Laterally extended endopelvic resection for gynecological malignancies, a comparison between laparoscopic and laparotomic approach

Giulio Sozzi; Sonia Lauricella; Giuseppe Cucinella; Vito Andrea Capozzi; Roberto Berretta; Mariano Catello Di Donna; Vincenzo Giallombardo; Giovanni Scambia; Vito Chiantera

doi:10.1016/j.ejso.2023.107102

Laterally extended endopelvic resection for gynecological malignancies, a comparison between laparoscopic and laparotomic approach

Eur J Surg Oncol. 2023 Nov;49(11):107102. doi: 10.1016/j.ejso.2023.107102. Epub 2023 Sep 28.

Authors

Giulio Sozzi¹, Sonia Lauricella², Giuseppe Cucinella³, Vito Andrea Capozzi⁴, Roberto Berretta⁴, Mariano Catello Di Donna³, Vincenzo Giallombardo⁵, Giovanni Scambia⁶, Vito Chiantera⁵

Affiliations

¹ Dipartimento della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Obstetrics and Gynecology, Fondazione Istituto G. Giglio, Cefalù, Italy. Electronic address: giuliosozzi@hotmail.it.
² Department of Obstetrics and Gynecology, Fondazione Istituto G. Giglio, Cefalù, Italy.
³ Department of Gynecologic Oncology, University of Palermo, Palermo, Italy; Department of Surgical, Oncological and Oral Sciences (Di. Chir. On. S.), University of Palermo, Palermo, Italy.
⁴ Department of Obstetrics and Gynecology, University of Parma, Parma, Italy.
⁵ Department of Gynecologic Oncology, University of Palermo, Palermo, Italy.
⁶ Dipartimento della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Dipartimento Scienze della vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy.

PMID: 37801833
DOI: 10.1016/j.ejso.2023.107102

Abstract

Introduction: The historical approach to LEER is laparotomic, but recently laparoscopy has been proposed. The objective of this study was to compare surgical and oncological outcomes between the two approaches and to assess the overall quality of life (QoL).

Materials and methods: Women submitted to LEER between October 2012 and March 2020 were retrospectively recruited. Peri-operative data were analyzed and compared. Recurrence-free (RFS) and overall survival (OS) were calculated using the Kaplan-Meier method. The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, QLQ-CX24, and QLQ-OV28 questionnaires were administered 6 months after surgery in women with no evidence of recurrence after LEER.

Results: Of the included 41 patients, 20 were submitted to laparoscopic LEER (L-LEER) and 21 to open LEER (O-LEER). Median operating time (442 vs 630 min, p = 0.001), median blood loss (275 vs 800 ml, p < 0.001), and median length of hospital stays (10 vs 16 days, p = 0.002) were shorter in the laparoscopic group, while tumor resection rate and peri-operative complications were similar. After a median follow-up of 27.5 months, no differences, in terms of DFS (p = 0.83) and OS (p = 0.96) were observed between the two approaches. High functional scores and low levels of adverse symptoms were observed on the surviving women.

Conclusion: QoL after LEER is acceptable, and laparoscopy provides better surgical and similar oncological outcomes when compared to laparotomy. L-LEER can be considered a further option of treatment for women with gynecological tumors infiltrating the pelvic sidewall.

Keywords: L-LEER; LEER; Laparoscopic LEER; Laterally extended endopelvic resection; Pelvic side wall.

MeSH terms

Female
Genital Neoplasms, Female* / surgery
Humans
Laparoscopy* / methods
Laparotomy
Quality of Life
Retrospective Studies
Treatment Outcome