Research Supports Laparoscopic Hysterectomy for Early Endometrial Cancer

A review comparing laparoscopic hysterectomy versus abdominal hysterectomy for early-stage endometrial cancer has found that rates of overall survival and disease-free survival are similar for the surgical procedures.¹

The traditional management of early-stage endometrial cancer is removal of the uterus and both fallopian tubes and ovaries (hysterectomy with bilateral salpingo-oophorectomy) performed using laparotomy. However, this open procedure is associated with significant morbidity.² Laparoscopic hysterectomy and bilateral salpingo-oophorectomy is less invasive and has been associated with lower morbidity,² but there is a lack of evidence showing how laparoscopy compares with laparotomy in terms of overall survival and disease-free survival for women with early-stage endometrial cancer. 

To better understand how these procedures compare in terms of survival outcomes, researchers identified 8 randomized controlled trials involving 3644 women that compared laparotomy with laparoscopy for the surgical management of early-stage endometrial cancer.¹ No statistically significant difference was found between procedures for risk of death and disease recurrence (3 trials, 359 paricipants). The rates of perioperative death, blood transfusions, and injury to the bladder, ureters, or bowel also were similar between groups.

Women undergoing the laparoscopic procedure, however, lost an average of 106.82 mL less blood than women undergoing the open abdominal procedure-a statistically significant difference-according to results of a meta-analysis of 2 trials. In addition, there were significantly fewer severe but unspecified post-operative adverse events in women undergoing laparoscopy than in those undergoing laparotomy (2 trials, 2923 women), according to the researchers’ findings. The results also confirmed a finding of another study that showed the hospital stay of women who had laparoscopy, compared with those who had laparotomy, was significantly shorter.^1,2

The review authors concluded that evidence supports the use of laparoscopy for the management of early-stage endometrial cancer. Although the overall survival and disease-free survival rates of laparoscopy and laparotomy are similar, laparoscopy is associated with significantly reduced serious postoperative adverse events, a shorter hospital stay, and lower rates of operative morbidity.

Endometrial cancer, the fifth most common cancer among women younger than 65 years, is rare in women younger than 40 years.^3,4 More than half of all cases of endometrial cancer occur in women aged 50 to 69 years. In 2012 in the United States, more than 47,000 new cases were diagnosed and more than 8000 deaths resulted because of endometrial cancer.³

Pertinent Points:
- Laparoscopic hysterectomy with bilateral salpingo-oophorectomy is a good surgical treatment option for early-stage endometrial cancer.
- Disease-free and long-term survival outcomes do not significantly differ between laparascopic and abdominal surgical procedures for total hysterectomy in patients with early-stage endometrial cancer.
- Patients who underwent laparoscopic hysterectomy, compared with abdominal hysterectomy, for early-stage endometrial cancer had fewer serious postoperative adverse events, lower rates of operative morbidity, and shorter hospital stays.

References:

1. Galaal K, Bryant A, Fisher AD, et al. Laparoscopy versus laparotomy for the management of early stage endometrial cancer. Cochrane Database System Rev. 2012;9:CD006655. DOI:10.1002/14651858.CD006655.pub2.
2. Mourits, MJE, Bijen CB, Arts HJ, et al. Safety of laparoscopy versus laparotomy in early-stage endometrial cancer: a randomised trial. Lancet Oncology. 2010;11:763-771.
3. National Cancer Institute. Endometrial cancer. Available at: http://www.cancer.gov/cancertopics/types/endometrial. Accessed October 10, 2012.
4. American Cancer Society. Endometrial (uterine) cancer. Available at: http://www.cancer.org/Cancer/EndometrialCancer/DetailedGuide/endometrial-uterine-cancer-key-statistics. Accessed October 10, 2012.