alexa Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2.
Microbiology

Microbiology

Journal of Antivirals & Antiretrovirals

Author(s): Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB,

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Abstract 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.
This article was published in J Clin Oncol and referenced in Journal of Antivirals & Antiretrovirals

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