Evaluation of clinical outcome of laparoscopic hysterectomy versus open abdominal hysterectomy with pelvic lymphadenectomy in endometrial carcinoma early stage


  • Waleed M. Tawfik Department of Obstetrics and Gynecology, Faculty of Medicine, Banha University, Banha, Egypt
  • Ahmed F. Sherif Department of Obstetrics and Gynecology, Faculty of Medicine, Banha University, Banha, Egypt
  • Wagdy M. Amer Department of Obstetrics and Gynecology, Faculty of Medicine, Banha University, Banha, Egypt




Laparoscopic hysterectomy, Open abdominal hysterectomy, Lymphadenectomy


Background: the aim of this study was to compare the operative, post-operative, and the oncological short-term outcomes of laparoscopic hysterectomy with lymphadenectomy and open abdominal hysterectomy with lymphadenectomy for early-stage endometrial cancer.

Methods: 80 patients with clinical stage I endometrial cancer were enrolled in this trial; they were divided according to their selection of the method of intervention after counselling into two groups: total laparoscopic hysterectomy with pelvic lymphadenectomy group and total abdominal hysterectomy with pelvic lymphadenectomy group.

Results: The mean operative time in the TLH group was 140.85± 10.033 minutes and was 118.45±12.713 minutes in the TAH group (p<0.001). The mean blood loss in the TLH group was 127.5±42.9 ml and 220.5± 84.82 ml in TAH group (p<0.001). The mean duration of postoperative ileus was 12.8±5.022 hours in the TLH group, and it was 22.3±5.573 hours in the TAH group (p<0.001). The mean time of hospital stay in the TLH group was 26.7±5.667 hours and in the TAH group was 116.4± 17.31 hours (p<0.001).

Conclusions: Complete surgical staging of endometrial cancer can be performed using laparoscopy as an alternative to routine open method with similar efficacy about nodal retrieval and complication rate, and better operative and postoperative compliance in means of blood loss, ileus and hospital stay which may have an implication on cost saving in the medical service. Lymphadenectomy can be omitted in low-risk cases of endometrial cancer.


American cancer society: cancer facts & figures. Available at: https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2010.html. Accessed on 20 January 2021.

Gallup DG, Stock RJ. Adenocarcinoma of the endometrium in women 40 years of age or younger. Obstet Gynecol. 2012;64:417-20.

Norris HJ, Tavassoli FA, Kurman RJ. Endometrial hyperplasia and carcinoma, diagnostic consideration. Am J Surg Pathol. 2018;7: 839-47.

Trimble EL, Harlan LC, Clegg L, et al.: Pre-operative imaging, surgery, and adjuvant therapy for women diagnosed with cancer of the corpus uteri in community practice in the US. Gynecol Oncol. 2015; 96:741-8.

Creasman W, Odicino F, Maisonneuve P. Carcinoma of the corpus uteri. Int J Gynecol Obstet. 2006;95(1): S105-43.

Naumann RW, Coleman R. The use of adjuvant radiation therapy in early endometrial cancer by members of the Society of Gynecologic Oncologists in 2005. Gynecol Oncol. 2017;105:7-12.

Nathan GK, Allan BW, William EL. Anatomy in principles and practice of obstetrics and gynecology. New York: John Wiley & Sons Inc.; 2013:10-26.

Rock JA, Jones HW. Surgical anatomy of the female pelvis, in te linde's operative gynecology. 10th ed. United States: Lippincott Williams & Wilkins; 2008:104-5.

Benoit L, Pierre S. Anatomical bases for the radiological delineation of lymph node areas. Part III: Pelvis and lower limbs. Radiother Oncol. 2019;92:22-33.

Parkin DM, Whelan SL, Ferlay J. Cancer incidence in five continents. Lyon: IARC; 2007:7(147);45-9.

Watson P, Lynch H. Extracolonic cancer in hereditary nonpolyposis colorectal cancer. Cancer. 2003;71:677-85.

Berends M, Wu Y, Sijmons R. Toward new strategies to select young endometrial cancer patients for mismatch repair gene mutation analysis. J Clin Oncol. 2009;23:4364-70.

Schmeler K, Lynch H, Chen L. Prophylactic surgery to reduce the risk of gynecologic cancers in the Lynch syndrome. N Engl J Med. 2016;354:261-9.

Akhmedkhanov A, Zeleniuch-Jaquotte A, Toniolo P. Role of exogenous and endogenous hormones in endometrial cancer. Ann NY Acad Sci. 2011;943: 296-315.

Key TJA, Pike MC. The dose effect relationship between unopposed estrogens and endometrial mitotic rate: its central role in explaining and predicting endometrial cancer risk. Br J Cancer. 2008;57:205-12.

Henderson BE, Feigelson HS. Hormonal carcinogenesis. Carcinogenesis. 2000;21:427-33.

Grady D, Gebretsadik DT, Kerlikowske K. Hormone replacement therapy and endometrial cancer risk: a meta-analysis. Obstet Gynecol. 2005;85:304-13.

Schottenfeld D. Epidemology of endometrial neoplasia. J Cell Biochem. 2015;23:151-9.

Parazzini F, La Vecchia C, Negri E. Diabetes and endometrial cancer: an Italian case-control study. Int J Cancer. 2009;81:539-42.

Rutanen EM. Insulin-like growth factors in endometrial function. Gynecol Endocrinol. 2000;12: 399-406.






Original Research Articles