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

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• 作者：Andreas Obermair^a ; ; Monika Janda^b ; Jannah Baker^b ; Srinivas Kondalsamy-Chennakesavan^a ; Alison Brand^c ; Russell Hogg^c ; Thomas W. Jobling^d ; Russell Land^e ; Tom Manolitsas^d ; Marcelo Nascimento^e ; Deborah Neesham^f ; James L. Nicklin^e ; Martin K. Oehler^g ; Geoff Otton^h ; Lewis Perrin^e ; Stuart Salfingerⁱ ; Ian Hammond^j ; Yee Leung^k ; Peter Sykes^l ; Hextan Ngan^m ; Andrea Garrett^e ; Michael Laney^l ; Tong Yow Ng^m ; Karfai Tam^m ; Karen Chan^m ; David H. Wrede^f ; Selvan Patherⁿ ; Bryony Simcock^l ; Rhonda Farrell^o ; Gregory Robertson^o ; Graeme Walker^p ; Anthony McCartney^j ; Val Gebski^q
• 关键词：Endometrial cancer ; Safety ; Surgery
• 刊名：European Journal of Cancer
• 出版年：2012
• 期刊代码：88_09598049
• 类别：med
• 出版时间：May, 2012
• 卷：48
• 期：8
• 页码：1147-1153
• 文件大小：354 K

摘要

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 2 g/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.