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document
A Comparison of Outcomes Following Laparoscopic and Open Hysterectomy With or Without Lymphadenectomy for Presumed Early-Stage Endometrial Cancer : Results From the Medical Research Council ASTEC Trial . OBJECTIVES Laparoscopic hysterectomy ( LH ) is increasingly used for the management of endometrial malignancy . Its benefits may be particularly pronounced as these women are more likely to be older or obese . The aim of this study was to determine whether outcomes for LH are comparable to the open hysterectomy ( OH ) . DESIGN This was a prospective cohort study nested within the multicenter ASTEC ( A Study in the Treatment of Endometrial Cancer ) randomized controlled trial ( 1998-2005 ) . POPULATION Women with presumed early endometrial cancer were included . METHODS Laparoscopic hysterectomy was compared with OH with or without systematic lymphadenectomy . MAIN OUTCOME MEASURES Overall survival , time to first recurrence , complication rates , and surgical outcomes were the main outcome measures . RESULTS Of 1408 women , 1309 ( 93 % ) received OH , and 99 ( 7 % ) had LH . LH was associated with longer operating time ( median , LH 105 minutes [ interquartile range ( IQR ) , 60-150 ] vs OH 80 minutes [ IQR , 60-95 ] ; P < 0.001 ) but 50 % shorter hospital stay ( median , LH 4 days [ IQR , 3-5 ] vs OH 6 days [ IQR , 5-7 ] ) . The number of harvested lymph nodes was similar ( median , LH 13 [ IQR , 10-16 ] vs OH 12 [ IQR , 11-13 ] ; P = 0.67 ) . LH had fewer intraoperative and postoperative adverse events ( 9 % difference , LH 21 % vs OH 30 % ; borderline significance ; P = 0.07 ) . The rate of conversion to laparotomy for the LH group was high ( 27 % ) . The median follow-up was 37 months . After adjusting for significant prognostic factors , the hazard ratio for overall survival in those who underwent LH compared with those who underwent OH was 0.67 ( 95 % confidence interval , 0.31-1.43 ) ( P = 0.30 ) . CONCLUSIONS Laparoscopic hysterectomy for early endometrial cancer is safe . Although it requires longer operating time it is associated with shorter hospital stay and favorable morbidity profile . Further studies are required to assess the long-term safety .
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Intervention_Surgical
Laparoscopic
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Intervention_Surgical
Open Hysterectomy
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Intervention_Surgical
Laparoscopic hysterectomy ( LH )
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Intervention_Surgical
Laparoscopic hysterectomy
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Intervention_Physical
OH
72321
Intervention_Physical
systematic lymphadenectomy
72322
Intervention_Surgical
LH
72323
Intervention_Surgical
OH
72324
Intervention_Surgical
OH
72325
Intervention_Surgical
LH
72326
Intervention_Surgical
OH
72327
Intervention_Surgical
LH
72328
Intervention_Surgical
LH
72329
Intervention_Surgical
LH
72330
Intervention_Surgical
OH
72331
Intervention_Surgical
Laparoscopic hysterectomy
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Outcome_Physical
Overall survival
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Outcome_Mental
time to first recurrence
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Outcome_Mental
complication rates
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Outcome_Mental
surgical outcomes
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Outcome_Other
operating time
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Outcome_Other
hospital stay
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Outcome_Physical
number of harvested lymph nodes
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Outcome_Adverse-effects
intraoperative and postoperative adverse events
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Outcome_Other
rate of conversion to laparotomy
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Outcome_Mortality
hazard ratio for overall survival
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Outcome_Other
operating time
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Outcome_Physical
hospital stay
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Outcome_Mortality
morbidity profile
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Outcome_Other
long-term safety
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Participant_Condition
Presumed Early-Stage Endometrial Cancer
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Participant_Sex
women
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Participant_Age
older
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Participant_Sex
Women
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Participant_Sample-size
1408
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Participant_Sex
women
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Participant_Sample-size
1309
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Participant_Condition
OH
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Participant_Sample-size
99
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Participant_Condition
LH