Laparoscopy Compared With Laparotomy for Comprehensive Surgical Staging of Uterine Cancer: Gynecologic Oncology Group Study LAP2
Laparoscopy vs. laparotomy in achieving best outcomes regarding complete comprehensive surgical staging of uterine cancer
Type of study
Randomised controlled trial (RCT)
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)
Recurrence free survival
- 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
- Clinical stage I-IIA uterine cancer
- Patient can undergo surgery
- Gynaecologic Oncology Group performance status <4.
- Prior malignancy if no evidence of cancer
- Clinical stage IIB+ uterine cancer
- 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
- 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.
- 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