Bennich Gitte, Rudnicki Martin, Lassen Pernille D
Department of Obstetrics and Gynecology, Zealand University Hospital, Roskilde, Denmark.
Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark.
Acta Obstet Gynecol Scand. 2016 Aug;95(8):894-900. doi: 10.1111/aogs.12908. Epub 2016 May 30.
The purpose of the present study was to evaluate learning curves and short-term outcomes following laparoscopic surgery for early endometrial cancer in women of different body mass index (BMI) classes.
Data from 227 women planned for laparoscopic surgery for presumed stage I endometrial cancer were collected retrospectively from a Danish gynecologic oncology unit. Surgery included laparoscopic hysterectomy and bilateral salpingo-oophorectomy with or without pelvic lymphadenectomy (PLA).
Median length of operations was 60 min (range, 30-197) and 120 min (range, 60-230), depending on whether PLA was included. The median pelvic lymph node yield was 18 (range, 7-42). For staging with PLA there was a learning curve when measured as operative time as well as lymph node yield, and a level of proficiency was not reached after 40 operations. The women had a perioperative complication rate of 4.5% and a median hospital stay of one night. Postoperative complication rate was 12%, comprising vaginal cuff hematoma (3.1%), vaginal cuff rupture (0.9%), trocar hernia (1.3%), ureter lesion (0.4%), bowel lesion (0.4%), reoperation (0.9%) and other complications (4.5%). All peri- and postoperative outcomes were independent of BMI classes.
Our data suggest that laparoscopic surgery for early endometrial cancer is feasible and safe. With increasing surgeon's experience there is a significant decrease in operative time and increase in the number of lymph nodes harvested. In experienced hands, either operative time, complications or length of stay are not affected by increasing BMI, even when women are morbidly obese.
本研究的目的是评估不同体重指数（BMI）类别的女性早期子宫内膜癌腹腔镜手术后的学习曲线和短期结局。
回顾性收集来自丹麦妇科肿瘤科室计划接受腹腔镜手术治疗疑似I期子宫内膜癌的227名女性的数据。手术包括腹腔镜子宫切除术和双侧输卵管卵巢切除术，可选择是否进行盆腔淋巴结清扫术（PLA）。
根据是否进行PLA，手术中位时长分别为60分钟（范围30 - 197分钟）和120分钟（范围60 - 230分钟）。盆腔淋巴结中位获取数量为18个（范围7 - 42个）。对于进行PLA分期而言，以手术时间和淋巴结获取数量衡量存在学习曲线，40例手术后未达到熟练水平。这些女性围手术期并发症发生率为4.5%，中位住院时间为一晚。术后并发症发生率为12%，包括阴道断端血肿（3.1%）、阴道断端破裂（0.9%）、穿刺孔疝（1.3%）、输尿管损伤（0.4%）、肠道损伤（0.4%）、再次手术（0.9%）和其他并发症（4.5%）。所有围手术期和术后结局均与BMI类别无关。
我们的数据表明，早期子宫内膜癌的腹腔镜手术是可行且安全的。随着外科医生经验的增加，手术时间显著缩短，获取的淋巴结数量增加。在经验丰富的医生手中，即使女性为病态肥胖，手术时间、并发症或住院时长也不会因BMI增加而受到影响。
