Laparoscopy versus laparotomy in endometrial cancer: first analysis of survival of a randomized prospective study.
OBJECTIVE
Laparoscopy has been proved to be safe and reliable in staging of patients with endometrial cancer. It has definite advantages over laparotomy, but a comparable survival outcome is still to be verified in prospective randomized trials.


METHODS
Prospective, randomized clinical trial.


METHODS
Department of Gynecology, Friedrich Schiller University, Jena, Germany.


METHODS
One hundred twenty-two women with uterine cancer.


METHODS
Laparotomy and laparoscopy.


RESULTS
Sixty-three patients were allocated to the laparoscopy arm, and 59 were allocated to the laparotomy arm. Median follow-up for all patients was 44 months (range 5-96 months). Eight patients (12.6%) in the laparoscopy group had a recurrence versus five patients (8.5%) in the laparotomy group (p = .65). At median follow-up, disease-free survival (DFS) and overall survival (OS) in the laparoscopy group and laparotomy group were 87.4% versus 91.6% and 82.7% versus 86.5%, respectively. Cause-specific survival (CSS) was 90.5% in the laparoscopy group versus 94.9% in the laparotomy group. In patients with International Federation of Gynecology and Obstetrics stage I, DFS was 91.2% in the laparoscopy group versus 93.8% in the laparotomy group, OS was 86.5% versus 89.7%, and CSS was 93.4% versus 95.9%.


CONCLUSIONS
Laparoscopic vaginal treatment of patients with endometrial cancer provides a survival outcome comparable with laparotomy. If these data are confirmed, laparoscopic procedures should be included in routine therapy for patients with endometrial cancer.
Tozzi
Roberto
R
Department of Gynaecologic Oncology, The Royal Marsden Hospital, London, United Kingdom.
Malur
Sabine
S
Koehler
Christhardt
C
Schneider
Achim
A
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D002288:Adenocarcinoma, Mucinous / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D002296:Carcinosarcoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000453:epidemiology; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D014463:Ultrasonography