Improved surgical safety after laparoscopic compared to open surgery for apparent early stage endometrial cancer : results from a randomised controlled trial

Obermair, Andreas, Janda, Monika, Baker, Jannah, Kondalsamy-Chennakesavan, Srinivas, Brand, Alison, Hogg, Russell, Jobling, Thomas W., Land, Russell, Manolitsas, Thomas, Nascimento, Marcelo, Neesham, Deborah, Nicklin, James L., Oehler, Martin K., Otton, Geoff, Perrin, Lewis, Salfinger, Stuart, Hammond, Ian, Leung, Yee, Sykes, Peter, Ngan, Hextan, Garrett, Andrea, Laney, Michael, Ng, Tong Yow, Tam, Karfai, Chan, Karen, Wrede, David H., Pather, Selvan, Simcock, Bryony, Farrell, Rhonda, Robertson, Gregory, Walker, Graeme, McCartney, Anthony, & Gebski, Val (2012) Improved surgical safety after laparoscopic compared to open surgery for apparent early stage endometrial cancer : results from a randomised controlled trial. European Journal of Cancer, 48(8), pp. 1147-1153.

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AIM: 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.

Impact and interest:

31 citations in Scopus
22 citations in Web of Science®
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ID Code: 54779
Item Type: Journal Article
Refereed: Yes
Keywords: Laparoscopic surgery, Endometrial cancer, Early stage endometrial cancer, Safety, Open surgery, Comparison, randomized-controlled trial
DOI: 10.1016/j.ejca.2012.02.055
ISSN: 0959-8049
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Public Health & Social Work
Copyright Owner: Copyright 2012 Elsevier
Copyright Statement: This is the author’s version of a work that was accepted for publication in European Journal of Cancer. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in European Journal of Cancer, [VOL 48, ISSUE 8, (2012)] DOI: 10.1016/j.ejca.2012.02.055
Deposited On: 15 Nov 2012 03:38
Last Modified: 15 Nov 2012 23:57

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