LAP2 Study
Laparoscopy Compared With Laparotomy for Comprehensive Surgical Staging of Uterine Cancer: Gynecologic Oncology Group Study LAP2
Disease site
Uterine
Pubmed link
Publication month/year
October 2009
Study question
Laparoscopy vs. laparotomy in achieving best outcomes regarding complete comprehensive surgical staging of uterine cancer
Type of study
Randomised controlled trial (RCT)
Interventions compared
Laparoscopic vs. laparotomy/open approach for completion of hysterectomy, bilateral salpingo-oophorectomy, peritoneal cytology and pelvic and para-aortic lymph node dissection
Experimental arm (Intervention)
Laparoscopic approach
Control arm
Laparotomy/open approach
Primary outcome
Recurrence free survival
Secondary outcome
- Perioperative adverse events
- Laparoscopy converted to laparotomy
- Length of hospital stay post operatively
- Operative time
- Patient reported quality of life
- Sites of recurrence
- 6 week morbidity and mortality
Inclusion criteria
- Clinical stage I-IIA uterine cancer
- Patient can undergo surgery
- Gynaecologic Oncology Group performance status <4.
- Prior malignancy if no evidence of cancer
Exclusion criteria
- Clinical stage IIB+ uterine cancer
Results
- Conversion in 25.8% of laparoscopy due to poor visibility (14.6%), metastatic cancer (4.1%), bleeding (2.9%) and other reasons (4.2%)
- Similar overall advanced stage detection – IIIA/IIIC/IVB (17% p= 0.841) in both arms
- Similar detection of lymph node metastases (9%) in both arms
- Better patient reported quality of life including less invasive technique, reduced pain and faster recovery in laparoscopy arm
Conclusions
- Laparoscopic approach to complete comprehensive surgical staging for uterine cancer is feasible and safe when compared to laparotomy.
- There was no difference in intraoperative complications.
- Laparoscopy resulted in decrease in post-operative complications and length of hospital stay.
Study limitations
- Data maturity to determine primary outcome outstanding
- Laparoscopic technique not specified (total laparoscopic/robotic/laparoscopy assisted)
- Surgical variation regarding decisions to complete lymph node dissection once positive lymph node(s) documented
- Surgical bias in determination of risk of metastases vs. operative morbidity
- Variation in physician preferences and surgical experience
- On-going controversy regarding the therapeutic value of surgical staging in uterine cancer
Additional resources
For recurrence and survival rates please read https://pubmed.ncbi.nlm.nih.gov/22291074/