Laparoscopy Compared With Laparotomy for Comprehensive Surgical Staging of Uterine Cancer: Gynecologic Oncology Group Study LAP2
Open accessAbstract
Purpose: The objective was to compare laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer. Patients and Methods: Patients with clinical stage I to IIA uterine cancer were randomly assigned to laparoscopy (n = 1,696) or open laparotomy (n = 920), including hysterectomy, salpingo-oophorectomy, pelvic cytology, and pelvic and para-aortic lymphadenectomy. The main study end points were 6-week morbidity and mortality, hospital length of stay, conversion from laparoscopy to laparotomy, recurrence-free survival, site of recurrence, and patient-reported quality-of-life outcomes. Results: Laparoscopy was initiated in 1,682 patients and completed without conversion in 1,248 patients (74.2%). Conversion from laparoscopy to laparotomy was secondary to poor visibility in 246 patients (14.6%), metastatic cancer in 69 patients (4.1%), bleeding in 49 patients (2.9%), and other cause in 70 patients (4.2%). Laparoscopy had fewer moderate to severe postoperative adverse events than laparotomy (14% v 21%, respectively; P < .0001) but similar rates of intraoperative complications, despite having a significantly longer operative time (median, 204 v 130 minutes, respectively; P < .001). Hospitalization of more than 2 days was significantly lower in laparoscopy versus laparotomy patients (52% v 94%, respectively; P < .0001). Pelvic and para-aortic nodes were not removed in 8% of laparoscopy patients and 4% of laparotomy patients (P < .0001). No difference in overall detection of advanced stage (stage IIIA, IIIC, or IVB) was seen (17% of laparoscopy patients v 17% of laparotomy patients; P = .841). Conclusion: Laparoscopic surgical staging for uterine cancer is feasible and safe in terms of short-term outcomes and results in fewer complications and shorter hospital stay. Follow-up of these patients will determine whether surgical technique impacts pattern of recurrence or disease-free survival.
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The 'obesity paradox' has been described in a variety of disease processes, including other gynecologic cancers.
“The “obesity paradox”, which suggest a positive association between increasing BMI as it pertains to a specific disease, was firstly reported in heart failure31, but has since been described in a variety of disease processes, including other gynecologic cancers32–34.”
From Gut microbiome diversity is an independent predictor of survival in cervical cancer patients receiving chemoradiation (2021) · cites this paper as [33]
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- Authors
- Walker, J. L., Piedmonte, M. R., Spirtos, N. M., Eisenkop, S. M., Schlaerth, J. B., Mannel, R. S., Spiegel, G., Barakat, R., Pearl, M. L., & Sharma, S. K.
- Affiliations
- St Thomas' Hospital (GB)
- Venue
- Journal of Clinical Oncology
- Published
- 2009-11-10
- Volume
- 27
- Issue
- 32
- Pages
- 5331-5336
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- PMC
- PMC2773219
- OpenAlex
- W2070692747
- Cited by
- 1,288
- References
- 29
- Citations by year
- 2026: 37 · 2025: 71 · 2024: 62 · 2023: 75 · 2022: 72 · 2021: 98 · 2020: 101 · 2019: 89 · 2018: 76 · 2017: 78 · 2016: 82 · 2015: 94 · 2014: 73 · 2013: 69 · 2012: 89
- FWCI
- 79.61
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Clinical Oncology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (CA27469, U10CA037517, U10CA027469, (CA 37517)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Endometrial and Cervical Cancer Treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Health Sciences › Medicine › Reproductive Medicine › Ovarian cancer diagnosis and treatment
- Keywords
- laparoscopy, laparotomy, uterine cancer, surgical staging, hysterectomy, salpingo-oophorectomy, pelvic lymphadenectomy, para-aortic lymphadenectomy, conversion to open surgery, postoperative complications, length of hospital stay, recurrence-free survival, quality of life
- MeSH terms
- Abscess, Aged, Female, Fever, Humans, Intraoperative Complications, Laparotomy, Length of Stay, Middle Aged, Neoplasm Staging, Laparoscopy, Urinary Tract Infections, Uterine Neoplasms, Outcome Assessment, Health Care
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