title: Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2.
abstract: OBJECTIVE
  The objective was to compare laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer.
  
  
  METHODS
  Patients with clinical stage I to IIA uterine cancer were randomly assigned to laparoscopy (n = 1,696) or open laparotomy (n = 920), including hysterectomy, salpingo-oophorectomy, pelvic cytology, and pelvic and para-aortic lymphadenectomy. The main study end points were 6-week morbidity and mortality, hospital length of stay, conversion from laparoscopy to laparotomy, recurrence-free survival, site of recurrence, and patient-reported quality-of-life outcomes.
  
  
  RESULTS
  Laparoscopy was initiated in 1,682 patients and completed without conversion in 1,248 patients (74.2%). Conversion from laparoscopy to laparotomy was secondary to poor visibility in 246 patients (14.6%), metastatic cancer in 69 patients (4.1%), bleeding in 49 patients (2.9%), and other cause in 70 patients (4.2%). Laparoscopy had fewer moderate to severe postoperative adverse events than laparotomy (14% v 21%, respectively; P < .0001) but similar rates of intraoperative complications, despite having a significantly longer operative time (median, 204 v 130 minutes, respectively; P < .001). Hospitalization of more than 2 days was significantly lower in laparoscopy versus laparotomy patients (52% v 94%, respectively; P < .0001). Pelvic and para-aortic nodes were not removed in 8% of laparoscopy patients and 4% of laparotomy patients (P < .0001). No difference in overall detection of advanced stage (stage IIIA, IIIC, or IVB) was seen (17% of laparoscopy patients v 17% of laparotomy patients; P = .841).
  
  
  CONCLUSIONS
  Laparoscopic surgical staging for uterine cancer is feasible and safe in terms of short-term outcomes and results in fewer complications and shorter hospital stay. Follow-up of these patients will determine whether surgical technique impacts pattern of recurrence or disease-free survival.
authors.affiliation: University of Oklahoma, Oklahoma City, OK 73190, USA. joan-walker@ouhsc.edu
authors.forename: Joan L
authors.initials: JL
authors.lastname: Walker
authors.forename: Marion R
authors.initials: MR
authors.lastname: Piedmonte
authors.forename: Nick M
authors.initials: NM
authors.lastname: Spirtos
authors.forename: Scott M
authors.initials: SM
authors.lastname: Eisenkop
authors.forename: John B
authors.initials: JB
authors.lastname: Schlaerth
authors.forename: Robert S
authors.initials: RS
authors.lastname: Mannel
authors.forename: Gregory
authors.initials: G
authors.lastname: Spiegel
authors.forename: Richard
authors.initials: R
authors.lastname: Barakat
authors.forename: Michael L
authors.initials: ML
authors.lastname: Pearl
authors.forename: Sudarshan K
authors.initials: SK
authors.lastname: Sharma
mesh_terms: D000038:Abscess / Q000209:etiology; D000368:Aged; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D017063:Outcome Assessment, Health Care; D014552:Urinary Tract Infections / Q000209:etiology; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*