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Laparoscopic hysterectomy & Uterine Cancer Laparoscopic hysterectomy & Uterine Cancer

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Unread 11-16-2007, 07:24 PM
Laparoscopic hysterectomy & Uterine Cancer

I just had my first meeting with my oncologist and was scheduled for a hysterectomy on December 6th.

I made an assumption that because they would want to take a look around that I would be having an abdominal hysteretomy. And my gynecologist gave me a 6 week recovery time which is typical for abdominal hysterectomies.

I was surprised and I am a bit concerned, but I'm not sure why. Has anyone had or has heard of laperoscopic hysterectomies as a normal procedure for grade 1, well differentiated uterine cancer?

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Unread 11-16-2007, 07:56 PM
Laparoscopic hysterectomy & Uterine Cancer

Hi Shadowmaker,

I had laproscopic surgery to remove two fibroids before finding out they were infact tumors (from pathology reports). I then returned to my gynecologist to ask if I could have a hysterectomy using the same procedure and he strongly advised against it. I got a second opinion from gynecologis and third opinion from a gyno oncologist and they all recommend I have the abdominal surgery. I ended up getting abdominal surgery (horizontal incision) done by the gyno oncologist.

The reason they advised against the laproscopic surgery is because:

1. They do not have a chance to get lymph node/fatty tissue samples in different parts of the adbomen.
2. They do not have the chance to do an abdominal wash which can pick up cancer cells.
3. They don't have as clear a view of the abdomen and can not check surrounding areas to make sure there are no other areas of concern.

Prior to surgery I had a CT scan that came back clear, blood tests came back clear and the ultrasound looked good. Despite this the doctor said that you can't stage or grade a cancer until you do the surgery and get back the pathology reports from the samples. I was graded at 1a and even thought it is a longer recovery period I feel more comfortable having had the open surgery. At the end of the day it is cancer and it pays to be cautious.

I would recommend that you get a second opinion. Hope this information is useful to you. All the best of luck with surgery.
Unread 11-16-2007, 10:25 PM
Laparoscopic hysterectomy & Uterine Cancer

I don't have any experience with that type of cancer, but it doesn't make much sense to me. Singa's experience really helps to explain why. Wouldn't they want to "see" inside you optimally? I am glad that you are questioning it. I would get at least another opinion!

You didn't mention a gynecological oncologist - I really hope that you have consulted one. They are the best to perform surgery when cancer is involved. They can provide the best advice, and the best treatment.

Don't fear questioning your doctors. YOU are your own advocate. No one else will be looking out for your best interests, as well as YOU!
Please keep us updated.
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Unread 11-16-2007, 11:24 PM
Laparoscopic hysterectomy & Uterine Cancer

Thank you both for your replies. I do have a gynecological oncologist. And he did say he could do the wash and take some lymph nodes laparoscopically.

I feel like I should be relieved because of how much easier the recovery is, but I don't feel reassured. I am going to get a second opinion, but I am then also worried about time. I just want this out of me.

As you can probably tell, I am a bit stressed out and unsettled. I want to take the most conservative route - take a real good look around and take out more than less.
Unread 11-16-2007, 11:50 PM
Laparoscopic hysterectomy & Uterine Cancer

I had a laproscopic hysterectomy and they took washes and lymph nodes and had a little peek around. I had stage 1, low grade endo ca. and was considered a good candidate for the surgery. I am very pleased with the surgery and am extremely glad I had it.

When I signed the consent form I agreed that once on the table if they determined I needed an abdominal hyster then I would have one. You might want to check that out.
Unread 11-17-2007, 06:31 AM
Laparoscopic hysterectomy & Uterine Cancer

Dear Shadowmaker,

Here's a brief summary of what I know about laparoscopic hysterectomies for cancer. First of all, this is the way all hysters are performed at the two top cancer hospitals in the country, MD Anderson and Sloan Kettering.

This should tell you something right away -- laparscopic hyst is the most advanced way to do the procedure. Properly done, there is no diminishing of the normal procedures, like node removal and the wash, but there are great advantages, like in healing time.

The only caveat is that the surgeon should be highly trained and experienced, so that's what you want to be sure about with your doctor.

If this is just as good or better than abdominal hyster, why isn't it done more? Sadly, I found out AFTER my TAH that my gyn/onc simply was never trained in laparoscopic surgery, as many of the older surgeons are not (old dogs?). This is definitely not something they tend to advertise.

If you decide to go ahead with laparoscopic surgery, you'll find that your healing time will be greatly accelerated. I hope it works out for you.

PS Second opinions are always a good idea in any cancer case.
Unread 11-17-2007, 07:26 AM
Laprascopic vs TAH for sarcoma's

Sarcoma's behave differently than other uterine/endo cancers which could be the reason for the abdominal hysterectomy vs the laproscopic.
Unread 11-17-2007, 03:35 PM
Here is a study on LAH

Gemignani ML; Curtin JP; Zelmanovich J; Patel DA; Venkatraman E; Barakat RR
"Laparoscopic-assisted vaginal hysterectomy for endometrial cancer: clinical outcomes and hospital charges"
Gynecologic oncology, 1999 Apr;73(1):5-11

OBJECTIVE: Our objective was to compare the clinical outcomes and associated hospital charges between two methods of hysterectomy for patients with early-stage endometrial cancer.

METHODS: Retrospective chart review of 320 patients with early-stage endometrial cancer treated by laparoscopic-assisted vaginal hysterectomy (LAVH) or total abdominal hysterectomy (TAH) was performed for the period of July 1, 1991, to September 30, 1996, at Memorial Sloan-Kettering Cancer Center.

RESULTS: Sixty-nine patients (22%) were treated by LAVH, and 251 (78%) were treated by TAH. The majority of the patients (80%) had Stage I disease. The mean age was similar for both groups: 60 years for the LAVH vs 61 years for TAH. The mean weight was significantly lower for the LAVH group, 71 kg (range 43-117 kg), than for the TAH group, 82 kg (range 38-200 kg), (P < 0.05). Overall complication rates were lower among patients treated by LAVH. Operating room time was longer for the LAVH group (214 min) than for the TAH group (144 min) (P < 0.05). The median length of stay was significantly shorter for patients treated by LAVH (2.0 days) compared to TAH (6.0 days) (P < 0.05). Room charges were significantly higher for the TAH patients ($6960) compared to the LAVH patients ($3130) (P < 0.05). Overall mean total charges were significantly less for the LAVH group ($11,826) than for the TAH group ($15,189) (P < 0.05). With a median follow-up of 30 months for the TAH group and 18 months for the LAVH group, there was no significant difference in disease recurrence (P = 0.91).

CONCLUSION: Patients treated by LAVH for early-stage endometrial cancer had significantly shorter hospitalization and fewer complications, resulting in less overall hospital charges when compared to patients treated by TAH. Long-term outcome was similar. Laparoscopic-assisted vaginal hysterectomy is an attractive alternative for selected patients with early-stage endometrial cancer
Unread 11-17-2007, 06:29 PM
Laparoscopic hysterectomy & Uterine Cancer

I visited 3 gyn/oncologists regarding my cancer and hysterectomy. All three recommended LAVH for me. One doctor was at Memorial Sloan Kettering and the other at NYU Cancer Center and another one was with a NorthShore Hospital.

I learned that they inflate the abdominal cavity and with cameras the visablity is amazing. If for any reason the cancer is more invasive, they would "convert" to a traditional hysterectomy. They are doing a wash and biopsing lymph nodes.

I am going for an MRI on Tuesday to try to locate any more cancer prior to the surgery. I was also dx with stage 1, well differieniated cancer.

I posted a study for you to see. My doctor told me that the long term results are the same, but the recovery period is shorter for the laproscopic procedure.

So now you have two contradictory pieces of information. I am sorry that this is not easy.

Not everyone is a candidate for LAVH, because the review is done on a case by case basis. The doctors assured me that if possible, this is a good way to go.

I also have just been dx with stage one uterine cancer that is well differeniated.

Best wishes!

Unread 11-17-2007, 08:06 PM
Laparoscopic hysterectomy & Uterine Cancer

You're diagnosis, surgery type, and your feelngs could all be mine! I, too was very concerned that my gyn/oncologist planned to perform a LAVH/BSO. Everything that I had read said that with a cancer dx, an abdominal has to be done.
Not to worry! Come to find out, my DR is one of the best in the country!
I am 2 weeks post op and doing great. He is convinced that it is all gone and no further treatment will be necessary.
I think this type of surgergy is becoming more accepted. You just have to have someone to trust.
Take care and good luck!

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