Total laparoscopic hysterectomy with pelvic/aortic lymph node dissection for endometrial cancer--a consecutive series...

To determine feasibility of duplicating operative time and nodal yield of "open" procedures by using laparoscopy for clinically localized endometrial cancer without case selection and eliminating influence of BMI on conversion.

In this retrospective study 210 consecutive patients were laparoscoped between July, 2006 and November, 2009 to perform total laparoscopic hysterectomy with bilateral salpingoophorectomy and pelvic/aortic lymph node dissection (TLH/BSO/LND) using pulsed bipolar cautery to complete all phases of the procedure. Outcomes ("Scope" group) are compared to historic consecutive TAH/BSO/LND controls ("Open" group) operated on 2004-2009 and "open" series in the literature.

Two hundred (95.2%) procedures were completed laparoscopically, 3 (1.4%) required a minilaparotomy to remove the uterus, and 7 (3.3%) were converted to complete the hysterectomy with some portion of LND. There was no influence of BMI (P=0.688), age (P=0.748) or the number of prior abdominal operations (P=0.875) on probability of conversion (Logistic regression). The mean age, BMI, number of prior abdominal procedures, and GOG performance status were equivalent in both study groups. The mean operative time was 139.5 min (IQR 125-152) for the "Scope" group and 128.4 min (IQR 105-124) for the "Open" group (P=0.008). The mean nodal yield was 34.7 (IQR 24-40) for the "Scope" group and 25.7 (IQR 18-30) for the "Open" group (P<0.001). The mean hospital stay was 3.2 days (IQR 2-4) for the "Scope" group and 7.9 days (IQR 5-9) for the "Open" group (P<0.001).

For clinically localized endometrial cancer, TLH/BSO/LND can functionally duplicate operative time equivalent to "open" procedures, while improving nodal yield, and minimizing influence of BMI on conversion to laparotomy and case selection.