Feasibility of minimally invasive surgery with implementation of ERAS protocol versus traditional laparotomy in the management of early-stage endometrial cancer

Document Type : Original Article

Authors

1 Department of Obstetrics and Gynecology, Faculty of medicine, Minia University

2 Department of oncology and general surgery, El Salam Oncology centre, Cairo

Abstract

Background: It has been suggested that the laparoscopic approach is associated with a reduction in 
operative morbidity. Over the last two decades there has been a steady increase in the use of 
laparoscopy for endometrial cancer. This review investigated the evidence of benefits and harms of 
laparoscopic surgery with implementation of ERAS program, versus traditional laparotomy for 
presumed early stage endometrial cancer. Study objective: To study the efficacy of laparoscopic 
radical hysterectomy with implementation of ERAS protocol for treatment of endometrial cancer on 
operative outcome and overall survival in comparison with traditional abdominal hysterectomy. 
Selection criteria: Non randomized controlled trial comparing laparoscopy with ERAS and 
laparotomy with mechanical bowel preparation for treatment of early stage endometrial cancer. Data 
collection and analysis: The study was done in El- Salam Oncology center, Cairo and Minia 
maternity university hospital (MMUH), Egypt. The study included two groups of patients diagnosed 
as endometrial carcinoma ( stage I) prepared for operations. First group (27 patients ) managed with 
laparoscopy with implementation of ERAS protocol while the other group (31 patients) managed with 
conventional laparatomy. Results: There was statistically significant reduction in action group than in 
conventional group as regarding : LOS (2.15 + 0.71 Vs 0.39+ 0.80), reduction in post operative pain 
which assessed by VAS score ( 3.04 +1.05) vs ( 5.71 + 1.00) and post operative fluid balance (916.67
ml) vs ( 2345.16 ml). There was statistically insignificant difference between both groups in 
postoperative pneumonia, urinary tract infection, surgical site infection. As a result readmission to 
hospital was less in active group than conventional (2 vs 8patients). Conclusion: Implementation of 
ERAS protocol in gynecologic surgery for endometrial carcinoma tailored according to the situation 
in each case, But in general; use of laparoscopy with ERAS was associated with controlled 
intravenous fluids utility, comparable pain, better operative outcome with less complication rates 
compared to conventional laparotomy. 
 

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