Laparoscopic, Abdominal Hysterectomy Equivalent For Stage I Endometrial Cancer DFS

Disease-free survival after laparoscopic hysterectomy for stage I endometrial cancer matches that achieved by open abdominal surgery

medwireNews: Disease-free survival in women with stage I endometrioid endometrial cancer is comparable after total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH), research demonstrates.

“The LACE trial reported by Janda et al in this issue of JAMA provides confirmation that laparoscopic hysterectomy is a safe and effective treatment modality for women with early-stage endometrial cancer”, says Jason Wright, from Columbia University in New York, USA, in a linked opinion.

“The favourable short-term outcomes along with equivalent oncological outcomes make laparoscopic hysterectomy the preferred surgical modality in this setting”, he continues, adding that “efforts to promote the procedure for women with endometrial cancer should now be a priority.”

The LACE investigators followed up 760 patients in Australia, New Zealand or Hong Kong for 4.5 years after their procedure performed by one of 27 surgeons in 20 tertiary clinics, at which time DFS was achieved by 81.6% of those randomly assigned to undergo TLH and 81.3% of patients who received TAH.

The 0.3% difference in DFS rates favoured TLH and was within a prespecified margin of 7% of less, thus “meeting criteria for equivalence”, say Andreas Obermair, from the Royal Brisbane and Women’s Hospital in Queensland, Australia, and co-authors.

Nor did the TLH and TAH groups differ significantly with regard to the secondary endpoints of endometrial cancer recurrence (8.1 vs 7.9%) or the all-cause death rate (7.4 vs 6.8%) over the study.

Exploratory analysis suggested that among women with a body mass index of less than 30 kg/m2, patients in the TAH group had better DFS rate than their TLH counterparts (86.6 vs 77.4%), whereas for patients with a body mass index of 30 kg/m2 or above, the opposite was true (78.9 vs 84.4%).

However, the researchers describe this finding as “counterintuitive” and suggest that it may be a “statistical artifact”.

Andreas Obermair et al emphasize: “Laparoscopic surgery has benefits for patients with regard to quality of life, recovery after surgery, hospital stay, and adverse events.

“Given its better short term outcomes, updated meta-analyses should now be conducted to determine whether total laparoscopic hysterectomy should become the standard approach for patients with stage I endometrial cancer”, they advise.

References

Janda M, Gebski V, Davies LC, et al. Effect of total laparoscopic hysterectomy vs total abdominal hysterectomy on disease-free survival among women with stage I endometrial cancer. A randomized clinical trial. JAMA 2017; 317: 1224–1233. 28 March 2017. doi:10.1001/jama.2017.2068

Wright JD. Laparoscopic hysterectomy for endometrial cancer. A procedure 25 years in the making. JAMA 2017; 317: 1215–1216. 28 March 2017. doi:10.1001/jama.2017.2067

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