Laparoscopic Treatment of Uterine Cancer Safe and Effective

Women with uterine cancer who are treated with laparoscopy have a 3-year rate of overall survival similar to that of women who undergo traditional laparotomy, according to a study presented at the Society for Gynecologic Oncologists’ 2010 Annual Meeting. The study was presented in a late-breaking abstract session by Joan L. Walker, MD, Obstetrics and Gynecology, University of Oklahoma, Oklahoma City.

As part of the Gynecologic Oncology Group (GOG), Walker and colleagues randomized women with stage I to stage IIA uterine cancer to laparoscopy (n = 1696) or open laparotomy (n = 920). All patients had hysterectomy, bilateral salpingo-oophorectomy, pelvic cytology, and pelvic and para-aortic lymphadenectomy. The study’s primary endpoint was recurrence-free survival (RFS) and investigators also looked at 6-week surgical outcomes.

Preliminary data were reported in a November 2009 article in the Journal of Clinical Oncology (Walker et al, JCO, 2009;27(32)5331-5336), showing that patients receiving laparoscopy had a superior quality of life in the 6 weeks after surgery compared with patients that had laparotomy. Laparoscopy resulted in less pain, shorter hospitalization, and faster recovery. In approximately 25% of cases, laparoscopy had to be converted to laparotomy, with failure of laparoscopy increasing in correlation with body mass index (BMI). The conversion rate declined to 17.5% in women with a BMI of 25 kg/m2.

Walker said hospitalization was 3 days for the laparoscopy group overall compared with 4 days for patients who had laparotomy, including the conversion group. Excluding the conversion group, hospitalization for laparoscopy patients averaged 2 days. The incidence of moderate to severe complications was higher in the laparotomy group (21% vs 14%, respectively; P <.001) . Patients undergoing laparotomy had significantly higher rates of ileus and cardiac arrhythmia. One area where laparotomy fell short of laparoscopy was removal of pelvic and para-aortic nodes. They were not removed in 8% of laparoscopy patients compared with 4% of laparotomy patients (P <.0001).

Despite the fact that laparoscopy was not as effective in detecting metastatic disease, OS at 3 years’ follow-up was nearly identical in the two groups: at 89.8% for the laparoscopy arm compared with 89.9% for those in the laparotomy arm (hazard ratio, 1.15; 95% confidence interval [CI], 0.93-1.48). Rate of recurrence at 60 months was 13.68% in the laparoscopy group compared with 11.61% in the laparotomy group (95% CI, -0.61-5.22). Investigators were reassured that trochar sites did not become areas for recurrence.

Walker told Oncology & Biotech News that the study demonstrates “patients benefit from laparoscopy…survival is exactly the same.” In the future, Walker said, “Most patients will be wanting laparoscopy [and] most doctors will be offering it since it is safe from a cancer standpoint and has fewer complications.” She said laparotomy might still be preferable in patients with metastatic disease and those with a very large uterus.

In her presentation, she highlighted areas where laparoscopy could be improved, including decreasing conversions to open laparotomy, performing complete staging of the left para-aortic nodes, and enhancing detection of stage IV disease. Some of the laparoscopic procedures were performed using robotic surgery, and Walker said this may help decrease conversion rates in women with higher BMI and allow more thorough staging of nodes.