Total Laparoscopic Hysterectomy Versus Abdominal Hysterectomy With Lymphadenectomy for Early-Stage Endometrial Cancer: A Prospective Randomized Study

Several studies have demonstrated that laparoscopic hysterectomy with lymphadenectomy (LPS) is an acceptable alternative to abdominal hysterectomy with lymphadenectomy (LPT) in patients with endometrial cancer. LPS is associated with shorter hospital stay, and reduced or similar postoperative complications, but the risk of recurrence and survival rates after laparoscopy are unclear. This prospective randomized study compared the safety, morbidity, overall survival, disease-free survival, and recurrence rate of LPS and LPT in women with early-stage endometrial cancer. Between 2001 and 2006, 159 patients with clinical stage I endometrial cancer were randomized to either total LPS with pelvic and aortic lymph node dissection (n = 81) or LPT with pelvic and aortic lymph node dissection (n = 76). Disease-free survival was calculated as the period from surgery until the date of first recurrence. Overall survival was defined as the period from the date of surgery to the date of death. There were significant differences between the two groups with respect to (1) mean operative time (136 minute for the LPS group versus 123 minute for the LPT group, P < 0.01); (2) mean blood loss (50 ml for the LPS group versus 145 ml for the LPT group, P < 0.01); and (3) mean length of hospital stay (2.1 days in the LPS group versus 5.1 days in the LPT group, P < 0.01). No difference was found between the two groups in recurrence rates, overall survival and disease-free survival. The investigators conclude from these findings that laparoscopy is a safe and effective alternative to laparotomy for management of early-stage endometrial cancer.