Improving Standard of Care Through Introduction of Laparoscopy for the Surgical Management of Gynecological XXXX .

@entity1 @entity190 @entity5 @entity1204
OBJECTIVE: This study aimed to evaluate the impact on perioperative and medium-term oncologic outcomes of the implementation of laparoscopy into a preexisting oncologic setting. METHODS: Data from consecutive 736 @entity1 undergoing surgery for apparent early stage gynecological @entity5 ( @entity1204 ) between 2000 and 2011 were reviewed. Complications were graded per the Accordion classification. Survival outcomes within the first 5 years were analyzed using Kaplan-Meier method. RESULTS: Overall, 493 (67%), 162 (22%), and 81 (11%) had surgery for apparent early stage @entity1204 . We assisted at an increase of the number of @entity1 undergoing surgery via laparoscopy through the years (from 10% in the years 2000-2003 to 82% in years 2008-2011; P < 0.001 for trend); while the need to perform open surgery decreased dramatically (from 83% to 10%; P < 0.001). Vaginal approach was nearly stable over the years (from 7% to 8%; P = 0.76). A marked reduction in estimated @entity190 , length of hospital stay, blood transfusions as well as grade greater than or equal to 3 postoperative complications over the years was observed (P < 0.001). Surgical radicality assessed lymph nodes count was not influenced by the introduction of laparoscopic approach (P > 0.05). The introduction of laparoscopy did not adversely affect medium-term (within 5 years) survival outcomes of @entity1 undergoing surgery for apparent early stage @entity5 of the endometrium, uterine cervix, and adnexa (P > 0.05 log-rank test). CONCLUSIONS: The introduction of laparoscopy into a preexisting oncologic service allows an improvement of standard of care due to a gain in perioperative results, without detriments of medium-term oncologic outcomes.
