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O007/#202 Recurrence and survival after laparoscopy versus laparotomy in early-stage endometrial cancer: long-term outcomes of a randomised trial
  1. M Van Suijlichem1,
  2. B Reijntjes1,
  3. J Woolderink2,
  4. M Bongers3,
  5. L Paulsen4,
  6. PVD Hurk5,
  7. A Kraayenbrink6,
  8. M Apperloo7,
  9. B Slangen8,
  10. T Schukken9,
  11. F Tummers10,
  12. P Van Kesteren11,
  13. J Huirne12,
  14. D Boskamp13,
  15. M Mourits1 and
  16. G De Bock14
  1. 1University Medical Center Groningen, Gynaecology and Obstetrics, Groningen, Netherlands
  2. 2Martini Hospital Groningen, Gynaecology and Obstetrics, Groningen, Netherlands
  3. 3Maxima Medical Center Veldhoven, Gynaecology and Obstetrics, Veldhoven, Netherlands
  4. 4Wilhelmina Hospital Assen, Gynaecology and Obstetrics, Assen, Netherlands
  5. 5Nij Smellinghe Hospital Drachten, Gynaecology and Obstetrics, Drachten, Netherlands
  6. 6Rijnstate Hospital Arnhem, Gynaecology and Obstetrics, Arnhem, Netherlands
  7. 7Medical Center Leeuwarden, Gynaecology and Obstetrics, Leeuwarden, Netherlands
  8. 8Maastricht University Medical Center, Gynaecology and Obstetrics, Maastricht, Netherlands
  9. 9Antonius Hospital Sneek, Gynaecology and Obstetrics, Sneek, Netherlands
  10. 10Leiden University Medical Center, Gynaecology and Obstetrics, Leiden, Nepal
  11. 11Onze Lieve Vrouwe Gasthuis Amsterdam, Gynaecology and Obstetrics, Amsterdam, Netherlands
  12. 12Amsterdam University Medical Center, Gynaecology and Obstetrics, Amsterdam, Netherlands
  13. 13VieCuri Medical Center Venlo, Gynaecology and Obstetrics, Venlo, Netherlands
  14. 14University Medical Center Groningen, Epidemiology, Groningen, Netherlands


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.

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