Only small differences in recurrence rates for laparoscopy compared to laparotomy
TUESDAY, Jan. 31 (HealthDay News) -- Comprehensive surgical staging of endometrial cancer can be performed laparoscopically with relatively small differences in recurrence rates compared to laparotomy, according to a study published online Jan. 30 in the Journal of Clinical Oncology.
Joan L. Walker, M.D., of the University of Oklahoma Health Sciences Center in Oklahoma City, and colleagues randomly assigned patients with clinical stages I to IIA uterine cancer in a 2:1 ratio to laparoscopy (1,696 women) versus laparotomy (920 women) for hysterectomy, salpingo-oophorectomy, pelvic cytology, and pelvic and para-aortic lymphadenectomy. Noninferiority of recurrence-free interval was the primary end point, and was defined as no more than a 40 percent increase in the risk of recurrence with laparoscopy versus laparotomy.
The researchers found that, over a median of 59 months of follow-up, there were 309 recurrences (210 laparoscopy; 99 laparotomy) and 350 deaths (229 laparoscopy; 121 laparotomy). For laparoscopy versus laparotomy, the estimated hazard ratio was 1.14 (90 percent lower bound, 0.92; 95 percent upper bound, 1.46), which did not meet the pre-specified noninferiority criteria. The actual recurrence rates were substantially lower than expected, with an estimated three-year recurrence rate of 11.4 and 10.2 percent with laparoscopy and laparotomy, respectively (difference of 1.14 percent; 90 percent lower bound, −1.28; 95 percent upper bound, 4.0). An almost identical five-year overall survival, 89.8 percent, was seen in both groups.
"The potential for increased risk of cancer recurrence with laparoscopy versus laparotomy was quantified and found to be small, providing accurate information for decision making for women with uterine cancer," the authors write.