Caquant Frédéric, Mas-Calvet Marie, Turbelin Caroline, Lesoin Anne, Lefebvre Daniele, Narducci Fabrice, Querleu Denis, Leblanc Eric
Centre Oscar-Lambret, 3, rue Frédéric-Combemale, BP 307, 59020 Lille Cedex.
Bull Cancer. 2006 Apr;93(4):402-6.
To prove feasibility of laparoscopic and vaginal surgical approach in obese patients with endometrial cancer, 81 patients were included retrospectively in 2 Cancer Centres : 41 obese and 40 non obese. We performed hysterectomy with oophorectomy and pelvic lymphadenectomy by laparoscopic and vaginal approach. Operative time was higher for obese patients vs non obese (150 vs 121 minutes, p = 0.01) but pelvic nodes (16.3 vs 16.2), postoperative stay (3.8 [2-8] vs 3.6 days [2-7]), complications and disease-free survival (93 % vs 83 %) were similar. Matching 41 obese patients treated by laparoscopy with 29 obese patients with endometrial cancer treated by laparotomy, hospital stay was shorter in the laparoscopic group (3.8 [2-8] vs 7.4 days [5-10] p < 0.001) and pelvic nodes (16.3 [3-50] vs 11.5 [2-34]), operative time (149.9 [80-300] vs 167.9 minutes [60-390]) and disease-free survival (93 vs 80 %) were similar. One patient treated by laparotomy never received intended radiotherapy because of a delay greater than 3 months caused by cutaneous necrosis. For obese patients with stage I endometrial adenocarcinoma, laparoscopic approach should be first choice because of similar operative complications and pelvic nodes, shorter hospital stay and less abdominal wall morbidity associated with lower risk to delay adjuvant radiotherapy.
为证明腹腔镜和阴道手术方法在肥胖子宫内膜癌患者中的可行性，2个癌症中心回顾性纳入了81例患者：41例肥胖患者和40例非肥胖患者。我们通过腹腔镜和阴道入路进行子宫切除术、卵巢切除术和盆腔淋巴结清扫术。肥胖患者的手术时间高于非肥胖患者（150分钟对121分钟，p = 0.01），但盆腔淋巴结数量（16.3对16.2）、术后住院时间（3.8[2 - 8]天对3.6天[2 - 7]）、并发症和无病生存率（93%对83%）相似。将41例接受腹腔镜治疗的肥胖患者与29例接受开腹手术治疗的肥胖子宫内膜癌患者进行匹配，腹腔镜组的住院时间更短（3.8[2 - 8]天对7.4天[5 - 10]，p < 0.001），盆腔淋巴结数量（16.3[3 - 50]对11.5[2 - 34]）、手术时间（149.9[80 - 300]分钟对167.9分钟[60 - 390]）和无病生存率（93%对80%）相似。1例接受开腹手术治疗的患者因皮肤坏死导致延迟超过3个月而从未接受预期的放疗。对于I期子宫内膜腺癌肥胖患者，由于手术并发症和盆腔淋巴结情况相似、住院时间更短、腹壁发病率更低且延迟辅助放疗风险更低，腹腔镜入路应作为首选。
