Comparison Of Laparoscopic And Open Surgeries For Endometrial Cancer In Obese Patients

Background: Endometrial cancer is the one of most common female reproductive tract of cancer. In recent years, the incidence of endometrial cancer is obviously rising around the world. With the popularity of laparoscopic techniques, lots of gynecological tumor doctors suggest the application of laparoscopic treatment in early endometrial cancer. Obesity is considered to be a relative contraindication for laparoscopic surgery. However, it may be seen in 48% of women with early stage endometrial cancer. WHO recommends the use of the following BMI ranges for Asian-Pacific region: underweight(BMI<18.5 kg/m2), normal-weight(BMI 18.5~22.9 kg/m2), overweight(BMI 23.0~24.9 kg/m2), obese(BMI 25~29.9 kg/m2), and morbid obese(BMI ≥30 kg/m2).Objective: Research showed that laparoscopic surgery was safe and feasible for obese patients with early endometrial cancer. The aim of our study was to compare the feasibility, morbidity, safety, disease-free survival, and overall survival of the laparoscopic approach to early-stage endometrial cancer in obese patients compared to the traditional laparotomic approach.Methods: We retrospectively analyzed the clinicopathologic data of sixty obese patients with Body Mass Index >25 kg/m2 and clinical early-stage endometrial cancer who underwent staging surgery by laparoscopy(30 cases) or laparotomy(30 cases) from January 2011 to June 2014. Contrast the perioperative complication and postoperative curative effect in two groups. Staging surgery includes: basin abdominal exploration, ascites cytological examination, hysterectomy and bilateral salpingo-oophorectomy, pelvic lymph nodes dissections and/or abdominal aortic lymph node dissections.Result: There were no significant difference in the clinicopathologic data of age, body mass index, menopause, delivery times, hypertension, diabetes, CA125 value and the positive rate of ascites cytological examination etc. within two groups of patients. The average operating time were respectively(156.5±53.8)min and(147.9±58.1)min, P>0.05; The average amount of blood loss were respectively(113.0±84.5)ml and(384.0±290.0)ml, P=0.009; The average length of hospital stay were respectively(15.0±4.5)d and(23.3±6.0)d, P<0. 01; The average time to recovery of bowel movenment were respectively(2.0±0.3)d and(2.7±0.6)d, P<0.01. In the surgical pathology classification, FIGO stages and pathological types, P>0.05; The average number of resected pelvic lymph node were respectively(28.0±8.8) and(25.2±10.2), P>0.05. And there were no significant difference in the overall survival time or diseasefree survival time between the two groups.Conclusion: Small sample size clinical studies showed that, laparoscopic surgery can be considered a safe, feasible and effective therapeutic procedure for managing early-stage endometrial cancer in obese women with less blood loss, quicker recovery and shorter hospitalization time. And with the improving skills, the operating time of laparoscopic surgery is not significant longer than laparotomy now.