Laparoscopy Acceptable for Staging Endometrial Cancer

Laparoscopic staging of uterine cancer is associated with only a small increased risk of recurrence, according to a new study in the Journal of Clinical Oncology.

Dr. Joan L. Walker, professor and James A. Merrill Chair of gynecologic oncology at the University of Oklahoma Health Sciences Center, Oklahoma City, and colleagues conducted a randomized trial of patients with stages I to IIA uterine cancer. Women received either laparoscopy (N=1,696) or laparotomy (N=920) for hysterectomy, salpingo-oophorectomy, pelvic cytology, and pelvic and para-aortic lymphadenectomy.

Patients were followed for a median of 59 months. During that time, Walker and colleagues found a total of 309 recurrences and 350 deaths (Figure). The researchers calculated an estimated hazard ratio for laparoscopy relative to laparotomy of 1.14. This increase fell short of the protocol-specified definition of noninferiority, which Walker et al. determined was a 40% increase in the risk of recurrence with laparoscopy compared with laparotomy. In addition, the researchers found that the actual recurrence rates were substantially lower than anticipated, with an estimated 3-year recurrence rate of 11.4% and 10.2% with laparoscopy and laparotomy, respectively. Walker and colleagues noted the estimated 5-year overall survival was about 89.8% and was practically identical in both study groups.

Figure. Number of recurrences and deaths following laparoscopy/laparotomy treatment for uterine cancer

(Click to full size)

“This study demonstrates that comprehensive surgical staging of endometrial cancer can be performed laparoscopically with relatively small differences in recurrence rates,” the authors explained.

Walker and colleagues noted the clinical significance of their study: “These results, combined with previous findings from this study of improved QOL [quality of life] and decreased complications associated with laparoscopy, are reassuring to patients and allow surgeons to reasonably suggest this method as a means to surgically treat and stage patients with presumed early-stage uterine cancers.”

References:

Reference:
Walker JL, Piedmonte MR, Spirtos NM, et al. Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group LAP2 Study. J Clin Oncol. 2012;Jan 30 [Epub].