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Master's Dissertation
DOI
https://doi.org/10.11606/D.17.2020.tde-18082020-220056
Document
Author
Full name
Licério Miguel
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2019
Supervisor
Committee
Reis, Francisco José Cândido dos (President)
Herren, Helmer
Teixeira, Julio Cesar
Title in Portuguese
Cirurgia para o câncer de endométrio: comparação das abordagens laparotômica e laparoscópica
Keywords in Portuguese
Câncer de endométrio
Cirurgia
Laparoscopia
Laparotomia
Abstract in Portuguese
Introdução: O câncer de endométrio é a segunda neoplasia ginecológica mais frequente no Brasil. A cirurgia é o procedimento primário na maioria dos casos e tem como objetivo fundamental o estadiamento da doença, sendo na maioria das vezes também o tratamento definitivo. É característica das pacientes com esta doença a presença de obesidade e de comorbidades associadas. O uso de técnicas minimamente invasivas para a sua abordagem tem sido cada vez mais empregado e discutido. Objetivo: Comparar os aspectos referentes à abordagem cirúrgica por via aberta ou laparoscópica para o câncer endometrial, avaliando as duas possibilidades, suas complicações, recorrência e sobrevida. Métodos: Foram levantados os dados de todas as pacientes submetidas ao tratamento cirúrgico para o câncer endometrial a partir de janeiro de 1998, quando se iniciou a abordagem laparoscópica no serviço de Oncologia Ginecológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Ribeirão Preto (HC FMRP-USP), até dezembro de 2017. Durante esse período, a cirurgia minimamente invasiva e a cirurgia aberta tradicional foram usadas no serviço, de acordo com a preferência do cirurgião, como forma de abordagem dessas pacientes. A análise foi baseada em dados dos registros médicos do paciente: tipo de cirurgia, resultados a curto prazo, resultados a longo prazo e fatores intercorrentes. Resultados: Do total de 400 mulheres incluídas neste estudo, 316 foram submetidas à laparotomia e 84 à laparoscopia. As mulheres submetidas à laparotomia apresentaram maior frequência de tumores grau 3 (22,8% vs. 11,9%; p = 0,006) e maior frequência de quimioterapia adjuvante (14,6% vs. 6%; p = 0,055). A laparoscopia foi associada ao aumento do tempo cirúrgico (194,7 min vs. 165,1 min; p < 0,001) e redução da taxa de complicações cirúrgicas (0 vs. 9,2%; p = 0,008). A laparoscopia não aumentou o risco de recorrência (HR: 0,43, IC 95% 0,18-1,02; p = 0,06) e aumentou a sobrevida global em dez anos (HR: 0,44, IC 95% 0,22-0,91; p = 0,03). Conclusão: A laparoscopia apresentou vantagens claras sobre a laparotomia para o câncer endometrial precoce. Foi associado a uma menor taxa de complicações cirúrgicas e melhor sobrevida global.
Title in English
Endometrial cancer surgery: comparison of laparotomic and laparoscopic approaches
Keywords in English
Endometrial cancer
Laparoscopy
Laparotomy
Surgery
Abstract in English
Introduction: Endometrial cancer is the second most common gynecological cancer in Brazil. Surgery is the primary procedure in most cases and its main objective is the staging of the disease, most of the time also being the definitive treatment. It is characteristic of the patients with this disease the presence of obesity and associated comorbidities. The use of minimally invasive techniques for its approach has been increasingly employed and discussed. Objective: To compare the aspects regarding the open or laparoscopic surgical approach for endometrial cancer, evaluating the two surgical possibilities and their complications, recurrence and survival. Methods: Data were collected from all patients undergoing surgical treatment for endometrial cancer from January 1998, when the laparoscopic approach was initiated at the Gynecological Oncology service of the Clinics Hospital of Ribeirão Preto Medical School until December 2017. During this period, minimally invasive surgery and traditional open surgery were used in our service, according to the surgeon's preference to approach these patients. The analysis was based on data from the patient's medical records: type of surgery, short-term outcome, long-term outcome, and intercurrent factors. Results: From a total of 400 women were included in this study, 316 undergone to laparotomy and 84 to laparoscopy. Women submitted to laparotomy presented higher frequency of grade 3 tumors (22.8% vs. 11.9%; p = 0.006) and higher frequency of adjuvant chemotherapy (14.6% vs. 6%; p = 0.055). Laparoscopy was associated with increased surgical time (194.7 min vs. 165.1 min; p < 0.001), and reduced rate of surgical complications (0 vs. 9.2%; p = 0.008). Laparoscopy did not increase the risk of recurrence (HR: 0.43, 95% CI 0.18-1.02; p = 0.06) and increased the ten-years overall survival (HR: 0.44, 95% CI 0.22-0.91; p = 0.03). Conclusion: Laparoscopy presented clear advantages over laparotomy for early endometrial cancer. It was associated with a lower rate of surgical complications and better overall survival.
 
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Publishing Date
2020-10-20
 
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