Page 33 - WJOLS - Laparoscopic Journal

WJOLS

Role of Minimally Invasive Surgery in Gynecological Cancers
Table 3: Various studies comparing laparoscopic approach vs conventional approach for management of ovarian cancer
Sl. no. Name Type of study Intervention Participants Results
1 Chi et al 12 Prospective Laparoscopic staging vs 50 The authors concluded that patients with
staging via laparotomy for apparent stage I ovarian and fallopian
apparent stage I ovarian or tube cancers can safely and adequately
fallopian tube cancers undergolaparoscopic surgical staging
2 Leblanc Prospective Laparoscopic staging of 42 They found it to be safe, accurate, and with
et al 13 incompletely staged invasive a low incidence of complications, particularly
adnexal tumors in the group of patients who had already
undergone prior abdominal surgery. They
found that the rates of negative evaluations
and recurrence rates were comparable
between patients undergoing laparoscopy
and those undergoing laparotomy.
3 Hua 2005 14 Prospective Laparoscopic surgical staging 21 Significantly fewer postoperative
case-control vs open surgical staging of complications with laparoscopy compared
early ovarian cancer with laparotomy
4 Angioli Retro- or Open diagnostic laparoscopy; 87 53 where indicated to be operable. Of these
2005 15 prospective examination of the whole 51 had operable disease at laparotomy and
enrolment not abdominal cavity, biopsies 2 not. The other 34 patients were treated with
known for frozen section, performed NACT and 25 received an interval debulking
by gynecological oncologist. surgery after 3 courses of chemotherapy
If judged resectable direct
cytoreduction was done

sence of this residual tissue, awareness should allow for the bladder, uncontrolled bleeding, and conversion to
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correction of this potential surgical shortcoming. Also, laparotomy. Holub et al concluded that the expected
there was concern that tumor implantation might be more outcome should be balanced with risks, but emphasized
commonly associated with laparoscopy. Abu-Rustum that laparoscopic surgery in obese women, much like in
17
et al noted that subcutaneous tumor implantation is not nonobese women, is safe, feasible, and should be consi-
limited to laparoscopy. In a 12-year period, 1,288 patients dered in patients with endometrial cancer. Injuries to the
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had 1,335 transperitoneal laparoscopies. Laparoscopy- bladder and epigastric artery, as reported by Holub et al,
related subcutaneous tumor implantation was noted to highlight the difficulties of trocar placement in patients
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be rare (0.97%) in women undergoing transperitoneal who are morbidly obese. Childers et al also found
laparoscopy with malignant disease. Patients with that, in patients with endometrial cancer, obesity was
advanced intra-abdominal or pelvic metastatic disease the limiting factor in performing lymphadenectomies.
and progressive carcinomatosis appeared at greatest risk. Eltabbakh et al were unable to perform para-aortic
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Abu-Rustum et al concluded that the risk for subcutane- lymph node samplings in two patients because of poor
ous tumor implantation should not preclude laparoscopy visualization secondary to obesity. However, they did
in women with gynecologic malignancies managed by report higher pelvic lymph node yields laparoscopically
gynecologic oncologists. Frequently, obesity can pre- when compared with laparotomy. Finally, assessment of
sent a challenge in managing early endometrial cancer complications and conversion rate need to be addressed
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via a minimally invasive approach. Eltabbakh et al as the role of minimally invasive surgery increases in the
prospectively studied 42 obese women with clinical management of gynecologic cancers. In evaluating their
21
stage I endometrial cancer over a 2-year period. Forty initial 10-year experience with laparoscopy, Chi et al
patients were offered laparoscopic surgery. The proce- noted a low complication rate (2.5% grade 3–5) and a
dure was converted to open laparotomy in three (7.5%) low conversion rate of 7%. They identified older age,
of the patients. Holub et al also reported on peri- and malignancy, previous radiation, and previous abdomi-
postoperative outcomes in obese vs nonobese patients nal surgery as significant risk factors for complications
using a minimally invasive surgical approach. They or conversion to laparotomy, which should help guide
reported no statistical difference in operating time, lymph patient selection and surgical planning.
node counts, blood loss, or hospital stay. However, in a
group of 33 obese and 32 nonobese patients, there was a CONCLUSION
higher number of major complications in obese patients After a literature search, it seems that minimal inva-
than in nonobese patients (eight vs five). In the obese sive surgical staging operation is a safe and effective
subgroup, complications included pulmonary micro- therapeutic procedure for management of gynecological
embolism, injury to the epigastric artery, injury to cancers, with an acceptable morbidity compared to the
World Journal of Laparoscopic Surgery, September-December 2015;8(3):96-100 99