Laparoscopic Assisted Surgical Staging using Intraoperative Frozen-Section Diagnosis in Patients with Endometrial Cancer

Objective : To report our experiences in laparoscopic assisted surgical staging (LASS) to manage the patients with endometrial cancer. Methods : From June 1997 to June 2003, we performed LASS in 31 patients with clinical stage I adenocarcinoma of the endometrium. We performed laparoscopic assisted vaginal hysterectomy (LAVH) with bilateral salpingo-oophorectomy (BSO) and intraoperative frozen-section (IFS) diagnosis. The depth of myometrial invasion, tumor differentiation, histologic types, cervical invasion, and adnexal involvement were determined by IFS diagnosis. Laparoscopic pelvic and/or para-aortic lymphadenectomies were performed based on the pathologically confirmed risk factors for nodal metastasis. Results : Fifteen patients only underwent LAVH with BSO and peritoneal washing cytology because they were identified by IFS diagnosis as low risk group for nodal metastasis. Sixteen patients had LAVH with BSO, peritoneal washing cytology and pelvic and/or para-aortic lymphadenectomies because they were identified as intermediate or high risk group. There were 15 patients with stage IA, 8 patients with stage IB, 1 patient with stage IC, 1 patient with stage IIA, 2 patients with stage IIB, 2 patients with stage IIIA and 2 patients with stage IIIB. Total length of the operation time ranged from 60 minutes to 280 minutes and the mean was 138 minutes. The mean hemoglobin decrement after the surgery was 1.3 gm/dL. One received blood transfusion. The average number of pelvic and para-aortic lymph nodes removed were 24.4 and 11.6, respectively. After the surgery, the patients passed gas after an average of 1.5 days and urinated after an average of 2.1 days. No one had serious complications after LASS. Conclusion : Based on our experiences, LASS might be an alternative to the traditional surgical approach in patients with early-stage endometrial carcinoma.