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Laparoscopic Surgery Associated With Better Short-Term Quality of Life Among Endometrial-Cancer Patients: Presented at SGO

By Norra MacReady

PALM SPRINGS, CA -- March 27, 2006 -- Overall quality of life and physical functioning are better six weeks postoperatively following laparoscopic rather than open surgery for endometrial cancer, according to findings from a study presented here at the 37^th Annual Meeting of the Society of Gynecologic Oncologists (SGO).

In a large, prospective, randomized trial, women who underwent laparoscopy gave significantly superior marks to general well-being, physical symptoms, mildness of pain and its impact on quality of life, and sexual functioning than women who underwent laparotomy.

Those differences, however, had mostly resolved within 6 months, noted Alice B. Kornblith, PhD, director, psycho-oncology research, Dana-Farber Cancer Institute, Boston, Massachusetts.

Laparoscopy candidates who required conversion to laparotomy had quality-of-life scores similar to patients who started out in the laparotomy group, said Dr. Kornblith.

The study, sponsored by the Gynecologic Oncology Group, included 524 women who underwent laparoscopy and 258 who underwent laparotomy. Of patients in the laparoscopy group, 109 (21%) required subsequent conversion to open surgery. At baseline assessment and before randomization, each patient was given 4 copies of the follow-up questionnaires, with instructions to complete them at 1, 3, and 6 weeks, as well as 6 months after surgery. The questionnaires examined overall quality of life, physical symptoms from laparoscopy, short-term pain, physical and sexual functioning, fear of recurrence, body image, and resumption of normal activities.

In an intent-to-treat analysis, patients who underwent laparoscopy reported better overall quality of life and physical functioning, fewer physical symptoms, and an earlier resumption of normal activities than women who underwent laparotomy (P < 0.01). By 6 months, there were no significant differences between the groups except for body image, which was higher in the laparoscopy group (P < 0.001).

In general, laparoscopic surgery is less invasive and less painful and is associated with faster recovery and fewer complications than open surgery. In this study, 14% of the laparoscopy patients developed grade 2 complications, significantly less than the 21% of patients in the laparotomy group. All of this could explain the differences in short-term findings, Dr. Kornblith said.

Laparoscopy was also associated with a mean hospital stay of three days, compared to four days associated with laparotomy, a statistically significant difference.

The differences might have been even greater had fewer patients randomized to laparoscopy not converted to laparotomy, Dr. Kornblith added.

Since there were no differences in quality of life or length of stay between patients who required conversion and those who went immediately to laparotomy, "there is no harm in starting the procedure laparoscopically, with the hopes of obtaining the better outcome, and then converting to laparotomy," Dr. Kornblith suggested.


[Presentation title: Quality of Life (QOL) of Patients in a Randomized Clinical Trial of Laparoscopy (scope) Vs. Open Laparotomy (open) for the Surgical Resection and Staging of Uterine Cancer: A Gynecologic Oncology Group (GOG) study. Abstract 47]

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