Comparative study between laparoscopic hysterectomy and abdominal hysterectomy for the treatment of early stage endometrial cancer

Rumi Bhattacharjee, Nitin P. Dhungat, Vishal Sheth


Background: Aim was to study the feasibility of total laparoscopic pan hysterectomy in patients with early stage endometrial cancer.

Methods: Retrospective and prospective study of 100 patients with clinical early stage endometrial cancer was done in Bombay Hospital & Research Center over 3 years. 44 patients underwent total laparoscopic hysterectomy while 56 patients underwent abdominal pain hysterectomy. Pelvic lymphadenectomy was performed in patients with myometrium invasion greater than 50%, size of tumor >2 cm, non-endometroid pathology, Grade 3.

Results: The mean operating time was 2 hours in the abdominal hysterectomy group and 2.5 hrs. In the laparoscopic group. Average blood loss was 350 ml in the abdominal (Abd) group & 250 ml in the laparoscopic (lap) group. Which was comparable. The abdominal hysterectomy group experienced more postoperative pain than the laparoscopy group. However, cost wise laparoscopy group incurred more expenditure than the abdominal group. Among the post-operative complications, nausea vomiting, paralytic ileus and wound dehiscence were significantly more in the abdominal group as compared to the laparoscopy group.

Conclusions: Morbidity is much less in laparoscopy route compare to open abdominal hysterectomy with equivalent survival.


Endometrial cancer, Total laparoscopic hysterectomy, Pelvic lymphadenectomy

Full Text:



American cancer society, cancer Facts & Figures 1212. Available at: /cancer-facts-statistics/all-cancer-facts-figures/ cancer-facts-figures-2020.html. Accessed on 02 May 2020.

Brinton LA, Berman ML, Mortel R, Twiggs LB, Barrett RJ, Wilbanks GD, et al. Reproductive, menstrual, and medical risk factors for endometrial cancer: results from a case-control study. Americ J Obstet Gynecol. 1992;167(5):1317-25.

Lader H, N. SEER Cancer Statistics Review. 1975-2008. 2011. Available at: archive/csr/1975_2008/. Accessed on 25 May 2020.

Weiderpass E, Persson I, Adami HO, Magnusson C, Lindgren A, Baron JA. Body size in different periods of life, diabetes mellitus, hypertension, and risk of postmenopausal endometrial cancer (Sweden). Canc Cause Contr. 2000;11(2):185-92.

Childers JM, Surwit EA. Combined laparoscopic and vaginal surgery for the management of two cases of stage 1 endometrial cancer. Gynecol Oncol. 1992;46-51.

Scribner DR, Mannel RS, Walker JL, Johnson GA. Cost analysis of laparoscopy versus laparotomy for early endometrial cancer. Gynecol Oncol. 1999;75(3):460-3.

Holub Z, Voracck J, Shomani A. A comparison of laparoscopic surgery with open procedure in endometrial cancer. Eur J Gynaecol Oncol. 1998;19;294-6.

Spirtos NM, Schlaerth JB, Gross GM, Spirtos TW, Schlaerth AC, Ballon SC. Cost and quality-of-life analyses of surgery for early endometrial cancer: laparotomy versus laparoscopy. Americ J Obstet Gynecol. 1996;174(6):1795-800.

Spirtos NM, Schlaerth JB, Spirtos TW, Schlaerth AC, Indman PD, et al. Laparoscopic bilateral pelvic and paraaortic lymph node sampoing: An evolving technique. Americ J Obstet Gynecol. 1995;173(1):105-11.

Eltabbakh GH. Effect of surgeon's experience on the surgical outcome of laparoscopic surgery for women with endometrial cancer, Gynaecol Oncol. 2000; 78:58-61.

Scribner Jr DR, Walker JL, Johnson GA, McMeekin SD, Gold MA, Mannel RS. Laparoscopic pelvic and paraaortic lymph node dissection: analysis of the first 100 cases. Gynecol Oncol. 2001;82(3):498-503.

Gary S. Leiserowitz, MD, Guibo Xing, PhD Arti Parikh-Patel, et al. Laparoscopic Versus Abdominal Hysterectomy for Endometrial Cancer. Int J Gynaecol Canc. 2009 Nov: 19(8):1370-6.

Eltabbakh GH, Shamonki MI, Moody JM, Garafano LL. Hysterectomy for obese women with endometrial cancer: laparoscopy or laparotomy?. Gynecol Oncol. 2000;78(3):329-35.

Ghezzi F, Cromi A, Bergamini V, Uccella S, Beretta P, Franchi M, et al. Laparoscopic management of endometrial cancer in nonobese and obese women; A consecutive series. J Minim Invasive Gynecol. 2006;13, 269-275.

Scribner Jr DR, Walker JL, Johnson GA, McMeekin DS, Gold MA, Mannel RS. Laparoscopic pelvic and paraaortic lymph node dissection in the obese. Gynecol Oncol. 2002;84(3):426-30.

Holub Z, Jabor A, Bartos P, Eim J, Urbanek S, Pivovarnikova R. Laparoscopic surgery for enodometrial cancer: long- term results of a multicentric study. Eur J Gynaecol Oncol. 2002;23,305-10.

Scribner DR, Walker JL, Johnson GA, McMeekin SD, Gold MA, Mannel RS. Surgical management of early-stage endometrial cancer in the elderly: is laparoscopy feasible?. Gynecol Oncol. 2001;83(3):563-8.

Malzoni M, Tinelli R, Cosentino F, Perone C, Rasile M, Iuzzolino D, et al. Total laparoscopic hysterectomy versus abdominal hysterectomy with lymphadenectomy for early-stage endometrial cancer: a prospective randomized study. Gynecol Oncol. 2009;112(1):126-33.

Kong TW, Lee KM, Cheong JY, Kim WY, Chang SJ, Yoo SC, et al. Comparison of laparoscopic versus conventional open surgical staging procedure for endometrial cancer. J Gynecol Oncol. 2010;21(2):106-11.

Gemignani ML, Curtin JP, Zelmanovich J, Patel DA, Venkatraman E, Barakat RR. Laparoscopic-assisted vaginal hysterectomy for endometrial cancer: clinical outcomes and hospital charges. Gynecol Oncol. 1999;73(1):5-11.

Kuoppala T, Tomas E, Heinonen PK. Clinical outcome and complications of laparoscopic surgery compared with traditional surgery la women with endometrial cancer Arch Gynaecol Obstet. 2004;270:25-30.

Fram KM, Laparoscopically assisted vaginal hysterectomy versus abdominal hysterectomy in stage 1 endometrial cancer. Int J Gynaecol Cancer 2002;12:57-61.

Obermair A, Manolitsas TP, Leung Y, Hammond IG, McCartney AJ. Total laparoscopic hysterectomy for endometrial cancer: patterns of recurrence and survival. Gynecol Oncol. 2004;92(3):789-93.

Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, et al. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer; Gynaecologic Oncology Group Study LAP2. J Clin Oncol 2009;27:5331-6.

Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, 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 Clinic Oncol. 2012;30(7):695.

Manolitsas TP, McCartney AJ. Total laparoscopic hysterectomy in the management of endometrial carcinoma. J Americ Assoc Gynecol Laparoscop. 2002;9(1):54-62.