Originally published as JCO Early Release 10.1200/JCO.2009.22.3248 on October 5 2009

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Laparoscopy Compared With Laparotomy for Comprehensive Surgical Staging of Uterine Cancer: Gynecologic Oncology Group Study LAP2

From the University of Oklahoma, Oklahoma City, OK; Gynecologic Oncology Group Statistical and Data Center, Buffalo; Memorial Sloan-Kettering Cancer Center, New York; State University of New York at Stony Brook, Stony Brook, NY; Women's Cancer Center of Nevada, Las Vegas, NV; Women's Cancer Center, Southern California, Sherman Oaks; Pacific Gynecologic Specialists, Pasadena, CA; Hinsdale Hospital, Hinsdale, IL; and St. Thomas Hospital, London, United Kingdom.

Corresponding author: Joan L. Walker, MD, Obstetrics and Gynecology, University of Oklahoma, HSC, PO Box 26901, Oklahoma City, OK, 73190; e-mail: joan-walker{at}ouhsc.edu.

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.

See accompanying editorial on page 5305 and article on page 5337

Supported by National Cancer Institute Grant No. CA 27469 to the Gynecologic Oncology Group (GOG) Administrative Office and Grant No. CA 37517 to the GOG Statistical and Data Center.

Presented in part at the 11th Biennial Meeting of the International Gynecologic Cancer Society, October 14-18, 2006, Santa Monica, CA; the 37th Annual Meeting of the Society of Gynecologic Oncologists, March 22-26, 2006, Palm Springs, CA; and the 42nd Annual Meeting of the American Society of Clinical Oncology, June 2-6, 2006, Atlanta, GA.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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