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Incorporating Laparoscopy in the Practice of a Gynecologic Oncology Service: Actual Impact Beyond Clinical Trials Data

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Feasibility and safety of laparoscopic management of gynecologic cancers have been established by numerous clinical trials. However, the degree to which such results are achievable outside the context of formal research programs and the actual extent of laparoscopy uptake since its introduction are unclear. Purpose of this study was to examine the impact upon operative and cancer outcomes of the incorporation of laparoscopy into the surgical practice of our gynecologic oncology service.

Methods

Data from 383 consecutive women undergoing surgery for the treatment of an apparently early-stage gynecologic cancer between 2000 and 2008 were analyzed. Integration of minimally access surgery for the treatment of invasive malignancies began with borderline ovarian tumors in 2001 and proceeded sequentially to include endometrial, ovarian, and cervical cancer patients.

Results

The annual proportion of laparoscopic cases has increased significantly over the study period from 7.7% in 2001 to 90.9% in 2008 (P < 0.0001 for trend). A temporal trend toward reduction in estimated blood loss was observed in both endometrial cancer and cervical cancer patients (P < 0.0001). There was a significant decrease in the percentage of patients requiring blood transfusions [18 (17.1%) during the period 2000–2002, 19 (13.6%) during 2003–2005, and 8 (5.8%) during 2006–2008; P = 0.005 for trend]. Length of hospital stay has decreased significantly over time for all disease sites (P < 0.0001 for endometrial and cervical cancer; P = 0.02 for ovarian cancer). No difference was found in median operative time, number of lymph nodes harvested, complication rates, 1- and 2-year disease-free survival, and overall survival when data of subsequent time periods were compared.

Conclusions

Substantial utilization of laparoscopy in the existing practice of a gynecologic oncology service provided benefits to patients without detrimental effects on clinical outcomes. The relatively short follow-up time of laparoscopic cases disallows firm conclusions on long-term survival.

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References

  1. Frumovitz M, Ramirez PT, Greer M, Gregurich MA, Wolf J, Bodurka DC, et al. Laparoscopic training and practice in gynecologic oncology among Society of Gynecologic Oncologists members and fellows-in-training. Gynecol Oncol. 2004;94:746–53.

    Article  PubMed  Google Scholar 

  2. Frumovitz M, Soliman PT, Greer M, Schmeler KM, Moroney J, Bodurka DC, et al. Laparoscopy training in gynecologic oncology fellowship programs. Gynecol Oncol. 2008;111:197–201.

    Article  PubMed  Google Scholar 

  3. Mabrouk M, Frumovitz M, Greer M, Sharma S, Schmeler KM, Soliman PT, et al. Trends in laparoscopic and robotic surgery among gynecologic oncologists: A survey update. Gynecol Oncol. 2009. In press.

  4. Walker J, Mannel R, Piedmonte M, Schlaerth J, Spirtos N, Spiegel G. Phase III trial of laparoscopy versus laparotomy for surgical resection and comprehensive surgical staging of uterine cancer: a gynaecologic oncology group study funded by the national cancer institute [abstract]. Gynecol Oncol. 2006;101:S11.

    Google Scholar 

  5. Nezhat FR, Ezzati M, Chuang L, Shamshirsaz AA, Rahaman J, Gretz H. Laparoscopic management of early ovarian and fallopian tube cancers: surgical and survival outcome. Am J Obstet Gynecol. 2009;200:83.e1–6.

    Google Scholar 

  6. Magrina JF, Weaver AL. Laparoscopic treatment of endometrial cancer: five-year recurrence and survival rates. Eur J Gynaecol Oncol. 2004;25:439–41.

    PubMed  CAS  Google Scholar 

  7. Frumovitz M, dos Reis R, Sun CC, Milam MR, Bevers MW, Brown J, et al. Comparison of total laparoscopic and abdominal radical hysterectomy for patients with early-stage cervical cancer. Obstet Gynecol. 2007;110:96–102.

    PubMed  Google Scholar 

  8. Abu-Rustum NR, Sonoda Y. Transperitoneal laparoscopic staging with aortic and pelvic lymph node dissection for gynecologic malignancies. Gynecol Oncol. 2007;104:5–8.

    Article  PubMed  Google Scholar 

  9. Ramirez PT, Slomovitz BM, Soliman PT, Coleman RL, Levenback C. Total laparoscopic radical hysterectomy and lymphadenectomy: the M. D. Anderson Cancer Center experience. Gynecol Oncol. 2006;102:252–5.

    Article  PubMed  Google Scholar 

  10. Barakat RR, Lev G, Hummer AJ, Sonoda Y, Chi DS, Alektiar KM, et al. Twelve-year experience in the management of endometrial cancer: a change in surgical and postoperative radiation approaches. Gynecol Oncol. 2007;105:150–6.

    Article  PubMed  Google Scholar 

  11. Ghezzi F, Cromi A, Bergamini V, Uccella S, Beretta P, Franchi M, et al. Laparoscopic-assisted vaginal hysterectomy versus total laparoscopic hysterectomy for the management of endometrial cancer: a randomized clinical trial. J Minim Invasive Gynecol. 2006;13:114–20.

    Article  PubMed  Google Scholar 

  12. Ghezzi F, Cromi A, Ciravolo G, Volpi E, Uccella S, Rampinelli F, et al. Surgicopathologic outcome of laparoscopic versus open radical hysterectomy. Gynecol Oncol. 2007;106:502–6.

    Article  PubMed  Google Scholar 

  13. Ghezzi F, Cromi A, Uccella S, Bergamini V, Tomera S, Franchi M, et al. Laparoscopy versus laparotomy for the surgical management of apparent early stage ovarian cancer. Gynecol Oncol. 2007;105:409–13.

    Article  PubMed  Google Scholar 

  14. Ghezzi F, Cromi A, Bergamini V, Uccella S, Beretta P, Franchi M, et al. Laparoscopic management of endometrial cancer in nonobese and obese women: a consecutive series. J Minim Invasive Gynecol. 2006;13:269–75.

    Article  PubMed  Google Scholar 

  15. Ghezzi F, Cromi A, Bergamini V, Uccella S, Siesto G, Franchi M, et al. Should adnexal mass size influence surgical approach? A series of 186 laparoscopically managed large adnexal masses. BJOG. 2008;115:1020–7.

    Article  PubMed  CAS  Google Scholar 

  16. Jennings TS, Dottino P, Rahaman J, Cohen CJ. Results of selective use of operative laparoscopy in gynecologic oncology. Gynecol Oncol. 1998;70:323–8.

    Article  PubMed  CAS  Google Scholar 

  17. Chi DS, Abu-Rustum NR, Sonoda Y, Awtrey C, Hummer A, Venkatraman ES, et al. Ten-year experience with laparoscopy on a gynecologic oncology service: analysis of risk factors for complications and conversion to laparotomy. Am J Obstet Gynecol. 2004;191:1138–45.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy

    Fabio Ghezzi MD, Antonella Cromi PhD, Stefano Uccella MD, Gabriele Siesto MD, Francesca Zefiro MD & Pierfrancesco Bolis MD

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  1. Fabio Ghezzi MD
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  2. Antonella Cromi PhD
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  3. Stefano Uccella MD
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  4. Gabriele Siesto MD
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  5. Francesca Zefiro MD
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  6. Pierfrancesco Bolis MD
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Correspondence to Fabio Ghezzi MD.

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Ghezzi, F., Cromi, A., Uccella, S. et al. Incorporating Laparoscopy in the Practice of a Gynecologic Oncology Service: Actual Impact Beyond Clinical Trials Data. Ann Surg Oncol 16, 2305–2314 (2009). https://doi.org/10.1245/s10434-009-0514-5

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  • DOI: https://doi.org/10.1245/s10434-009-0514-5

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