| Background Endometrial carcinoma is now the most common pelvic genital cancer in women.The peak incidence of onset is in the sixth and seventh decades,but 2-5% occurs before age 40 years,and the disease has been reported in women aged 20-30.In the USA,white women have a lifetime risk of endometrial carcinoma of 2.4% compared with 1.3%for black women.A doubling of the incidence of endometrial cancer in the 1970s correlated with unopposed estrogen use in hormone replacement and sequential oral contraceptive over the previous 10 years.The declining incidence in the 1980s paralleled progesterone use in hormone replacement regimens and low-dose estrogen combination birth control pills.The incidence of endometrial cancer has now remained stable over the past 10 years.The onset of endometrial bleeding facilitates detection in the earlier stages of stages.Consequently,the overall prognosis is considerably better than the other major gynecologic cancers.Estrogens have been implicated as a causative factor in endometrial carcinoma, because there is a high incidence of this disease in patients with presumed alteration in estrogen metabolism and in those who take exogenous estrogens.Classically,it affects the affluent obese,nulliparous,infertile,hypertensive,and diabetic white woman,but it can occur in the absence of all these factors.Unlike cervical cancer,it is not related to sexual history.Fortunately for the victim,there is a warning;abnormal bleeding usually occurs early in the course of the disease and alerts the patient or physician to an endometrial abnormality.A total hysterectomy with bilateral salpingo-oophorectomy is usually the first step in treatment.Prior to 1988,a clinical staging system classified cancers of the endometrium.Presently the stage of an endometrial carcinoma is based on abdominal exploration,pelvic washings,total hysterectomy with salpingo-oophorectomy,and selective pelvic and periaortic lymph node biopsies.Recent advances in the application of laparoscopic surgical techniques to gynecologic malignancies have made this approach useful in treating patients with early uterine cancer.Laparoscopy has been reported to provide exact staging and effective treatment of endometrial carcinoma,along with shorter hospital stay,earlier recovery, and better quality of life.Objective To compare the results of surgical treatment of endometrial cancer with the use of laparoscopy and the traditional approach of laparotomy,and to evaluate the feasibility of laparoscopic surgical treatment of early stage endometrial cancer.Metrods 47 patients with early endometrial carcinoma were reviewed,26 of whom underwent laparoscopic subradical hysterectomy(laparoscopic group),and 21 of whom were treated by laparotomic subradical hysterectomy(open group).The operative parameters including operating time,intra-operative blood loss,the number of lymph nodes removed,the gastrointestinal recovery time,the self retaining catheter time, complications and post-operative hospital stay were compared.Results The clinicopathological characteristics before operation between both groups were similar.No significant differences were found in age(50.04±9.20 vs 54.88±8.02 years,P＞0.05 )and BMI(23.05±3.83 vs 25.05±3.66Kg/m~2,P＞0.05 )between the two groups.As compared with the open group,the laparoscopic group presented a longer operation time(251.40±80.95min vs 192.50±36.92min,P＜0.01),less blood loss (230.00±112.73ml vs 328.13±159.13ml,P＜0.05),shorter hospital stay(8.16±2.46 d vs 10.13±1.96 d,P＜0.05),shorter gastrointestinal recovery time(2.00±0.71d vs 2.69±0.87d).While there was no significant difference between two groups in the number of lymph nodes removed,,the self retaining catheter time and complications. Conclusions Laparoscopy is feasible and safe in treatment of early endometrial cancer.Laparoscopic surgery for endometrial carcinoma is associated with significantly less blood loss,shorter hospital stay,longer operation time,and similar lymph nodes yielded when compared with laparotomy. |
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