Page 156 - EJMO-9-3

Eurasian Journal of
Medicine and Oncology Pfannenstiel incision in endometrial cancer

performed in conjunction with other surgical procedures, 2. Materials and methods
particularly oophorectomy. These surgeries can be
performed using laparoscopy, laparotomy, or robotic- 2.1. Patients
4-6
assisted methods. Several studies have compared A retrospective study was conducted on the records of
midline and Pfannenstiel incisions for laparotomy in 224 patients diagnosed with EC between April 2010 and
early-stage EC. 7-10 Although laparoscopy offers greater April 2024. The staging was performed according to revised
comfort for patients, each surgical method has distinct the International Federation of Gynecology and Obstetrics
19
advantages and disadvantages. Laparoscopic surgery (FIGO) 2009 criteria. Serous and clear cell carcinomas
may pose challenges, especially in patients with a history were classified as grade 3. Only stage I and grade I –
20
of pelvic surgery or those who are superobes. In such II endometrioid-type EC were included in the study.
11
cases, although the midline incision used in laparotomy Women aged 18 and older, who were postmenopausal
provides a broader operative field, it is associated with or perimenopausal and had complete preoperative and
higher complication rates compared to the Pfannenstiel postoperative data, were eligible for inclusion. After
incisions. Staging with a Pfannenstiel incision may be a excluding 94 patients with non-endometrioid histology,
12
surgical option in patients with vaginal stenosis, morbid stage II – IV disease, grade 3 tumors, and synchronous
obesity that precludes trocar insertion, unsuitability for tumors, a total of 130 patients were included in the final
a manipulator, history of multiple abdominal surgeries, analysis. Data related to age, body mass index (BMI),
enlarged uteri, or suspected pelvic adhesions. In such stage, grade, and survival were extracted from medical
complex scenarios, the choice of incision in laparotomy records. BMI was calculated as weight in kilograms (kg)
2
becomes critical. Although a midline incision can provide divided by height in meters squared (m ). Participants
extensive exposure and easier access to pelvic organs, it were categorized into two groups: Group 1 (63 patients
is associated with higher postoperative pain, increased who underwent surgery through Pfannenstiel incision)
wound infection rates, and longer recovery times and Group 2 (67 patients who underwent laparoscopic
compared to the Pfannenstiel incision. 13 surgery). All patients underwent preoperative magnetic
resonance imaging (MRI) to assess myometrial invasion,
The Pfannenstiel incision, characterized by its cervical involvement, and pelvic/paraaortic lymph node
transverse suprapubic placement, generally offers metastasis. Patients with suspicious findings for stage
superior cosmetic outcomes, less postoperative pain, and II – IV on preoperative MRI were excluded, as they
reduced wound-related complications. Previous studies underwent complete lymph node dissection. Patients
comparing midline and Pfannenstiel incisions in early- were followed until April 2024 or their date of death. All
stage EC surgery have reported lower complication rates, patients completed appropriate adjuvant therapy in the
including wound infections and incisional hernias, with postoperative period.
Pfannenstiel incisions. 14,15 Recent data suggest that in
patients unsuitable for minimally invasive techniques, 2.2. Sample evaluation
the Pfannenstiel incision serves as a valuable alternative, The surgical procedure using the Pfannenstiel incision
offering some of the benefits of minimally invasive surgery included total hysterectomy, bilateral salpingo-
while retaining the advantages of an open approach. 16,17 oophorectomy, omental biopsy, and pelvic lymph node
Moreover, patient satisfaction related to postoperative sampling. Pelvic lymph nodes were removed starting from
pain management, hospital stay duration, and cosmetic the distal part of the common iliac artery to the circumflex
outcomes is notably higher among those undergoing iliac vein and anterior to the obturator nerve. In our
surgery through the Pfannenstiel incision compared to clinic, para-aortic lymph node sampling is not performed
midline laparotomy. 18
in patients with low-grade, early-stage EC as assessed by
Taken together, the Pfannenstiel incision represents preoperative MRI. Sentinel lymph node (SLN) mapping is
a viable alternative to laparoscopy in patients for whom also not performed due to the lack of equipment. Instead,
minimally invasive surgery is contraindicated or not pelvic lymph node sampling, cytology collection, and
feasible. It also offers a compromise between the benefits omental sampling are performed for staging purposes.
of open and minimally invasive surgery. Some reports have For laparoscopic surgery, a 10 mm, 0° laparoscope was
shown that adequate lymph node retrieval can be achieved routinely used. We opted for umbilical access using the
through the Pfannenstiel incision without compromising open entry (Hasson) technique under direct vision, with
21
oncologic safety. In this study, we aimed to compare a small transverse or longitudinal incision made at the
laparoscopy and Pfannenstiel incision in early-stage, low- umbilicus. A uterine manipulator was routinely used, and
grade EC surgery. the fallopian tubes were sealed with bipolar energy before

Volume 9 Issue 3 (2025) 148 doi: 10.36922/EJMO025150106