title: Improved surgical safety after laparoscopic compared to open surgery for apparent early stage endometrial cancer: results from a randomised controlled trial.
abstract: OBJECTIVE
  To compare Total Laparoscopic Hysterectomy (TLH) and Total Abdominal Hysterectomy (TAH) with regard to surgical safety.
  
  
  METHODS
  Between October 2005 and June 2010, 760 patients with apparent early stage endometrial cancer were enroled in a multicentre, randomised clinical trial (LACE) comparing outcomes following TLH or TAH. The main study end points for this analysis were surgical adverse events (AE), hospital length of stay, conversion from laparoscopy to laparotomy, including 753 patients who completed at least 6 weeks of follow-up. Postoperative AEs were graded according to Common Toxicity Criteria (V3), and those immediately life-threatening, requiring inpatient hospitalisation or prolonged hospitalisation, or resulting in persistent or significant disability/incapacity were regarded as serious AEs.
  
  
  RESULTS
  The incidence of intra-operative AEs was comparable in either group. The incidence of post-operative AE CTC grade 3+ (18.6% in TAH, 12.9% in TLH, p 0.03) and serious AE (14.3% in TAH, 8.2% in TLH, p 0.007) was significantly higher in the TAH group compared to the TLH group. Mean operating time was 132 and 107 min, and median length of hospital stay was 2 and 5 days in the TLH and TAH group, respectively (p<0.0001). The decline of haemoglobin from baseline to day 1 postoperatively was 2g/L less in the TLH group (p 0.006).
  
  
  CONCLUSIONS
  Compared to TAH, TLH is associated with a significantly decreased risk of major surgical AEs. A laparoscopic surgical approach to early stage endometrial cancer is safe.
authors.affiliation: University of Queensland School of Medicine, QLD, Australia.
authors.forename: Andreas
authors.initials: A
authors.lastname: Obermair
authors.forename: Monika
authors.initials: M
authors.lastname: Janda
authors.forename: Jannah
authors.initials: J
authors.lastname: Baker
authors.forename: Srinivas
authors.initials: S
authors.lastname: Kondalsamy-Chennakesavan
authors.forename: Alison
authors.initials: A
authors.lastname: Brand
authors.forename: Russell
authors.initials: R
authors.lastname: Hogg
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Jobling
authors.forename: Russell
authors.initials: R
authors.lastname: Land
authors.forename: Tom
authors.initials: T
authors.lastname: Manolitsas
authors.forename: Marcelo
authors.initials: M
authors.lastname: Nascimento
authors.forename: Deborah
authors.initials: D
authors.lastname: Neesham
authors.forename: James L
authors.initials: JL
authors.lastname: Nicklin
authors.forename: Martin K
authors.initials: MK
authors.lastname: Oehler
authors.forename: Geoff
authors.initials: G
authors.lastname: Otton
authors.forename: Lewis
authors.initials: L
authors.lastname: Perrin
authors.forename: Stuart
authors.initials: S
authors.lastname: Salfinger
authors.forename: Ian
authors.initials: I
authors.lastname: Hammond
authors.forename: Yee
authors.initials: Y
authors.lastname: Leung
authors.forename: Peter
authors.initials: P
authors.lastname: Sykes
authors.forename: Hextan
authors.initials: H
authors.lastname: Ngan
authors.forename: Andrea
authors.initials: A
authors.lastname: Garrett
authors.forename: Michael
authors.initials: M
authors.lastname: Laney
authors.forename: Tong Yow
authors.initials: TY
authors.lastname: Ng
authors.forename: Karfai
authors.initials: K
authors.lastname: Tam
authors.forename: Karen
authors.initials: K
authors.lastname: Chan
authors.forename: David H
authors.initials: DH
authors.lastname: Wrede
authors.forename: Selvan
authors.initials: S
authors.lastname: Pather
authors.forename: Bryony
authors.initials: B
authors.lastname: Simcock
authors.forename: Rhonda
authors.initials: R
authors.lastname: Farrell
authors.forename: Gregory
authors.initials: G
authors.lastname: Robertson
authors.forename: Graeme
authors.initials: G
authors.lastname: Walker
authors.forename: Anthony
authors.initials: A
authors.lastname: McCartney
authors.forename: Val
authors.initials: V
authors.lastname: Gebski
mesh_terms: D000328:Adult; D000368:Aged; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D008197:Lymph Node Excision; D008875:Middle Aged; D009367:Neoplasm Staging