Surgical treatment of endometrial cancer: laparotomy or laparoscopy?

Abdominal total hysterectomy with bilateral adnexectomy, intra-operative peritoneal washing, and also lymphadenectomy in the case of a high risk of pelvic and para-aortic nodal metastasis, constitute the traditional method of treatment of endometrial cancer. The laparoscopic approach diminishes the risk of complications occurring during laparotomy. Initially, laparoscopic-assisted vaginal hysterectomy (LAVH) with lymphadenectomy was performed as an alternative to laparotomy in the case of endometrial cancer. Nowadays, total laparoscopic hysterectomy (TLH) with lymphadenectomy is used more often. Currently, numerous publications report about the safety, feasibility and benefits of applying the laparoscopic procedure in the management of endometrial cancer in comparison to the traditional management, i.e. shorter hospital stay, fewer complications, less blood loss, a better cosmetic result, possibility of implementing the complimentary treatment faster. Despite all these facts, there is a great number of gynecologists in the world who remain skeptic about laparoscopy in the treatment of endometrial cancer. Precise tissues preparation and less blood loss are the main advantages of the laparoscopic procedure. The laparoscopic approach diminishes the number of intra- and postoperative complications occurring during laparotomy, especially postoperative wound infection, wound dehiscence, and hernia in the postoperative wound. Laparoscopy is connected with shortened hospital stay in comparison to abdominal-access surgery. A significantly shorter hospital stay in the case of laparoscopic procedure is a result of smaller operative wounds, less blood loss, less complications, and faster convalescence. Moreover, most authors of available publications confirm lack of statistical differences in the number of lymph nodes taken during the laparoscopy and laparotomy for histopathological examination, what proves similar efficacy of both procedures. Moreover, numerous retrospective studies indicate comparable overall survival and recurrence rates after laparoscopy and laparotomy in the surgical treatment of endometrial cancer. Despite the benefits of applying laparoscopic procedure in endometrial cancer treatment there is still a great number of gynecologists in the world who have concerns and doubts about laparoscopy in the treatment of endometrial cancer. The reason for this is that laparoscopic techniques used in the surgical treatment of endometrial cancer are extremely difficult, which results in a longer learning curve and longer duration of surgery. What is more, the laparoscopic equipment is very expensive. Laparoscopy in the treatment of endometrial cancer is a safe and feasible procedure. It is characterized by a significantly smaller percentage of complications, better cosmetic result and shorter hospital stay.