Laparoscopic hysterectomy equivalent to abdominal hysterectomy in disease-free and overall survival

1. Among women with stage I endometrial cancer, total laparoscopic hysterectomy compared to total abdominal hysterectomy resulted in equivalent disease-free survival at 4.5 years.

2. No statistically significant differences were found in recurrence of endometrial cancer or overall survival between the groups.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Endometrial cancer is the most common gynecological cancer in developed countries and it is treated surgically by removing the uterus, both Fallopian tubes, and both ovaries. Laparoscopic hysterectomy has risen in popularity over open total abdominal hysterectomy due to its potential for less morbidity and pain, and its quicker recovery. However, it’s unknown if overall survival and outcomes are equivalent between the two procedures. This study randomized 760 women with stage I endometrial cancer between 2005 and 2010 at 20 different gynecological centers to total abdominal hysterectomy (TAH) or total laparoscopic hysterectomy (TLH). At 4.5 years of follow-up, the use of TAH compared with TLH resulted in equivalent disease-free survival of 81.3% in the TAH group and 81.6% in the TLH group. There was no statistically significant difference in recurrence of endometrial cancer or in overall survival.

Overall, this study suggests that for women with early-stage endometrial cancer, TLH may be an appropriate therapy given it’s equivalent disease-free survival and overall survival compared to TAH and its potential benefits in terms of post-operative recovery.

Click to read the study in JAMA

Relevant Reading: Quality of life after total laparoscopic hysterectomy versus total abdominal hysterectomy for stage I endometrial cancer (LACE): a randomized trial

In-Depth [randomized controlled trial]: This study was a multinational, phase 3, randomized equivalence trial that took place between 2005 and 2010 at 20 tertiary gynecological cancer centers in Australia, New Zealand, and Hong Kong. The authors randomized 760 women with stage I endometrial cancer to either TAH or TLH and patients were followed-up for a median of 4.5 years. Disease-free survival was 81.3% in the TAH group vs. 81.6% in the TLH group, with a difference of 0.3% (CI_95% -5.5% to 6.1%, p = 0.7) that met the criteria for equivalence. Recurrence of endometrial cancer was 7.9% in the TAH group vs. 8.1% in the TLH group (risk difference 0.2%; CI_95% -3.7% to 4.0%, p = 0.93) and thus there was no statistically significant difference. Similarly, there was no difference in overall survival, with 92.4% surviving at 4.5 years in the TAH group vs. 92.0% in the TLH group (HR 1.08; CI_95% 0.63 to 1.85, p = 0.78).

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