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Endometrial Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage I Endometrial Cancer


Patients who have medical contraindications to surgery may be treated with radiation therapy alone, but inferior cure rates below those attained with surgery may occur.[8,20,21]

Several randomized trials have compared total laparoscopic hysterectomy (TLH) with the standard open procedure, total abdominal hysterectomy (TAH), for patients with early-stage endometrial cancer. Feasibility of the laparoscopic approach has been confirmed, although TLH is associated with a longer operative time.[22,23,24] TLH had an improved [22,23] or similar [24] adverse event profile and a shorter hospital stay [22,23,24] when compared with TAH. TLH was associated with less pain and quicker resumption of daily activities,[24,25] although one study found that most of the gains in quality of life favoring laparoscopy at the 6-week postsurgical period were no longer significant at 6 months.[24,25]

The completed GOG-Lamina-associated polypeptide 2 (GOG-LAP2) trial included 2,616 patients with clinical stage I to IIA disease and randomly assigned them two-to-one to comprehensive surgical staging via laparoscopy or laparotomy.[26] Time to recurrence was the primary endpoint, with noninferiority defined as a difference in recurrence rate of less than 5.3% between the two groups at 3 years. The recurrence rate at 3 years was 10.24% for patients in the laparotomy arm, compared with 11.39% for patients in the laparoscopy arm, with an estimated difference between groups of 1.14% (90% lower bound, -1.278; 95% upper bound, 3.996). Although this difference was lower than the prespecified limit, the statistical requirements for noninferiority were not met because of a lower-than-expected number of recurrences in both groups. A Cochrane Review of the use of laparoscopic staging included four randomized controlled trials that reported OS and PFS, although 90% of the patients were from the GOG-LAP2 trial. Overall, laparoscopy was associated with similar OS and PFS rates when it was compared with laparotomy.[27][Level of evidence: 1iiA]The OS at 5 years was 89.8% in both groups. Future analyses may determine whether there are subgroups of patients for whom there is a clinically significant decrement when laparoscopic staging is utilized.[26][Level of evidence: 1iiDiii]

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