Recurrence and survival after laparoscopy versus laparotomy without lymphadenectomy in early-stage endometrial cancer: Long-term outcomes of a randomised trial.

Autor: Reijntjes B; Department of Gynaecology, University Medical Center Groningen, University of Groningen, the Netherlands., van Suijlichem M; Department of Gynaecology, University Medical Center Groningen, University of Groningen, the Netherlands., Woolderink JM; Department of Obstetrics and Gynaecology, Martini Hospital Groningen, the Netherlands., Bongers MY; Department of Obstetrics and Gynaecology, Maxima Medical Center Veldhoven, the Netherlands., Reesink-Peters N; Department of Obstetrics and Gynaecology, Medical Spectrum Twente Enschede/Hospital Group Twente Almelo, the Netherlands., Paulsen L; Department of Obstetrics and Gynaecology, Wilhelmina Hospital Assen, the Netherlands., van der Hurk PJ; Department of Obstetrics and Gynaecology, Nij Smellinghe Hospital Drachten, the Netherlands., Kraayenbrink AA; Department of Obstetrics and Gynaecology, Rijnstate Hospital Arnhem, the Netherlands., Apperloo MJA; Department of Obstetrics and Gynaecology, Medical Center Leeuwarden, the Netherlands., Slangen B; Department of Obstetrics and Gynaecology, Maastricht University Medical Center, the Netherlands., Schukken T; Department of Obstetrics and Gynaecology, Antonius Hospital Sneek, the Netherlands., Tummers FHMP; Department of Gynaecology, Leiden University Medical Center, the Netherlands., van Kesteren PJM; Department of Gynaecologie, 'Onze Lieve Vrouwe Gasthuis' Amsterdam, the Netherlands., Huirne JAF; Department of Gynaecology, Amsterdam University Medical Center, the Netherlands., Boskamp D; Department of Obstetrics and Gynaecology, VieCuri Medical Center Venlo, the Netherlands., Lunter G; Department of Epidemiology, University Medical Center Groningen, University of Groningen, the Netherlands., de Bock GH; Department of Epidemiology, University Medical Center Groningen, University of Groningen, the Netherlands., Mourits MJE; Department of Gynaecology, University Medical Center Groningen, University of Groningen, the Netherlands. Electronic address: m.j.e.mourits@umcg.nl.
Jazyk: angličtina
Zdroj: Gynecologic oncology [Gynecol Oncol] 2022 Feb; Vol. 164 (2), pp. 265-270. Date of Electronic Publication: 2021 Dec 23.
DOI: 10.1016/j.ygyno.2021.12.019
Abstrakt: Background: Laparoscopic hysterectomy is accepted worldwide as the standard treatment option for early-stage endometrial cancer. However, there are limited data on long-term survival, particularly when no lymphadenectomy is performed. We compared the survival outcomes of total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH), both without lymphadenectomy, for early-stage endometrial cancer up to 5 years postoperatively.
Methods: Follow-up of a multi-centre, randomised controlled trial comparing TLH and TAH, without routine lymphadenectomy, for women with stage I endometrial cancer. Enrolment was between 2007 and 2009 by 2:1 randomisation to TLH or TAH. Outcomes were disease-free survival (DFS), overall survival (OS), disease-specific survival (DSS), and primary site of recurrence. Multivariable Cox regression analyses were adjusted for age, stage, grade, and radiotherapy with adjusted hazard ratios (aHR) and 95% confidence intervals (95%CI) reported. To test for significance, non-inferiority margins were defined.
Results: In total, 279 women underwent a surgical procedure, of whom 263 (94%) had follow-up data. For the TLH (n = 175) and TAH (n = 88) groups, DFS (90.3% vs 84.1%; aHR[recurrence], 0.69; 95%CI, 0.31-1.52), OS (89.2% vs 82.8%; aHR[death], 0.60; 95%CI, 0.30-1.19), and DSS (95.0% vs 89.8%; aHR[death], 0.62; 95%CI, 0.23-1.70) were reported at 5 years. At a 10% significance level, and with a non-inferiority margin of 0.20, the null hypothesis of inferiority was rejected for all three outcomes. There were no port-site or wound metastases, and local recurrence rates were comparable.
Conclusion: Disease recurrence and 5-year survival rates were comparable between the TLH and TAH groups and comparable to studies with lymphadenectomy, supporting the widespread use of TLH without lymphadenectomy as the primary treatment for early-stage, low-grade endometrial cancer.
Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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