Erkılınç Selçuk, Özcan Sena, Öztürk Ayşe Betül, İşcan Serhan Can, Atlıhan Ufuk, Ata Can, Avşar Hüseyin Aytuğ, Bildacı Tevfik Berk, Çakır İlker
İzmir Democracy University, School of Medicine, Buca Seyfi Demirsoy Education and Research Hospital, Department of Gynecologic Oncology - İzmir, Turkey.
Ministry of Health, Sarıgöl Public Hospital, Department of Obstetrics and Gynecology - Manisa, Turkey.
Rev Assoc Med Bras (1992). 2025 Sep 19;71(8):e20250434. doi: 10.1590/1806-9282.20250434. eCollection 2025.
The objective of the study was to evaluate perioperative and oncologic outcomes of laparoscopy without the use of uterine manipulators and laparotomy in high-grade and serous endometrial cancer.
Patients with grade III endometrioid adenocarcinoma and serous carcinoma between 2018 and 2022 were included in the study. Preoperative staging with positron emission tomography/computed tomography or thoracoabdominal computed tomography and pelvic magnetic resonance imaging was performed. All patients underwent staging surgery including hysterectomy, bilateral salpingo-oophorectomy, peritoneal washing, omentectomy, and pelvic and paraaortic lymphadenectomy up to the renal vein. No uterine manipulator was used for laparoscopic hysterectomy. Age, CA 125 level, body mass index, accompanying diseases, pathologic data including stage, lymphovascular invasion, number of pelvic and paraaortic lymph nodes, and surgical data including surgical time, surgical complications, and adjuvant therapies were collected from the hospital database retrospectively.
Notably, 89 patients were included in the study: 34 underwent laparotomy and 55 underwent laparoscopy. Surgical times were similar between the groups. The mean pelvic lymph node count in the laparotomy and laparoscopy groups was 33 and 34, respectively. The mean paraaortic lymph node counts in the laparotomy and laparoscopy groups were 23 and 22, respectively. Red blood cell transfusion, hemorrhage, urinary tract infection, postoperative fever, bladder atony, bladder injury, and chylous leakage showed no significant differences between the groups. However, ileus, intestinal injury, and evisceration were significantly higher in the laparotomy group. Hospital stay was significantly longer in the laparotomy group compared with the laparoscopy group. Overall and recurrence-free survival were similar between the groups.
Laparoscopic surgery, performed without manipulators, provides comparable oncologic outcomes to open surgery in the treatment of high-grade endometrial cancer, while also offering improved perioperative results.
本研究的目的是评估在不使用子宫操纵器的腹腔镜手术和开腹手术治疗高级别浆液性子宫内膜癌中的围手术期和肿瘤学结局。
纳入2018年至2022年间患有III级子宫内膜样腺癌和浆液性癌的患者。术前行正电子发射断层扫描/计算机断层扫描或胸腹计算机断层扫描及盆腔磁共振成像进行分期。所有患者均接受分期手术，包括子宫切除术、双侧输卵管卵巢切除术、腹腔冲洗、大网膜切除术以及直至肾静脉水平的盆腔和腹主动脉旁淋巴结清扫术。腹腔镜子宫切除术不使用子宫操纵器。回顾性地从医院数据库收集年龄、CA 125水平、体重指数、伴随疾病、包括分期、淋巴血管浸润、盆腔和腹主动脉旁淋巴结数量的病理数据，以及包括手术时间、手术并发症和辅助治疗的手术数据。
值得注意的是，89例患者纳入本研究：34例行开腹手术，55例行腹腔镜手术。两组手术时间相似。开腹手术组和腹腔镜手术组的平均盆腔淋巴结计数分别为33个和34个。开腹手术组和腹腔镜手术组的平均腹主动脉旁淋巴结计数分别为23个和22个。两组之间在红细胞输血、出血、尿路感染、术后发热、膀胱无张力、膀胱损伤和乳糜漏方面无显著差异。然而，开腹手术组的肠梗阻、肠损伤和脏器脱出发生率显著更高。开腹手术组的住院时间明显长于腹腔镜手术组。两组之间的总生存期和无复发生存期相似。
不使用操纵器的腹腔镜手术在治疗高级别子宫内膜癌方面与开放手术具有相当的肿瘤学结局，同时围手术期结果更佳。
