Different types of treatment are available for patients with endometrial cancer. Three types of treatment are used, surgery, radiation therapy, and chemotherapy. Surgery is the most common treatment and only cure for endometrial cancer. A hysterectomy, surgical removal of the uterus, is required in order to remove the cancer. Laparoscopic hysterectomy offers women all of the benefits of minimally invasive surgery, including short to no hospital stay, minimal pain and fast recovery. The Women’s Surgery Center has found that a fast and easy recovery from surgery benefits cancer patients in particular. After laparoscopic surgery, women feel less sick, which enables them to have a brighter, more optimistic outlook. This positive outlook helps women through the rest of the cancer treatment and recovery process.
Laparoscopic Hysterectomy for Uterine Cancer
The Women’s Surgery Center treats patients with uterine cancer laparoscopically. We perform the most laparoscopic hysterectomy and staging for uterine cancer in the Mid-Atlantic region. Endometrial cancer is typically limited to the uterus, with most patients having complete removal of the cancer with hysterectomy.
Staging is performed at the time of the laparoscopic procedure to determine if the cancer has spread, and involves node dissection, or removal of the lymph nodes during the procedure. The removal of lymph nodes does not add time or additional complications to the surgical procedure. The Women’s Surgery Center uses a sophisticated Advanced Laparoscopic technique that allows us to remove more nodes completely than other surgeons.
Node dissection within pelvis and aortic area is crucial for the evaluation of the stage of cancer. More information about the stages of endometrial cancer is available in our Learning Center.
Will I need additional treatment after surgery?
Radiation and chemotherapy after surgery is called adjuvant therapy. Adjuvant therapy is not required in the vast majority of uterine cancer patients with early stage disease with minimal invasion into the uterine muscle. Treatment after surgery depends on the following factors:
- Lymph Node status – positive or negative for cancer
- Depth of the cancer invading or not into the muscle of the uterus and cervix
- Cancer cells in the lymph spaces of the uterus
- Involvement of the ovaries and tubes
- Grade of the cancer and cell type
- Whether or not the washings – a fluid wash of the pelvis and abdomen – are positive for cancer cells.
Will I need radiation or chemotherapy?
While most endometrial cancer patients will not require additional therapies, when it is required, the Women’s Surgery Center offers patients the same dedicated, premier, and compassionate care throughout their treatment and recovery process. If chemotherapy is indicated after surgery, the Women’s Surgery Center offers a comfortable, homelike environment at many of our locations. The chemotherapy program is designed to meet the needs of the individual patient. At the Women’s Surgery Center we understand the psychological uncertainty caused by cancer and we strive to provide a supportive atmosphere and continuity of care from the initial appointment through surgery, to chemotherapy and recovery.
Why is laparoscopic surgery better for uterine cancer?
Laparoscopic hysterectomy with staging for uterine cancer has been shown by the Women’s Surgery Center and in several recent studies published by the Society of Gynecologic Oncologists to be as effective as standard open surgery with a much faster recovery and fewer complications. However, few gynecological oncologists are fully trained in laparoscopic surgery and are able to perform minimally invasive surgical procedures.
Laparoscopic hysterectomy can be performed in almost all patients with cancer confined to the uterus and allows patients to be up and around much faster. If radiation or chemotherapy is required, these treatments can be started much sooner after surgery, minimizing delay in therapy. In addition, laparoscopic surgery limits adhesion formation, which is a significant benefit if radiation therapy is required. Adhesions, or scar tissue, “trap” the bowel in the pelvis, and may increase injury to the bowel during radiation therapy since it is not able to move in and out of the radiated field as would normally occur if adhesions were not present. This will increase the dose of radiation to the bowel, and can increase the incidence of bowel injury resulting in poor bowel function and possible obstruction.
Finally, laparoscopic surgery also allows patients to cope with their illness easier, since they are not hospitalized for an extensive period of time, and their recovery allows them to go about normal activities. Patients who feel well typically face their future treatment and recovery with a more hopeful outlook and experience faster recoveries, both physical and psychological, from their cancer.
The Women’s Surgery Center uses advanced laparoscopic surgery with retroperitoneal dissection for removal of the uterus with dramatically successful results. It is not necessary for patients to undergo large, vertical incisions with prolonged hospital stay and increased chances of surgical or post-operative complications.
The greatest barrier for most oncologists in successfully completing these procedures laparoscopically is lack of surgical technique and experience. It is NOT better to open a patient up with a 12 to 15 inch incision so that it is possible to “feel” inside. Since most cases of uterine cancer are limited to the uterus, the open approach does not provide patients with this disease the best care possible, but does expose them to unnecessary pain and complications.
The following is a comparison of the two types of surgical procedures available for the treatment of uterine cancer: hysterectomy including removal of tubes and ovaries as well as full staging. The chart illustrates the typical surgical experience with laparoscopic surgery at the Women’s Surgery Center as compared to the typical open surgery.
Comparison Chart
Laparoscopic Hysterectomy, Removal of Tubes and Ovaries, Pelvic and Aortic Node Dissection vs Open
| Laparoscopic Retroperitoneal Hysterectomy, Removal of Tubes and Ovaries, Pelvic and Aortic Node Dissection - WSC | Open Laparotomy with Abdominal Hysterectomy, Removal of Tubes and Ovaries, Pelvic and Aortic Node Dissection | |
| Dischage Home | 80% same day, up to 24 hours | 3 – 7 days |
| Recovery Time | 2 weeks or less | 6 – 8 weeks |
| Incision Size | 4 – 1/4 inch | 12 – 15 inches, vertical |
| Pain Tolerance | Excellent to good, mild to mod pain first 2 days | Poor secondary to large vertical incision |
| Node Yield | Average 15, range 7 to 36 nodes | Variable, depends on surgeon |
| Complications | Minimal secondary to small incisions, minimal pain, rapid discharge from hospital, immediately ambulatory | Incision: Increased incidence of wound breakdown and infection, incisional pain, pain with breathing Ambulation; difficulty ambulating with increased incidence of clots in legs and lung due to venous stasis Other: increased incidence of stroke and MI due to venous stasis and stress/pain, lung collapse and pneumonia, increased risk of hospital acquired infection (MRSA) secondary to prolonged hospital stay |
| Procedure Time | 1 – 1.5 hours | 1 – 2 hours |