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Objective: Recent publications have raised doubts about the oncological safety of a laparoscopic approach in the treatment of endometrial cancer. The aim of this study was to investigate the beneficial aspects of laparoscopy versus laparotomy in patients with endometrial cancer, and present oncological outcomes. Material and Methods: A retrospective study of patients who underwent surgery for the treatment of endometrioid endometrial cancer was performed. Surgical outcomes and complications in patients who were treated by laparoscopy or open surgery were compared. The patients were followed for 5-years. Patients' characteristics, tumor stage, complications rate and oncologic outcome were analyzed. Results: A total of 151 patients were included. The laparoscopy (n=80) and laparotomy (n=71) groups were homogeneous in regards of demographic data and tumor stage. Median average blood loss (1.31 vs. 1.92 g/dL), the mean duration of hospitalization (5.73 vs. 12.25 days), intraoperative (0 vs. 6%), and severe postoperative complications (5.1 vs. 14.3%) were significantly lower in the laparoscopy group. The numbers of pelvic or para-aortic lymph nodes removed during systematic lymphadenectomy were similar in both groups. Women who underwent laparoscopy and those who underwent laparotomy had similar five-year recurrence-free survival rates (88.7% vs. 91.5%, p=0.864), as well as similar overall five-year survival rates (91.2% vs. 97.2%, p=0.094). Conclusion: The oncological outcome of laparoscopy was similar to that of laparotomy in the treatment of patients with endometrial cancer. However, surgical outcomes and morbidity rates were significantly better in patients treated by laparoscopy. Clinical trials are essential to evaluate the oncological efficacy of laparoscopy in patients with endometrial cancer.
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Objective: Rising caesarean delivery (CD) rates throughout the world are accompanied with high rates of severe maternal complications. The aim of the present study was to analyze the outcome of trial of labor after caesarean section (TOLAC) in a Western population and identify factors associated with the success of vaginal birth after caesarean section (VBAC). Material and Methods: A retrospective study was performed at two large obstetric departments in Germany from 2008 to 2018. Women with singleton pregnancies, a history of only one previous CD with a low transverse incision, a viable fetus in cephalic presentation, and gestational age >32 weeks were included in the study. The characteristics and outcome of successful VBAC and failed TOLAC were compared. A subgroup analysis addressed gestational age, interpregnancy interval, fetal macrosomia, body mass index, and maternal age. Results: Of 1,546 patients, 62.3% achieved VBAC while 37.7% had a secondary CD. Independent factors associated with the success of TOLAC were a history of vaginal birth in previous pregnancies (p<0.001) and the use of oxytocin (p<0.001), whereas preterm birth between gestational week 32 and 37 signified a higher risk of failed TOLAC (p=0.04). The success of VBAC did not differ significantly for patients older than 40 years of age, those with a shorter interpregnancy interval than 12 months, and fetal macrosomia with birth weight exceeding 4000 grams. Maternal and neonatal outcomes were poorer in women with failed TOLAC. Conclusion: Nearly two thirds of women with a history of CD achieve VBAC in Germany. Previous vaginal birth and the augmentation of labor with oxytocin are positively associated with the achievement of VBAC and no major perinatal complications. The decision to have a TOLAC should be encouraged in the majority of patients. Further studies are needed to evaluate the feasibility of TOLAC in preterm delivery.
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Objective: The use of power morcellation at laparoscopy may worsen survival rates for patients with malignancy. The aim of the present study was to report the outcome of patients with early-stage uterine sarcoma after morcellation or total en-bloc resection, and evaluate potential signs of sarcoma preoperatively. Material and Methods: This multicenter retrospective study consisted of patients, who underwent surgery for FIGO-stage-1 uterine sarcoma. Twenty-four patients were divided into a non-morcellation group and a morcellation group. Clinical records and the outcomes of patients, including one-, three- and five-year survival rates were reviewed. Preoperative characteristics of patients with sarcoma were compared to those of a control group with uterine myoma (1:4 ratio), matched by age and type of operation. Results: Obesity was an independent risk factor for uterine myoma. Tumor growth, solitary growth, largest-diameter lesion >8.0 cm, and anechoic areas suggesting necrosis and increased vascularization were significantly more common in the sarcoma group. A large tumor diameter was significantly associated with mortality. Patients in the non-morcellation group had a slightly lower disease-free survival, but poorer overall survival (OS) rates compared to patients in the morcellation group, but neither difference was statistically significant. Patients in the non-morcellation group, who had undergone a re-exploration experienced late recurrence, but no upstaging was evident after the operation. Conclusion: Preoperative ultrasound characteristics could be useful to distinguish sarcoma from leiomyoma of uterus. Morcellation of a sarcoma may increase abdominal and pelvic recurrence rates, but may not be associated with OS in patients with FIGO-stage-1 disease.
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INTRODUCTION: The aim of the present study was to compare surgical outcomes of total laparoscopic hysterectomy with those of the robotic approach using the da Vinci Xi system. METHODS: Patients who underwent hysterectomy with da Vinci Xi for early endometrial cancer or benign indications from 2018 to 2019 were selected. The control group consisted of patients who underwent conventional laparoscopy. RESULTS: A total of 300 patients were included in the study. The mean duration of surgery differed significantly (p = 0.025) between those who underwent laparoscopy (125.01 ± 76.168) and robotic-assisted surgery (142.96 ± 82.657 min). Blood loss, median hospital stay, intraoperative and postoperative complications were similar in both groups. No statistical difference was observed in the subgroups with a body mass index of more than 30 kg/m2 or more than 40 kg/m2 concerning the duration of surgery or the surgical outcome. CONCLUSION: The da Vinci Xi did not improve surgical outcomes in patients who underwent hysterectomy by trained laparoscopists and takes more time than conventional laparoscopy when performed in patients of normal weight.
