Palomba Stefano, Ghezzi Fabio, Falbo Angela, Mandato Vincenzo Dario, Annunziata Gianluca, Lucia Emilio, Cromi Antonella, Zannoni Letizia, Seracchioli Renato, Giorda Giorgio, La Sala Giovanni Battista, Zullo Fulvio, Franchi Massimo
Obstetrics and Gynecology Unit, IRCCS - Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123, Reggio Emilia, Italy,
Surg Endosc. 2014 Nov;28(11):3200-9. doi: 10.1007/s00464-014-3589-4. Epub 2014 Jul 9.
Data on patients with endometrial cancer converted to laparotomy are totally lacking. The aim of the present study was to evaluate surgical and oncological outcomes in patients with endometrial cancer scheduled for laparoscopic staging but converted to laparotomy.
Data of consecutive patients who had undergone surgery for staging endometrial cancer in seven Italian centers were reviewed. Patients' characteristics and surgical and oncological data were noted and analyzed according to surgery, i.e. laparotomy, laparoscopy, and laparoscopy converted to laparotomy.
Seventy-one out of 512 (13.9 %) patients scheduled to laparoscopy were converted to laparotomy for reasons related to anesthesiology [38/71 (53.5 %)] or surgery [33/71 (46.5 %)]. The conversion rate varied among stages [41/460 (8.9 %), 13/27 (48.1 %), 17/25 (68.0 %) in patients with stage I, II, and endometrial cancers, respectively]. Significant (P < 0.05) differences among groups were detected in patients' age, body mass index and previous pelvic surgery, and in the distribution of stages and histotype of endometrial cancers. The Kaplan-Meier procedure showed that the cumulative probability of first recurrence (P = 0.089, 0.590 and 0.084 for stage I, II and III, respectively) and of death (P = 0.108, 0.567 and 0.372 for stage I, II and III, respectively) categorized by stages did not attain statistical significance by log-rank testing after correction for confounding factors.
The surgical and oncological outcomes of converted patients are no different from those of patients staged successfully with laparoscopy or with laparotomy. The conversion to laparotomy should be not considered per se a complication.
目前完全缺乏有关子宫内膜癌患者中转开腹手术的数据。本研究的目的是评估计划进行腹腔镜分期但中转开腹手术的子宫内膜癌患者的手术及肿瘤学结局。
回顾了意大利七个中心连续接受子宫内膜癌分期手术患者的数据。根据手术方式，即开腹手术、腹腔镜手术及中转开腹手术，记录并分析患者的特征、手术及肿瘤学数据。
计划行腹腔镜手术的512例患者中有71例（13.9%）因麻醉相关原因[38/71（53.5%）]或手术相关原因[33/71（46.5%）]中转开腹。不同分期患者的中转率有所不同[I期、II期和子宫内膜癌患者中转率分别为41/460（8.9%）、13/27（48.1%）、17/25（68.0%）]。在患者年龄、体重指数、既往盆腔手术以及子宫内膜癌的分期和组织学类型分布方面，各手术组间存在显著（P<0.05）差异。Kaplan-Meier法显示，校正混杂因素后，按分期分类的I期、II期和III期患者首次复发的累积概率（分别为P = 0.089、0.590和0.084）及死亡的累积概率（分别为P = 0.108、0.567和0.372）经对数秩检验未达到统计学显著性。
中转开腹患者的手术及肿瘤学结局与腹腔镜或开腹手术成功分期患者的结局并无差异。不应将中转开腹本身视为一种并发症。
