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Most Women Can Avoid Open Surgery for Endometrial-Cancer Staging: Presented at SGO

By Norra MacReady

PALM SPRINGS, C.A. -- March 27, 2006 -- Successful laparoscopic staging of endometrial cancer is feasible in most cases, and is associated with fewer complications and shorter length of hospital stay than open surgery, according to preliminary data from a Gynecologic Oncology Group study presented here at the 37^th Annual Meeting of the Society of Gynecologic Oncologists (SGC).

These findings suggest that it is feasible to attempt laparoscopy even in obese women, noted principal investigator Joan L. Walker, MD, professor and chief of the gynecology/oncology section, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, United States.

In this study, presented here on March 23^rd, women who required conversion to open surgery were, on average, older and heavier than those in whom laparoscopy was successful, said Dr. Walker. Poor visibility was the main reason for converting to open surgery, she added. Conversion had no impact on hospital length of stay or on subsequent quality of life.

The study included 2,574 women randomized to undergo laparoscopy or open surgery on a ratio of 2:1. Of 1,676 women randomized to the laparoscopy arm of the study, 434 (26%) required subsequent conversion. In an intention-to-treat analysis, the mean age of patients requiring conversion was 64 years, compared to a mean of 62 years among women who successfully completed laparoscopy. Women who underwent conversion had a mean weight of 84 kg and a mean body mass index (BMI) of 33, compared to a mean weight of 71 kg and BMI of 27 for women in whom laparoscopy was successful. All of these differences were statistically significant, Dr. Walker said.

At a mean duration of 203 minutes, laparoscopic surgery was significantly longer than the open procedures, which lasted a mean of 130 minutes. There were no significant differences in intraoperative injuries between the groups except for arterial injuries. Women in the laparoscopic arm had 30 injuries, including 19 experienced by those who required conversion, compared to five arterial injuries occurring in patients randomized to the open-surgery group. Postoperative arrhythmia, pneumonia, and ileus all were significantly more common in the open-surgery group.

The mean length of hospital stay was four days for women who underwent open surgery, due either to randomization or conversion. This was significantly higher than the three days required for the women in whom laparoscopy was successful.

Laparoscopic surgical staging, when completed, is an acceptable or even better alternative to open surgery, Dr. Walker concluded. Intraoperative injuries can largely be prevented with increased surgeon training and experience. Complications from laparoscopy can be reduced if a surgeon recognizes the best candidates for laparoscopy early on.

This study was funded by the National Cancer Institute.


[Presentation title: Phase III Trial of Laparoscopy (Scope) vs Laparotomy (Open) for Surgical Resection and Comprehensive Surgical Staging of Uterine Cancer: A Gynecologic Oncology Group (GOG). Abstract 22]

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