Page 23 - Journal of Laparoscopic Surgery

WJOLS
10.5005/jp-journals-10007-1134
REVIEW ARTICLE Advances in Minimal Access Surgery in the Surgical Staging of Carcinoma Endometrium

Advances in Minimal Access Surgery in the

Surgical Staging of Carcinoma Endometrium

Jayasree Santhosh
Specialist, Department of Obstetrics and Gynecology, Royal Hospital, Muscat, Oman

ABSTRACT

The concept of minimal access surgery for gynecologic malignancies has gone from a perceived near impossibility to a fully
recognized option for many patients over the past 10 years. This article reviews the different minimal access techniques used for
surgical staging of carcinoma endometrium, their outcome, feasibility and safety in comparison to conventional staging laparotomy.
After review of literature, it is concluded that laparoscopic and robotic-assisted procedures are acceptable and safer alternatives to
traditional laparotomy in the staging of carcinoma endometrium, especially in obese women. Long-term outcome reports for robotic
surgery is awaited.
Keywords: Carcinoma endometrium, Laparoscopy, Robotic surgery, Surgical staging.

INTRODUCTION published comparing the surgical, pathologic and quality of life
and survival outcomes for conventional laparotomy and the
Endometrial carcinoma is one of the most common gynecological two minimally invasive treatment modalities for endometrial
malignancies in women. It is expected to become more common cancer—laparoscopy and robotics. This article compares the
as the prevalence of obesity, one of the major risk factors of different modalities of surgical staging in carcinoma
endometrial carcinoma increases worldwide. 1 endometrium, the advances in minimal access surgery in this
Surgical management is the mainstay of initial treatment for context, its relevance and safety.
most patients and is usually curative.
Comprehensive surgical staging includes total OBJECTIVES
hysterectomy, bilateral salpingo-oophorectomy, pelvic and para The objective of this article is to review the advances in minimal
aortic lymphadenectomy and pelvic cytology. This has been access surgery in the surgical staging of carcinoma endometrium
shown to define the biology of disease and guides the use of and to compare the outcome of the different modalities of
postoperative adjuvant therapy. 2 surgical treatment in patients with carcinoma endometrium.
Regarding the therapeutic role of lymphadenectomy in
women with disease that clinically seems to be confined to the MATERIALS AND METHODS
uterus, there has been much debate. Although lymphadenec- Articles published regarding the methods of surgical staging in
tomy forms part of the International Federation of Gynecology carcinoma endometrium for a period of 10 years from January
3
and Obstetrics (FIGO) surgical staging system, evidence from 2001 to date were reviewed. The extensive electronic search
a large randomized controlled trial. A study in the treatment of included Medline, PubMed, Cochrane library, HighWire press,
endometrial cancer (ASTEC) showed that this approach does SAGES website, Google search engine, Yahoo search engine
4
not provide therapeutic benefit. Inspite of debates, surgical and SpringerLink Journal Electronic Library.
treatment and staging are performed according to the FIGO 5
staging system and American Joint Committee on Cancer. 6 REVIEW OF LITERATURE
Comprehensive surgical staging is technically difficult in Regardless of preoperative grade, our management goal in
obese patients with comorbidities which is the usual clinical endometrial cancer is comprehensive staging, to include pelvic
picture in endometrial cancer. Limiting surgical morbidity while washings, hysterectomy, bilateral salpingo-oophorectomy and
maintaining staging adequacy is a primary concern in patients pelvic-aortic lymphadenectomy. The boundaries of the pelvic
with uterine malignancy. Hence, research directed to improve and para-aortic lymph node dissection include up to the
surgical techniques to appropriately manage these patients is duodenum on the right side and to the inferior mesenteric artery
important. 7 on the left. 8
Surgical staging of carcinoma endometrium was primarily Historically, comprehensive surgical staging in endometrial
9
by laparotomy. Childers and Surwit first proposed laparoscopy cancer has been accomplished via open laparotomy. The decade
as an option for apparently early stage endometrial cancer (1993). of the 1990s brought the use of minimally invasive surgery to
Since April 2005, the role of robotic-assisted surgery in replicate the traditional goals of comprehensive surgical staging
gynecologic oncology was identified. Several studies are of endometrial cancer. Dargent and Querleu et al in France and

World Journal of Laparoscopic Surgery, September-December 2011;4(3):149-155 149