dept of Obstetrics & Gynecology, Hospital Putrajaya, Dept of Obstetrics & Gynecology, Hospital Kajang ,Dept of Obstetrics & Gynecology, Hospital Ampang




uring the last years, an increasing interest

was turned to the search of minimally invasive surgical techniques for treating gynecologic malignancies. Endometrial cancer is the commonest gynecological cancer mostly affecting women in the postmenopausal age group. Endoscopic surgeries for gynecological cancers have shown great advances.

1. To assess the efficacy of laparoscopy compared with laparotomy in radical hysterectomy and lymphadenectomy for endometrial cancer. 2. To present our experience in laparoscopic radical hysterectomy and lymphadenectomy in Management of Endometrial Cancer.

They were a total of 26 patients who were identified has having endometrial cancer. All cases were with a confirmed histo-pathological result. 18 patients that underwent radical hysterectomy and lymphadenectomy were included in this study analysis. 11 patients underwent open radical hysterectomy and lymphadenectomy While, 7 underwent laparoscopic radical hysterectomy and lymphadenectomy. Standard operative methods performed in all cases. Mean age of patients diagnosed with endometrial cancer is 55.07 8.31 years old with mean parity 1.73 2.12.

There is a significant reduction in operative blood loss in the laparoscopic group with mean 262.5047.87 and laparotomy group with mean 381.82138.33, 95% CI, p<0.05. There is no significant difference of mean operative time and duration of post operative stay. The mean operative time for laparotomy is 256 76.40 compared to laparoscopic 288.7543.66 and mean of postoperative stay were 8.001.41 and 7.643.67 respectively. More numbers of lymph nodes were harvested laparoscopically (29.7516.59) than laparotomy (23.012.62). However this was not significant.
Operative Outcome Laparotomy N = 11 Laparoscopy N =7 P value


Laparoscopic surgery had shown better haemostatic control by resulting in significant lesser blood loss compared to laparotomy. This study also shows laparoscopic surgery is comparable to laparotomy in surgical management of endometrial cancer. Experienced and trained surgeon would be able to perform radical hysterectomy and lymphadenectomy as equally good to laparotomy with adequate tumour excision and complete staging. Laparascopy patient will have faster healing and early recovery thus can initiate earlier adjuvant therapy if needed.
Keywords: endometrial cancer, laparoscopy, radical hysterectomy, lymphadenectomy.

Operative Time ( min) ( Mean SD) Post - operative hospital stay ( day) ( Mean SD) Estimated Blood loss (ml) (MeanSD) Number of lymph nodes removed (n)

256.00 76.40 8.001.41

288.7543.66 7.643.67

0.439 0.853


381.82138.3 3 23.012.62

262.5047.87 29.7516.59

0.122 0..410

This is a retrospective cohort study of women with Histo-pathological examination confirmed for endometrial cancer, and underwent radical hysterectomy between January 2010 and December 2012. Data collected using electronic medical records in Putrajaya Hospital. Case data are collected on demographic detail (age and parity), clinical symptoms ( pain and bleeding ) , Choice of surgery ( laparotomy or laparoscopy ), Stage of disease ( operative time, estimated blood loss and patients outcome ( length of hospital stay ).

0 para 0 para 1 para 2 para 3 para 4 para 5

**Variable is given as meanSD, N (%) or median. **P-values were obtained from a Students t test

Graph shows the frequency of occurrence of endometrial cancer comparison to parity of women. This study emphasis the facts that the incidence of endometrial cancer was higher among nulliparity compared to multiparity. An about 66.7% patient presented with postmenopausal bleeding.

Table . Comparison between laparotomy and laparoscopic techniques for both group of patients.. Post operative stay found to be longer in patient with co-morbidity; such as preexistences of hypertension or diabetes mellitus.

1. Zullo F, Palomba S, Falbo A, et al. Laparsocopic surgery vs laparotomy for early stage endometrial cancer: long term data of a randomized controlled trial. Am J Obstet Gynecol 2009. 2. Obermair A, Janda M, Baker J, et al. Improved surgical safety after laparoscopic compared to open surgery for apparent early stage endometrial cancer: results from a randomised controlled trial. Europe J of cancer (48)2012. 3. Javier F.M, Nina F.M, Amy L.W, et al. Lapasroscopic lymphadenectomy and vaginal or laparoscopic hysterectomy with bilateral salpingo- oophorectomy for endometrial cancer: Morbidity and survival.