Abstract and Introduction
Abstract
Background: Endometrial cancer is the most common gynecologic malignancy in the United States. Surgical staging is an integral component in the treatment of this disease. Minimally invasive surgical techniques have been utilized with increasing frequency in its management.
Methods: This article reviews the use of minimally invasive surgery for the treatment of endometrial cancer.
Results: Prospective trials and retrospective analyses have demonstrated the safety and feasibility of laparoscopy in performing hysterectomy, bilateral salpingo-oophorectomy, and pelvic and periaortic lymphadenectomy for surgical staging in endometrial cancer. The use of minimally invasive techniques does not appear to have an adverse impact on survival, and it improves quality of life in the postoperative period. Robotic surgery has been used in the management of this disease with promising preliminary results.
Conclusions: Laparoscopy is a safe and effective approach for surgical staging of selected patients with endometrial cancer. Further studies and cost-benefit analyses are required to determine if the use of robotics improves outcomes over standard laparoscopy and can extend the benefits of minimally invasive surgery to a larger proportion of patients with this common gynecologic malignancy.
Introduction
Minimally invasive surgery has been shown to be an appropriate, if not preferred, alternative in many wideranging surgical procedures. As with any procedure, careful patient selection is critical. In gynecologic oncology, the reported advantages of minimally invasive surgery include a shorter hospital stay, decreased analgesic requirements, faster recovery, lower intraoperative and postoperative complications, and improved quality of life. Laparoscopy has been used extensively for the management of benign gynecologic conditions such as the evaluation and treatment of endometriosis and benign adnexal masses. Since the 1960s and 1970s, laparoscopy has been used in benign gynecology. Case reports in the late 1980s demonstrated the use of minimally invasive surgery in gynecologic oncology. As advanced laparoscopic techniques and skills have improved and as innovative technologies have become available, minimally invasive surgery has been used with increasing frequency in the treatment of gynecologic malignancies, including endometrial cancer.
Historically, endometrial cancer surgery has been performed via laparotomy. This involves carefully exploring the abdomen and pelvis, obtaining washings for cytology, and performing a total abdominal hysterectomy, a bilateral salpingo-oophorectomy, and pelvic and periaortic lymphadenectomy. Patients with endometrial cancer often have significant medical comorbidities such as obesity, diabetes, hypertension, and older age. Alternative techniques such as minimally invasive surgery that would diminish procedure-related morbidity and expedite recovery may be especially beneficial in this patient population.