Laparoscopy Compared With Laparotomy for Comprehensive Surgical Staging of Uterine Cancer: Gynecologic Oncology Group Study LAP2
Laparoscopy Compared With Laparotomy for Comprehensive Surgical Staging of Uterine Cancer: Gynecologic Oncology Group Study LAP2
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DOI：
10.1200/jco.2009.22.3248
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发表时间：
2009-11-10
影响因子：
45.3
通讯作者：
Sharma, Sudarshan K.
中科院分区：
文献类型：
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作者：
Walker, Joan L.;Piedmonte, Marion R.;Sharma, Sudarshan K.
PurposeThe的目的是比较腹腔镜手术与剖腹手术的综合手术分期子宫cancer.Patients和MethodsPatients与临床阶段I至IIA子宫癌被随机分配到腹腔镜手术（n = 1,696）或开腹手术（n = 920），包括子宫切除术，输卵管卵巢切除术，盆腔细胞学检查，盆腔和腹主动脉旁淋巴结清扫术。主要的研究终点是6周的发病率和死亡率，住院时间，转换从腹腔镜到开腹手术，无复发生存率，复发的网站，和患者报告的生活质量outcomes. Results腹腔镜开始在1,682例患者和1,248例（74.2%）完成无转换。246例患者（14.6%）从腹腔镜转为开腹手术的原因是能见度差，69例患者（4.1%）转移癌，49例患者（2.9%）出血，70例患者（4.2%）其他原因。腹腔镜手术的中度至重度术后不良事件少于开腹手术（分别为14%和21%; P < .0001），但术中并发症发生率相似，尽管手术时间显著延长（中位数分别为204和130分钟; P < .001）。腹腔镜手术患者住院超过2天的比例明显低于开腹手术患者（分别为52%和94%; P <0.0001）。8%的腹腔镜手术患者和4%的剖腹手术患者未切除盆腔和主动脉旁淋巴结（P < .0001）。晚期（IIIA、IIIC或IVB期）的总体检测无差异（腹腔镜手术患者17%，剖腹手术患者17%; P = .841）。结论腹腔镜手术分期子宫癌在短期结局方面是可行和安全的，并发症少，住院时间短。这些患者的随访将确定手术技术是否影响复发模式或无病生存率。
PurposeThe objective was to compare laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer.Patients and MethodsPatients 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.ResultsLaparoscopy 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).ConclusionLaparoscopic 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.