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Preliminary prospective observations on the laparoscopic management of endometrial carcinoma using the two-stage
1New Margaret Hague Women's Health Institute, 1 Harmon Plaza, Secaucus, NJ 07094, USA.
Study Objective:
To determine the value of a two-stage approach to laparoscopic aortic lymphadenectomy (ALN) in women with endometrial cancer.
Design:
Prospective case series.
Patients:
Twenty-three consecutive, unselected women with endometrial cancer were managed prospectively according to a previously defined protocol. All had laparoscopic hysterectomy, ten required pelvic and one had an aortic lymphadenectomy (ALN). Pelvic lymph node metastases (PLNM) were present in two (20%) and aortic lymph node metastases in one (10%) patient. Mean age was 60; three women were over 80 years old, and two were 78 years old. Mean weight and body mass index were 192 and 33.5, respectively; two women weighed over 300 pounds and another two weighed over 250 pounds. Mean anesthetic time was 3.2 hours, mean blood loss 469 ccs, and mean drop in hemoglobin 2.5 g/dl. One patient was transfused. Median hospital stay was 2 days. One patient had a questionable ileus post-operatively, and another was hospitalized for 10 days to control her diabetes and blood pressure.
Conclusions:
By predicating ALN on the presence of PLNM in endometrial cancer, the number of ALN can be reduced without reducing the number of aortic lymph node metastases detected, and laparoscopic management can be extended to morbidly obese women.