Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2.
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.
Walker
Joan L
JL
University of Oklahoma, Oklahoma City, OK 73190, USA. joan-walker@ouhsc.edu
Piedmonte
Marion R
MR
Spirtos
Nick M
NM
Eisenkop
Scott M
SM
Schlaerth
John B
JB
Mannel
Robert S
RS
Spiegel
Gregory
G
Barakat
Richard
R
Pearl
Michael L
ML
Sharma
Sudarshan K
SK
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*