Use of Laparoscopy in the Treatment of Endometrial and Cervical Cancer – Results of a 2012 Germany-wide Survey

 

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Abstract

Introduction: Endoscopy has begun to play an increasingly important role in the surgical therapy of uterine cancers. To date, there is no data on the use of laparoscopy to treat endometrial cancer (EC) and cervical cancer (CC). Method: A Germany-wide, anonymised survey was done of all gynaecological clinics/endoscopy clinics, using a standardised questionnaire. Results: A total of 128 clinics responded: 16 university clinics (12.5 %), 30 hospitals offering maximum care (23.4 %), 66 general hospitals (51.5 %), 5 outpatient clinics (3,9 %), 4 physicians in private practice affiliated to hospitals (3.1 %) and 7 hospitals (5.4 %) which did not indicate status. Laparoscopy was used in the treatment of 82 % of all EC and 54 % of CC. Surgery for EC was done completely laparoscopically in 58 % of cases and with laparoscopic assistance using a vaginal approach in 32 % of cases. If lymphadenectomy (LNE) was additionally performed, this was done abdominally in 42 % of cases and laparoscopically in 53 %. Cervical cancer was treated by laparoscopic radical hysterectomy (HE) in 44 % of cases and by radical HE using a vaginal approach in 14 %. 4 % of hospitals reported the use of other endoscopic methods (e.g. DaVinci). While the majority of hospitals (43.3 %) treated more than 75 % of EC patients using laparoscopy, in many clinics (38.3 %) less than 25 % of CC patients were treated using endoscopy. Discussion: Laparoscopy is used more often in EC surgery as compared to surgery for CC. However, there are still major differences between hospitals with regard to case numbers, the number of uterine cancers treated using endoscopic surgery, and the type of endoscopic surgery.

Zusammenfassung

Einleitung: Die Endoskopie nimmt eine zunehmende Bedeutung in der operativen Therapie der Uteruskarzinome ein. Es gibt bis dato keine Daten, wie verbreitet der Einsatz der Laparoskopie (LSK) in der Therapie der Endometrium- (EC) und Zervixkarzinome (CC) ist. Methode: Deutschlandweite anonymisierte Klinikumfrage unter allen gynäkologisch/endoskopisch operierenden Kliniken mittels standardisiertem Fragebogen. Ergebnisse: 128 Klinikantworten: 16 Unikliniken (12,5 %), 30 Kliniken der Maximalversorgung (23,4 %), 66 Kliniken der Regelversorgung (51,5 %), 5 Tageskliniken (3,9 %), 4 Belegärzte (3,1 %) und 7 Kliniken (5,4 %) ohne Statusangabe. Die LSK kommt in 82 % aller EC- und in 54 % aller CC zum Einsatz. EC werden in 58 % der Fälle komplett laparoskopisch und in 32 % der Fälle vaginal assistiert laparoskopisch operiert. Im Falle einer Lymphonodektomie (LNE) erfolgt diese in 42 % der Fälle abdominal und in 53 % laparoskopisch. Beim CC erfolgt in 44 % eine laparoskopische radikale Hysterektomie (HE) und in 14 % eine radikale HE in Kombination mit vaginalem Vorgehen. 4 % der Kliniken geben an, weitere endoskopische Methoden (z. B. DaVinci) anzuwenden. Während die meisten Kliniken (43,3 %) mehr als 75 % der EC laparoskopisch behandeln, ist die Rate der endoskopisch operierten CC in den meisten Kliniken (38,3 %) unter 25 %. Diskussion: EC werden häufiger als CC laparoskopisch operiert. Zwischen den Kliniken gibt es jedoch noch große Unterschiede bez. Fallzahl, der Anzahl der endoskopisch operierten Uteruskarzinome und der Art der endoskopischen OP.

• References

• 1 AGO, DKG, DGGG. Diagnostik und Therapie des Endometriumkarzinoms. Interdisziplinäre S2-Leitlinie, AWMF 032/034. http://www.awmf.de
  PubMedGoogle Scholar
• 2 AGO, DKG, DGGG. Diagnostik und Therapie des Zervixkarzinoms. Interdisziplinäre S2 k-Leitlinie, AWMF 032/033. http://www.awmf.de
  PubMedGoogle Scholar
• 3 Robert Koch-Institut, die Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V., Hrsg. Krebs in Deutschland 2007/2008. 8. Ausgabe. Berlin: 2012
  Google Scholar
• 4 Waldmann A, Eisemann N, Katalinic A. Epidemiology of malignant cervical, corpus uteri and ovarian tumours – current data and epidemiological trends. Geburtsh Frauenheilk 2013; 73: 123-129
  Article in Thieme ConnectPubMedGoogle Scholar
• 5 Eltabbakh GH. Analysis of survival after laparoscopy in women with endometrial carcinoma. Cancer 2002; 95: 1894-1901
  CrossrefPubMedGoogle Scholar
• 6 Magrina JF, Mutone NF, Weaver AL et al. Laparoscopic lymphadenectomy and vaginal or laparoscopic hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer: morbidity and survival. Am J Obstet Gynecol 1999; 181: 376-381
  CrossrefPubMedGoogle Scholar
• 7 Magrina JF, Weaver AL. Laparoscopic treatment of endometrial cancer: five-year recurrence and survival rates. Eur J Gynaecol Oncol 2004; 25: 439-441
  PubMedGoogle Scholar
• 8 Zullo F, Palomba S, Russo T et al. A prospective randomized comparison between laparoscopic and laparotomic approaches in women with early stage endometrial cancer: a focus on the quality of life. Am J Obstet Gynecol 2005; 193: 1344-1352
  CrossrefPubMedGoogle Scholar
• 9 Spirtos NM, Schlaerth JB, Gross GM et al. Cost and quality-of-life analyses of surgery for early endometrial cancer: laparotomy versus laparoscopy. Am J Obstet Gynecol 1996; 174: 1795-1799 discussion 1799–1800
  CrossrefPubMedGoogle Scholar
• 10 Solomayer EF, Becker S. Neue Entwicklungen der Zervixkarzinom-Chirurgie – der laparoskopische Wertheim. Geburtsh Frauenheilk 2007; 12: 1375-1377
  Article in Thieme ConnectPubMedGoogle Scholar
• 11 Hidlebaugh DA, Orr RK. Staging endometrioid adenocarcinoma. Clinical and financial comparison of laparoscopic and traditional approaches. J Reprod Med 1997; 42: 482-488
  PubMedGoogle Scholar
• 12 Gemignani ML, Curtin JP, Zelmanovich J et al. Laparoscopic-assisted vaginal hysterectomy for endometrial cancer: clinical outcomes and hospital charges. Gynecol Oncol 1999; 73: 5-11
  CrossrefPubMedGoogle Scholar
• 13 Scribner jr. DR, Walker JL, Johnson GA et al. Surgical management of early-stage endometrial cancer in the elderly: is laparoscopy feasible?. Gynecol Oncol 2001; 83: 563-568
  CrossrefPubMedGoogle Scholar
• 14 Malur S, Possover M, Michels W et al. Laparoscopic-assisted vaginal versus abdominal surgery in patients with endometrial cancer – a prospective randomized trial. Gynecol Oncol 2001; 80: 239-244
  CrossrefPubMedGoogle Scholar
• 15 Holub Z, Jabor A, Bartos P et al. Laparoscopic surgery for endometrial cancer: long-term results of a multicentric study. Eur J Gynaecol Oncol 2002; 23: 305-310
  PubMedGoogle Scholar
• 16 Manolitsas TP, McCartney AJ. Total laparoscopic hysterectomy in the management of endometrial carcinoma. J Am Assoc Gynecol Laparosc 2002; 9: 54-62
  CrossrefPubMedGoogle Scholar
• 17 Fram KM. Laparoscopically assisted vaginal hysterectomy versus abdominal hysterectomy in stage I endometrial cancer. Int J Gynecol Cancer 2002; 12: 57-61
  CrossrefPubMedGoogle Scholar
• 18 Eltabbakh GH, Shamonki MI, Moody JM et al. Laparoscopy as the primary modality for the treatment of women with endometrial carcinoma. Cancer 2001; 91: 378-387
  CrossrefPubMedGoogle Scholar
• 19 Obermair A, Manolitsas TP, Leung Y et al. Total laparoscopic hysterectomy for endometrial cancer: patterns of recurrence and survival. Gynecol Oncol 2004; 92: 789-793
  CrossrefPubMedGoogle Scholar
• 20 Tozzi R, Malur S, Koehler C et al. Laparoscopy versus laparotomy in endometrial cancer: first analysis of survival of a randomized prospective study. J Minim Invasive Gynecol 2005; 12: 130-136
  CrossrefPubMedGoogle Scholar
• 21 Juhasz-Böss I, Haggag H, Baum S et al. Laparoscopic and laparotomic approaches for endometrial cancer treatment: a comprehensive review. Arch Gynecol Obstet 2012; 286: 167-172
  CrossrefPubMedGoogle Scholar
• 22 Zullo F, Falbo A, Palomba S. Safety of laparoscopy vs. laparotomy in the surgical staging of endometrial cancer: a systematic review and metaanalysis of randomized controlled trials. Am J Obstet Gynecol 2012; 207: 94-100
  CrossrefPubMedGoogle Scholar
• 23 Ju W, Myung SK, Kim Y et al. Comparison of laparoscopy and laparotomy for management of endometrial carcinoma: a meta-analysis. Int J Gynecol Cancer 2009; 19: 400-406
  CrossrefPubMedGoogle Scholar
• 24 Palomba S, Falbo A, Russo T et al. Updating of a recent meta-analysis of randomized controlled trials to assess the safety and the efficacy of the laparoscopic surgery for treating early stage endometrial cancer. Gynecol Oncol 2009; 114: 135-136
  CrossrefPubMedGoogle Scholar
• 25 Juhasz-Boess I. Oncological safety of laparoscopy in endometrium carcinoma. Onkologe 2012; 18: 714-717
  CrossrefPubMedGoogle Scholar
• 26 Mangler M, Zech N, Schneider A et al. Aspects of therapy for cervical cancer in Germany 2012 – results from a survey of german gynaecological hospitals. Geburtsh Frauenheilk 2013; 73: 1-12
  Article in Thieme ConnectPubMedGoogle Scholar
• 27 Juhasz-Böss I, Fehm T, Becker S et al. Endometrial cancer: comparison of patients with synchronous primary carcinoma of the endometrium and ovary vs. endometrial carcinoma with ovarian metastases. Geburtsh Frauenheilk 2012; 72: 721-726
  Article in Thieme ConnectPubMedGoogle Scholar
• 28 Walker JL, Piedmonte MR, Spirtos NM et al. Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group LAP2 Study. J Clin Oncol 2012; 30: 695-700
  CrossrefPubMedGoogle Scholar
• 29 Walker JL, Piedmonte MR, Spirtos NM et al. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. J Clin Oncol 2009; 27: 5331-5336
  CrossrefPubMedGoogle Scholar
• 30 Zorlu CG, Simsek T, Ari ES. Laparoscopy or laparotomy for the management of endometrial cancer. JSLS 2005; 9: 442-446
  PubMedGoogle Scholar
• 31 Malzoni M, Tinelli R, Cosentino F et al. Total laparoscopic hysterectomy versus abdominal hysterectomy with lymphadenectomy for early-stage endometrial cancer: a prospective randomized study. Gynecol Oncol 2009; 112: 126-133
  CrossrefPubMedGoogle Scholar
• 32 Zullo F, Palomba S, Falbo A et al. Laparoscopic surgery vs laparotomy for early stage endometrial cancer: long-term data of a randomized controlled trial. Am J Obstet Gynecol 2009; 200: 296.e1-296.e9
  PubMedGoogle Scholar
• 33 Janda M, Gebski V, Brand A et al. Quality of life after total laparoscopic hysterectomy versus total abdominal hysterectomy for stage I endometrial cancer (LACE): a randomised trial. Lancet Oncol 2010; 11: 772-780
  CrossrefPubMedGoogle Scholar
• 34 Mourits MJ, Bijen CB, Arts HJ et al. Safety of laparoscopy versus laparotomy in early-stage endometrial cancer: a randomised trial. Lancet Oncol 2010; 11: 763-771
  CrossrefPubMedGoogle Scholar

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