Objectives Laparoscopic hysterectomy is accepted globally as the standard treatment option for early-stage endometrial cancer, but there is limited long-term survival data. We compared the survival outcomes of total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH) for early-stage endometrial cancer up to 5 years after each procedure.

Methods Follow-up of a multi-centre, randomised controlled trial comparing TLH and TAH, without routine lymphadenectomy, for women with stage I endometrial cancer. Enrolment was between 2007 and 2009 by 2:1 randomisation to TLH or TAH. Assessed at 5 years, the primary outcome was the disease-free survival (DFS) and the secondary outcomes were the overall survival (OS), disease-specific survival (DSS), and primary site of recurrence. Multivariable Cox regression analyses were adjusted for age, stage, and grade, with adjusted hazard ratios (aHR) and 95% confidence intervals (95%CI) reported.

Results In total, 279 women underwent procedures and 263 (94%) of these had follow-up data. For the TLH (n=185) and TAH (n=94) groups, DFS (90.3% vs 84.1%; aHR[recurrence], 0.76; 95%CI, 0.35–1.66), OS (89.2% vs 82.8%; aHR[death], 0.64; 95%CI, 0.33–1.27), and DSS (95.0% vs 89.8%; aHR[death], 0.74; 95%CI, 0.28–1.99) were comparable at 5 years. There were no port-site or wound metastases, and local recurrence rates were comparable.

Conclusions No study has reported on survival among women with early-stage endometrial cancer treated by TLH or TAH without routine lymphadenectomy. Survival outcomes (DFS, OS and DSS) were comparable between the treatment options at 5 years, supporting the widespread use of TLH as a primary treatment for early-stage, low-grade endometrial cancer.