LAP2 Study

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

Disease site

Uterine

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
Laparoscopy Laparotomy (Open)
Randomised(n) 1696 920
Intraoperative complications 10% 8%
Postoperative complications 14% 21%
Operating time(median, min) 204 130
Hospital stay>2 days 52% 94%
  • 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/

Reviewer name