Total laparoscopic hysterectomy with and without lymph node dissection for uterine neoplasia.

摘要

STUDY OBJECTIVE: To compare surgical outcomes of patients with uterine neoplasia undergoing total laparoscopic hysterectomy only (TLH) with those having TLH and lymph node dissection (TLHND) from September 5, 1996 through January 13, 2007. DESIGN: Retrospective chart analysis (Canadian Task Force classification II-2). SETTING: Three tertiary surgical centers in California. PATIENTS: 112 patients with uterine neoplasia operated on from 1996 through 2006. INTERVENTIONS: All patients underwent total laparoscopic hysterectomy and bilateral salpingoophorectomy; however, 30 patients with FIGO stage IC or higher, lymph channel involvement, or grade 3 disease also underwent pelvic and aortic node dissection. MEASUREMENTS AND MAIN RESULTS: Of 807 patients having TLH, 112 had a uterine neoplasia: twenty-one hyperplasia, 86 carcinoma, 2 ovarian and endometrial carcinoma, and 3 low-grade endometrial stromal sarcoma; 82 had TLH and adnexectomy; and 30 had TLHND. For both groups, the mean age was 60 (NS), Quatlet index was 31.2 (NS), parity was 1.6 (NS), and the mean blood loss was 148 mL (NS). The node dissection added 56 minutes to TLH (132 vs 188 minutes, p <.001) and yielded a mean of 25 nodes. Patients in both groups spent a median of 1 day in the hospital (NS). There were 7 complications (6.3%) in the series: among the patients in the TLH group, 1 conversion to laparotomy for bleeding from an ovarian artery, 1 vaginal rupture during coitus at 6 weeks, and 1 nonsurgical episode of diverticulitis. There were 4 patients in the TLHLND group with complications: 1 ureteral injury, 1 trocar-site hernia, 1 vaginal laceration, and 1 pelvic abscess. CONCLUSIONS: Node dissection added 56 minutes and entailed no additional blood loss, transfusion, or length of hospital stay, as well as minimal risk of complication. Total laparoscopic hysterectomy with indicated lymph node dissections for endometrial disease is reasonably well tolerated and warrants prospective randomized study to document its role in the therapy of endometrial carcinoma.