Analysis of survival after laparoscopic management of endometrial cancer.
OBJECTIVE
To assess the effect of laparoscopic surgery on the survival of women with early-stage endometrial cancer and to analyze the factors that affect survival.


METHODS
Retrospective cohort study (Canadian Task Force classification II-2).


METHODS
Tertiary teaching hospital.


METHODS
Women with clinical stage I and II endometrial cancer (International Federation of Gynecology and Obstetrics staging, 1971) from January 1993 through June 2003.


METHODS
Demographic, surgical, perioperative, and pathologic characteristics of women treated with laparoscopy or laparotomy were compared by use of Fisher's exact test or the Student t test. Recurrence-free and overall survival was calculated by use of the Kaplan-Meier method. Stratified analyses were performed with the log-rank test for factors affecting survival (surgical stage, histologic study, and grade).


RESULTS
Sixty-seven and 127 women were treated with laparoscopy and laparotomy, respectively. Median follow-up was 36.3 months for the laparoscopy group and 29.6 months for the laparotomy group. The complication rates in the 2 groups were comparable. Women undergoing laparoscopy had shorter hospital stay and less morbidity related to infection. The 2- and 5-year estimated recurrence-free survival rates for the laparoscopy and laparotomy groups (93 % vs 91.7% and 88.5% vs 85%, respectively), as well as the overall 2- and 5-year survival rates (100% vs 99.2% and 100% vs 97%, respectively) were similar.


CONCLUSIONS
Laparoscopic surgery in women with early-stage endometrial carcinoma resulted in survival rates similar to laparotomy, although a small sample size precludes definitive conclusions. A larger randomized comparison of the 2 techniques is needed to validate these findings.
Nezhat
Farr
F
Division of Gynecologic Oncology, The Mount Sinai School of Medicine, New York, New York 10029, USA. Farr.Nezhat@mssm.edu
Yadav
Jyoti
J
Rahaman
Jamal
J
Gretz
Herbert
H
Cohen
Carmel
C
D000368:Aged; D016063:Blood Loss, Surgical; D000075202:Contraindications; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008197:Lymph Node Excision; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis