SAN DIEGO — The rate of surgical complications with laparoscopic hysterectomy is similar whether the procedure is performed for benign or cancerous conditions, Ali Mahdavi, M.D., said at an international congress of the Society of Laparoendoscopic Surgeons.
Laparoscopic hysterectomy in 74 women with gynecologic cancers required more surgical time and longer hospitalization, compared with laparoscopic hysterectomy in 85 women with benign gynecologic conditions, a retrospective review of consecutive cases found.
There were no significant differences between groups, however, in estimated blood loss, rate of procedures converted to laparotomy, and intraoperative bowel or bladder injuries, said Dr. Mahdavi, a gynecologic oncologist at the University of California, Irvine.
“Laparoscopic procedures for gynecologic cancers are complicated and technically demanding procedures,” but appear to be safe when done by experienced surgeons, Dr. Mahdavi said. “Operators who decide to proceed with laparoscopic hysterectomy for gynecologic cancers should not only be trained gynecologic oncologists, but should [also] have extensive operative laparoscopy skills.”
The study won first prize among scientific papers on gynecology presented at the meeting.
All hysterectomies were performed by the same group of surgeons, assisted by residents and fellows, using standard techniques and the same preoperative care for all patients. The study analyzed data from patient admission up to 30 days following discharge after surgery.
Women in the cancer group were older than the women with benign conditions (a mean age of 57 and 51 years, respectively) and had a larger mean body mass index (28 vs. 24 kg/m
Mean operating times were 253 minutes in the cancer group and 188 minutes in the benign conditions group. Patients remained hospitalized for 3.5 days in the cancer group, significantly longer than the 2.5 days in the benign conditions group.
Although the mean estimated blood loss did not differ significantly (201 and 184 mL, respectively), the rate of transfusion was significantly lower in the cancer group. Two women in the cancer group and four in the benign conditions group required transfusion.
A significantly higher rate of postoperative fever in the cancer group (four cases, compared with two in the benign conditions group) was not associated with major morbidity, however, Dr. Mahdavi noted.
Two surgeries in each group were converted to laparotomy. One patient in the cancer group suffered an intraoperative bladder injury. There were no bowel injuries or wound infections.
Laparoscopic hysterectomy is a relatively new approach to managing gynecologic cancers, and questions have been raised about perioperative complications and long-term outcomes, compared with abdominal or vaginal hysterectomies.
The results support retrospective studies suggesting the feasibility and safety of laparoscopic hysterectomy for gynecologic cancers, he said. Randomized, controlled trials comparing different hysterectomy routes may never be performed for some gynecologic cancers because the number of patients needed for such trials could not be attained, Dr. Mahdavi said.
In the current study, women in the cancer group had malignancies of the endometrium (49 patients), cervix (15), ovary (7), vagina (1), or other areas (2).
Women in the control group underwent laparoscopic hysterectomy for symptomatic uterine myomas (18 patients), benign adnexal masses (33), pelvic endometriosis (10), and other benign conditions (24), including genital prolapse, cervical dysplasia, and endometrial hyperplasia.
Most patients in the cancer group underwent cancer staging procedures such as lymphadenectomy in addition to hysterectomy, which contributed to operating time, he said.
Other additional procedures in the cancer group included salpingo-oophorectomy, sigmoidoscopy, and cystoscopy. Additional procedures in the control group included salpingo-oophorectomy, colpopexy, urethropexy, cystoscopy, appendectomy, and anterior or posterior colporrhaphy.
In the cancer group, 46 underwent laparoscopic-assisted vaginal hysterectomy, 24 had a total laparoscopic radical hysterectomy, and 2 each underwent total laparoscopic hysterectomy or laparoscopic supracervical hysterectomy.
In the control group, 59 patients had a laparoscopic vaginal hysterectomy, 15 underwent total laparoscopic hysterectomy, and 11 had a laparoscopic supracervical hysterectomy.