Role of laparoscopy in the treatment of patients with endometrial cancer

Patients with endometrial cancer (EC) are conventionally staged by surgery. Depending on the tumor risk factors and the surgical findings, adjuvant treatment is indicated in the form of radiotherapy or chemotherapy. The FIGO guidelines on surgical staging are clear on the importance of assessing the presence of extra-uterine spread of disease, but are elusive on how extensive the surgical staging should be. Also, the role of lymphadenectomy and adjuvant radiotherapy in these patients is the object of controversy, as confirmed by recent results of clinical trials. With surgery remaining the cornerstone of treatment, the surgical approach associated with the least complications should be pursued, particularly since the association of surgery and radiotherapy can escalate the overall treatment morbidity. Therefore, in the last 15 years, laparoscopy has slowly been replacing the traditional midline laparotomy. The results of the few clinical trials and several retrospective studies are unanimous. The laparoscopic approach is feasible, safe and effective and has a lower complication rate as compared to laparotomy in all patients. The number of patients with endometrial cancer included in published studies so far is too low to achieve statistical significance with respect to survival outcomes. However, for some groups of patients, there are results from clinical trials showing that laparoscopy is the method of choice in view of the outstanding reduced surgical morbidity. © 2007 Springer-Verlag.