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A Comparison of Outcomes Following Laparoscopic and Open Hysterectomy With or Without Lymphadenectomy for Presumed Early-Stage Endometrial Cancer: Results From the Medical Research Council ASTEC Trial
  1. Maria Kyrgiou, MD, PhD*,,
  2. Anne-Marie Swart, PhD,
  3. Wendi Qian, PhD§ and
  4. Jane Warwick, PhD
  1. *Department of Surgery& Cancer, Institute of Reproductive and Developmental Biology, Imperial College, London;
  2. West London Gynaecological Cancer Center, Queen Charlotte’s& Chelsea, Hammersmith Hospital, Imperial Healthcare NHS Trust, London;
  3. Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich;
  4. §Cambridge Cancer Trials Centre, Cambridge Clinical Trials Unit, Cancer Theme and Medical Research Council Biostatistics Unit Hub for Trials Methodology; and
  5. Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, United Kingdom.
  1. Address correspondence and reprint requests to Maria Kyrgiou, MD, PhD, West London Gynaecological Cancer Center, Department of Surgery and Cancer, Queen Charlotte’s & Chelsea, Hammersmith Hospital, Imperial Healthcare NHS Trust, Institute of Reproductive and Developmental Biology, Imperial College, 2nd Floor, Hamm House, Du Cane Rd, London W12 0HS, United Kingdom. E-mail: m.kyrgiou@imperial.ac.uk.

Abstract

Objectives Laparoscopic hysterectomy (LH) is increasingly used for the management of endometrial malignancy. Its benefits may be particularly pronounced as these women are more likely to be older or obese. The aim of this study was to determine whether outcomes for LH are comparable to the open hysterectomy (OH).

Design This was a prospective cohort study nested within the multicenter ASTEC (A Study in the Treatment of Endometrial Cancer) randomized controlled trial (1998–2005).

Population Women with presumed early endometrial cancer were included.

Methods Laparoscopic hysterectomy was compared with OH with or without systematic lymphadenectomy.

Main Outcome Measures Overall survival, time to first recurrence, complication rates, and surgical outcomes were the main outcome measures.

Results Of 1408 women, 1309 (93%) received OH, and 99 (7%) had LH. LH was associated with longer operating time (median, LH 105 minutes [interquartile range (IQR), 60–150] vs OH 80 minutes [IQR, 60–95]; P < 0.001) but 50% shorter hospital stay (median, LH 4 days [IQR, 3–5] vs OH 6 days [IQR, 5–7]). The number of harvested lymph nodes was similar (median, LH 13 [IQR, 10–16] vs OH 12 [IQR, 11–13]; P = 0.67). LH had fewer intraoperative and postoperative adverse events (9% difference, LH 21% vs OH 30%; borderline significance; P = 0.07). The rate of conversion to laparotomy for the LH group was high (27%). The median follow-up was 37 months. After adjusting for significant prognostic factors, the hazard ratio for overall survival in those who underwent LH compared with those who underwent OH was 0.67 (95% confidence interval, 0.31–1.43) (P = 0.30).

Conclusions Laparoscopic hysterectomy for early endometrial cancer is safe. Although it requires longer operating time it is associated with shorter hospital stay and favorable morbidity profile. Further studies are required to assess the long-term safety.

  • Endometrial cancer
  • Hysterectomy
  • Laparoscopy
  • Laparotomy
  • Survival

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Footnotes

  • The Medical Research Council (MRC) ASTEC (A Study in the Treatment of Endometrial Cancer) surgical trial was funded by the MRC. This prospective cohort study nested within the ASTEC trial did not receive any additional funding. M.K. was supported by the Imperial Healthcare NHS Trust National Institute of Health Research Biomedical Research Centre grant P45272.

  • The study received approval from the MRC Clinical Trials Unit for the release of the data.

  • The study was conceived and designed by M.K. The data were acquired and collated by M.K., J.W., W.Q., and A.M.S. and analyzed by M.K. and J.W. The manuscript was drafted and revised critically for important intellectual content by M.K., J.W., A.M.S., and W.Q. All the authors gave final approval of the version to be published and have contributed to the manuscript.

  • Ethics approval was granted as part of the MRC ASTEC surgical trial, published in The Lancet in 2009 (North West Multi-centre Regional Ethics Committee, United Kingdom). The current article presents a different analysis of the data collected as part of the trial.

  • The results have been presented at the European Society of Gynaecologic Oncology meeting in Liverpool, October 19 to 22, 2013, and the abstract was published in the conference proceedings: “Laparoscopic Versus OH for Early-Stage Endometrial Cancer: The ASTEC Trial.”

  • The authors declare no conflicts of interest.

  • Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (www.ijgc.net).

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