Objective: To evaluate the benefits of systematic preoperative treatment with LH- RH agonists prior to endometrial resection (ER). Study design: The study population was made up of 98 premenopausal women who underwent...Objective: To evaluate the benefits of systematic preoperative treatment with LH- RH agonists prior to endometrial resection (ER). Study design: The study population was made up of 98 premenopausal women who underwent resectoscopic treatment for abnormal uterine bleeding (AUB) between January 1996 and December 1997. Only patients with endometrial polyps or dysfunctional bleeding were included. The population was divided into two groups: patients who had (group B) and those who had not (group A) received LH- RH before the surgical intervention. Results: ER was carried out as a single procedure in 66 (67.5% ) of the patients. ER plus polypectomy was necessary in 32 (32.5% ) patients. There were no differences between the two groups as far as the operating time and total volume of distension medium were concerned. No intraoperative complications were seen in either group. A higher negative balance of distension medium was achieved in group A (320 ± 23 mL versus 187 ± 16 mL; P <0.001), and this difference was not modified when cases with polyps were excluded. The failure rate was similar in both groups both at 12 months [group A 6 (14.8% ) versus group B 7 (14.9% ) patients] and at 60 months [group A, 11 (21.6% )- versus group B 10 (21.2% ) patients]. Likewise, the amenorrhea and hypomenorrhea rates at 12 months and at 60 months were also shown to be the same in both groups. When two doses of LH- RH are used and the failure rate is taken into account the cost of an acceptable outcome increases from e843.37 to e1373.49 per patient, while the total cost of a hysterectomy is e1355.42. Conclusions: Endometrial suppression with LH- RH agonists did not guarantee better results of ER, but they are strongly recommended during the learning curve to achieve a safer procedure.展开更多
Objective. To assess the feasibility of laparoscopy in the treatment of early stage endometrial carcinoma and follow up outcomes compared to classic laparotomy. Methods. A retrospective review of 90 consecutive patien...Objective. To assess the feasibility of laparoscopy in the treatment of early stage endometrial carcinoma and follow up outcomes compared to classic laparotomy. Methods. A retrospective review of 90 consecutive patients with endometrial cancer managed between January 1997 and December 2003. Two groups were defined whether they had been treated by laparoscopy (N = 38; LPS group) or by laparotomy (N = 37; LPM group). Nine patients treated by vaginal hysterectomy and 6 cases with stages III- IV were excluded from the study. Results. Both groups were comparable in mean age and mean BMI. Mean operating time was longer for LPS group, 164.9 ± 5.60 (77- 240) vs. 129.97 ± 5.08 (60- 180) min (P < 0.05). Intraoperative complications were seen in 7 patients (18.9% ) from LPM and in 5 cases (13.2% ) in the laparoscopic group. Two patients (5.2% ) initially evaluated by laparoscopy were converted into laparotomy due to an increasing and uncontrollable hypercapnia. There were more post-operative complications in patients managed by laparotomy (14 cases; 38.8% ), than by laparoscopy (7 cases; 18.4% ) (P < 0.05). Blood transfusion was necessary in 4 patients (10.8% ) in LPM group while none was required in LPS group (P < 0.01). Hospital readmission was only recorded in 3 patients treated by laparotomy (6.7% ) (P < 0.05). Hospital stay was longer in LPM group 7.06 ± 0.58 (4- 21) vs LPS 5.04 ± 0.73 (2- 17) days (P < 0.05). With a median follow up of 53.21 ± 4.32 months for LPM (5- 90) and 36.31 ± 2.75 months for LPS (9- 65) there was no significant difference in disease recurrence between the two groups. Conclusion. Laparoscopic staging combined with vaginal hysterectomy appears to be a feasible alternative to classical surgical approach in patients with early stage I or II endometrial carcinoma.展开更多
文摘Objective: To evaluate the benefits of systematic preoperative treatment with LH- RH agonists prior to endometrial resection (ER). Study design: The study population was made up of 98 premenopausal women who underwent resectoscopic treatment for abnormal uterine bleeding (AUB) between January 1996 and December 1997. Only patients with endometrial polyps or dysfunctional bleeding were included. The population was divided into two groups: patients who had (group B) and those who had not (group A) received LH- RH before the surgical intervention. Results: ER was carried out as a single procedure in 66 (67.5% ) of the patients. ER plus polypectomy was necessary in 32 (32.5% ) patients. There were no differences between the two groups as far as the operating time and total volume of distension medium were concerned. No intraoperative complications were seen in either group. A higher negative balance of distension medium was achieved in group A (320 ± 23 mL versus 187 ± 16 mL; P <0.001), and this difference was not modified when cases with polyps were excluded. The failure rate was similar in both groups both at 12 months [group A 6 (14.8% ) versus group B 7 (14.9% ) patients] and at 60 months [group A, 11 (21.6% )- versus group B 10 (21.2% ) patients]. Likewise, the amenorrhea and hypomenorrhea rates at 12 months and at 60 months were also shown to be the same in both groups. When two doses of LH- RH are used and the failure rate is taken into account the cost of an acceptable outcome increases from e843.37 to e1373.49 per patient, while the total cost of a hysterectomy is e1355.42. Conclusions: Endometrial suppression with LH- RH agonists did not guarantee better results of ER, but they are strongly recommended during the learning curve to achieve a safer procedure.
文摘Objective. To assess the feasibility of laparoscopy in the treatment of early stage endometrial carcinoma and follow up outcomes compared to classic laparotomy. Methods. A retrospective review of 90 consecutive patients with endometrial cancer managed between January 1997 and December 2003. Two groups were defined whether they had been treated by laparoscopy (N = 38; LPS group) or by laparotomy (N = 37; LPM group). Nine patients treated by vaginal hysterectomy and 6 cases with stages III- IV were excluded from the study. Results. Both groups were comparable in mean age and mean BMI. Mean operating time was longer for LPS group, 164.9 ± 5.60 (77- 240) vs. 129.97 ± 5.08 (60- 180) min (P < 0.05). Intraoperative complications were seen in 7 patients (18.9% ) from LPM and in 5 cases (13.2% ) in the laparoscopic group. Two patients (5.2% ) initially evaluated by laparoscopy were converted into laparotomy due to an increasing and uncontrollable hypercapnia. There were more post-operative complications in patients managed by laparotomy (14 cases; 38.8% ), than by laparoscopy (7 cases; 18.4% ) (P < 0.05). Blood transfusion was necessary in 4 patients (10.8% ) in LPM group while none was required in LPS group (P < 0.01). Hospital readmission was only recorded in 3 patients treated by laparotomy (6.7% ) (P < 0.05). Hospital stay was longer in LPM group 7.06 ± 0.58 (4- 21) vs LPS 5.04 ± 0.73 (2- 17) days (P < 0.05). With a median follow up of 53.21 ± 4.32 months for LPM (5- 90) and 36.31 ± 2.75 months for LPS (9- 65) there was no significant difference in disease recurrence between the two groups. Conclusion. Laparoscopic staging combined with vaginal hysterectomy appears to be a feasible alternative to classical surgical approach in patients with early stage I or II endometrial carcinoma.
