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Sudarshan K. Sharma - One of the best experts on this subject based on the ideXlab platform.
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recurrence and survival after random assignment to laparoscopy versus Laparotomy for comprehensive surgical staging of uterine cancer gynecologic oncology group lap2 study
Journal of Clinical Oncology, 2012Co-Authors: Joan L Walker, Marion R Piedmonte, Scott M. Eisenkop, Nick M Spirtos, Richard R Barakat, John B. Schlaerth, Robert S Mannel, Michael L Pearl, Sudarshan K. SharmaAbstract:Purpose The primary objective was to establish noninferiority of laparoscopy compared with Laparotomy for recurrence after surgical staging of uterine cancer. Patients and Methods Patients with clinical stages I to IIA disease were randomly allocated (two to one) to laparoscopy (n = 1,696) versus Laparotomy (n = 920) for hysterectomy, salpingo-oophorectomy, pelvic cytology, and pelvic and para-aortic lymphadenectomy. The primary study end point was noninferiority of recurrence-free interval defined as no more than a 40% increase in the risk of recurrence with laparoscopy compared with Laparotomy. Results With a median follow-up time of 59 months for 2,181 patients still alive, there were 309 recurrences (210 laparoscopy; 99 Laparotomy) and 350 deaths (229 laparoscopy; 121 Laparotomy). The estimated hazard ratio for laparoscopy relative to Laparotomy was 1.14 (90% lower bound, 0.92; 95% upper bound, 1.46), falling short of the protocol-specified definition of noninferiority. However, the actual recurrence ...
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laparoscopy compared with Laparotomy for comprehensive surgical staging of uterine cancer gynecologic oncology group study lap2
Obstetrical & Gynecological Survey, 2010Co-Authors: Joan L Walker, Gregory Spiegel, Richard Barakat, Marion R Piedmonte, Scott M. Eisenkop, Nick M Spirtos, John B. Schlaerth, Robert S Mannel, Michael L Pearl, Sudarshan K. SharmaAbstract:The conventional method for comprehensive surgical staging in endometrial cancer is open Laparotomy. Since the 1990s, minimally invasive laparoscopy has been investigated for comprehensive surgical staging in endometrial cancer in small efficacy and safety studies. This prospective randomized trial was designed to compare use of Laparotomy and laparoscopy for complete comprehensive surgical staging of uterine cancer. Between 1996 and 2005, a total of 2616 patients with clinical stage I to IIA uterine cancer were randomly assigned —920 to open Laparotomy and 1696 to laparoscopy. The procedures undertaken with both methods included hysterectomy, salpingo-oophorectomy, pelvic and paraaortic lymphadenectomy, and peritoneal cytology. The primary study end points were short-term (6 weeks) surgical outcomes, including recurrence-free survival, intraoperative complications, laparoscopy conversion to Laparotomy, length of hospital stay, operative time, patient-reported quality of life, and sites of recurrence. The data was adjusted for patient age, race/ethnicity, body mass index, and performance status. Laparoscopy was completed without conversion to open Laparotomy in 1248 patients (74.2%). Conversion to Laparotomy was required in 434 participants (25.8%). Reasons for conversion included poor exposure in 246 patients (14.6%), metastatic cancer in 69 patients (4.1%), excessive bleeding in 49 patients (2.9%), and other causes in 70 patients (4.2%). Fewer moderate-to-severe postoperative adverse events occurred with laparoscopy compared to Laparotomy (14% versus 21%; P < 0.001). Although the median operative time was shorter for open Laparotomy than laparoscopy (130 versus 204 minutes; P < 0.001), there was no statistical difference between the 2 treatment groups in rates of intraoperative complications (Laparotomy: 8% versus laparoscopy: 10%; P = 0.106). The percentage of patients requiring more than 2 days of hospitalization after surgery was significantly lower in patients receiving laparoscopy compared with Laparotomy (52% versus 94%; P < 0.001). Both pelvic and paraaortic nodes were not removed in 4% of Laparotomy patients and 8% of laparoscopy patients (P < 0.0001). The proportion of Laparotomy and laparoscopy patients found to have advanced surgical stage (FIGO stage IIIA, IIIC, or IV) was not significantly different (17% for each method; P = 0.851). The investigators conclude from these findings that laparoscopic comprehensive surgical staging for uterine cancer is feasible. Compared to Laparotomy, short-term outcomes of laparoscopy show fewer postoperative complications, and shorter hospital stay without increased intraoperative injuries.
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laparoscopy compared with Laparotomy for comprehensive surgical staging of uterine cancer gynecologic oncology group study lap2
Journal of Clinical Oncology, 2009Co-Authors: Joan L Walker, Gregory Spiegel, Richard Barakat, Marion R Piedmonte, Scott M. Eisenkop, Nick M Spirtos, John B. Schlaerth, Robert S Mannel, Michael L Pearl, Sudarshan K. SharmaAbstract:Purpose The objective was to compare laparoscopy versus Laparotomy for comprehensive surgical staging of uterine cancer. Patients and Methods Patients 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. Results Laparoscopy 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...
Paul M Magtibay - One of the best experts on this subject based on the ideXlab platform.
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ovarian remnant syndrome comparison of Laparotomy laparoscopy and robotic surgery
Acta Obstetricia et Gynecologica Scandinavica, 2012Co-Authors: Ignacio Zapardiel, Javier F Magrina, Vanna Zanagnolo, Paul M MagtibayAbstract:Objective. To compare Laparotomy, laparoscopy and robotic surgery in the management of ovarian remnant syndrome. Design. Retrospective comparative study. Setting. Mayo Clinic Arizona and Mayo Clinic Rochester, USA. Population. Women who underwent surgical treatment for ovarian remnant syndrome. Methods. The clinical records of 223 patients with histologically documented residual cortical ovarian tissue excised at Mayo Clinic by Laparotomy, laparoscopy or a robotic approach, from January 1985 through February 2009, were reviewed. Data collected included the patient's age, body mass index, previous medical and surgical history, symptoms, prior management of ovarian remnant syndrome, preoperative imaging study, intraoperative details, postoperative course, complications and follow-up data. Main outcome measures. Intraoperative and postoperative outcomes. Results. One hundred and eighty-seven patients (83.9%) were operated by Laparotomy, 19 (8.5%) by laparoscopy and 17 (7.6%) by a robotic approach. Estimated blood loss and length of stay were significantly lower in the robotic and laparoscopic groups compared with Laparotomy (p < 0.01). After a mean follow-up of 21.1 ± 32.4 months, the rate of pain improvement was 93.1, 94.4 and 71.4% for the Laparotomy, laparoscopy and robotic surgery group, respectively. Conclusions. Robotic and laparoscopic surgery for the treatment of ovarian remnant syndrome offer advantages over Laparotomy in terms of reduced blood loss, lower postoperative complications and shorter length of stay.
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robotic approach for ovarian cancer perioperative and survival results and comparison with laparoscopy and Laparotomy
Gynecologic Oncology, 2011Co-Authors: Javier F Magrina, Vanna Zanagnolo, Brie N Noble, Rosanne M Kho, Paul M MagtibayAbstract:Abstract Objective Comparison of perioperative outcomes and survival of patients undergoing primary surgical treatment for epithelial ovarian cancer (EOC) by a robotic, laparoscopy, or Laparotomy approach. Methods Retrospective case–control analysis of 25 patients with EOC undergoing robotic surgical treatment between March 2004 and December 2008. Comparison was made with similar patients treated by laparoscopy and Laparotomy and matched by age, body mass index (BMI), and type of procedures between January 1999 and December 2006. Results The mean operating times were 314.8, 253.8 and 260.7min for robotic, laparoscopy and Laparotomy patients, respectively (p Conclusion Laparoscopy and robotics are preferable to Laparotomy for patients with ovarian cancer requiring primary tumor excision alone or with one additional major procedure. Laparotomy is preferable for patients requiring two or more additional major procedures. Survival is not affected by the type of surgical approach.
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robotic approach for ovarian cancer perioperative and survival results and comparison with laparoscopy and Laparotomy
Gynecologic Oncology, 2011Co-Authors: Javier F Magrina, Vanna Zanagnolo, Brie N Noble, Paul M MagtibayAbstract:Abstract Objective Comparison of perioperative outcomes and survival of patients undergoing primary surgical treatment for epithelial ovarian cancer (EOC) by a robotic, laparoscopy, or Laparotomy approach. Methods Retrospective case–control analysis of 25 patients with EOC undergoing robotic surgical treatment between March 2004 and December 2008. Comparison was made with similar patients treated by laparoscopy and Laparotomy and matched by age, body mass index (BMI), and type of procedures between January 1999 and December 2006. Results The mean operating times were 314.8, 253.8 and 260.7min for robotic, laparoscopy and Laparotomy patients, respectively (p Conclusion Laparoscopy and robotics are preferable to Laparotomy for patients with ovarian cancer requiring primary tumor excision alone or with one additional major procedure. Laparotomy is preferable for patients requiring two or more additional major procedures. Survival is not affected by the type of surgical approach.
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robotic radical hysterectomy comparison with laparoscopy and Laparotomy
Gynecologic Oncology, 2008Co-Authors: Javier F Magrina, Amy L. Weaver, Regina P Montero, Paul M MagtibayAbstract:Abstract Objective Comparison of perioperative results of patients undergoing radical hysterectomy by robotics, laparoscopy, and Laparotomy. Study design Prospective analysis of 27 patients undergoing robotic radical hysterectomy between April 2003 and September 2006. Comparison was made with patients operated by laparoscopy and Laparotomy matched by age, BMI, site and type of malignancy, FIGO staging, and type of radical hysterectomy. Results The mean operating times for patients undergoing robotic, laparoscopy and Laparotomy radical hysterectomy were 189.6, 220.4, and 166.8 min, respectively; the mean blood loss was 133.1, 208.4, and 443.6 ml, respectively; the mean rate of blood loss was 0.7, 0.9, and 2.6 ml/min, respectively; the mean number of removed lymph nodes was 25.9, 25.9, and 27.7, respectively; and the mean length of hospital stay was 1.7, 2.4, and 3.6 days, respectively. There were no significant differences in intra- or postoperative complications among the three groups, no fistula formation in any patient and no conversions in the robotic or laparoscopic groups. At a mean follow up of 31.1 months, none of the patients with cervical cancer has experienced recurrence. Conclusion Laparoscopy and robotics are preferable to Laparotomy for patients requiring radical hysterectomy. Operating times for robotics and Laparotomy were similar, and significantly shorter as compared to laparoscopy. Blood loss, rate of blood loss and length of hospital stay were similar for laparoscopy and robotics and significantly reduced as compared to Laparotomy.
Joan L Walker - One of the best experts on this subject based on the ideXlab platform.
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recurrence and survival after random assignment to laparoscopy versus Laparotomy for comprehensive surgical staging of uterine cancer gynecologic oncology group lap2 study
Journal of Clinical Oncology, 2012Co-Authors: Joan L Walker, Marion R Piedmonte, Scott M. Eisenkop, Nick M Spirtos, Richard R Barakat, John B. Schlaerth, Robert S Mannel, Michael L Pearl, Sudarshan K. SharmaAbstract:Purpose The primary objective was to establish noninferiority of laparoscopy compared with Laparotomy for recurrence after surgical staging of uterine cancer. Patients and Methods Patients with clinical stages I to IIA disease were randomly allocated (two to one) to laparoscopy (n = 1,696) versus Laparotomy (n = 920) for hysterectomy, salpingo-oophorectomy, pelvic cytology, and pelvic and para-aortic lymphadenectomy. The primary study end point was noninferiority of recurrence-free interval defined as no more than a 40% increase in the risk of recurrence with laparoscopy compared with Laparotomy. Results With a median follow-up time of 59 months for 2,181 patients still alive, there were 309 recurrences (210 laparoscopy; 99 Laparotomy) and 350 deaths (229 laparoscopy; 121 Laparotomy). The estimated hazard ratio for laparoscopy relative to Laparotomy was 1.14 (90% lower bound, 0.92; 95% upper bound, 1.46), falling short of the protocol-specified definition of noninferiority. However, the actual recurrence ...
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laparoscopy compared with Laparotomy for comprehensive surgical staging of uterine cancer gynecologic oncology group study lap2
Obstetrical & Gynecological Survey, 2010Co-Authors: Joan L Walker, Gregory Spiegel, Richard Barakat, Marion R Piedmonte, Scott M. Eisenkop, Nick M Spirtos, John B. Schlaerth, Robert S Mannel, Michael L Pearl, Sudarshan K. SharmaAbstract:The conventional method for comprehensive surgical staging in endometrial cancer is open Laparotomy. Since the 1990s, minimally invasive laparoscopy has been investigated for comprehensive surgical staging in endometrial cancer in small efficacy and safety studies. This prospective randomized trial was designed to compare use of Laparotomy and laparoscopy for complete comprehensive surgical staging of uterine cancer. Between 1996 and 2005, a total of 2616 patients with clinical stage I to IIA uterine cancer were randomly assigned —920 to open Laparotomy and 1696 to laparoscopy. The procedures undertaken with both methods included hysterectomy, salpingo-oophorectomy, pelvic and paraaortic lymphadenectomy, and peritoneal cytology. The primary study end points were short-term (6 weeks) surgical outcomes, including recurrence-free survival, intraoperative complications, laparoscopy conversion to Laparotomy, length of hospital stay, operative time, patient-reported quality of life, and sites of recurrence. The data was adjusted for patient age, race/ethnicity, body mass index, and performance status. Laparoscopy was completed without conversion to open Laparotomy in 1248 patients (74.2%). Conversion to Laparotomy was required in 434 participants (25.8%). Reasons for conversion included poor exposure in 246 patients (14.6%), metastatic cancer in 69 patients (4.1%), excessive bleeding in 49 patients (2.9%), and other causes in 70 patients (4.2%). Fewer moderate-to-severe postoperative adverse events occurred with laparoscopy compared to Laparotomy (14% versus 21%; P < 0.001). Although the median operative time was shorter for open Laparotomy than laparoscopy (130 versus 204 minutes; P < 0.001), there was no statistical difference between the 2 treatment groups in rates of intraoperative complications (Laparotomy: 8% versus laparoscopy: 10%; P = 0.106). The percentage of patients requiring more than 2 days of hospitalization after surgery was significantly lower in patients receiving laparoscopy compared with Laparotomy (52% versus 94%; P < 0.001). Both pelvic and paraaortic nodes were not removed in 4% of Laparotomy patients and 8% of laparoscopy patients (P < 0.0001). The proportion of Laparotomy and laparoscopy patients found to have advanced surgical stage (FIGO stage IIIA, IIIC, or IV) was not significantly different (17% for each method; P = 0.851). The investigators conclude from these findings that laparoscopic comprehensive surgical staging for uterine cancer is feasible. Compared to Laparotomy, short-term outcomes of laparoscopy show fewer postoperative complications, and shorter hospital stay without increased intraoperative injuries.
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laparoscopy compared with Laparotomy for comprehensive surgical staging of uterine cancer gynecologic oncology group study lap2
Journal of Clinical Oncology, 2009Co-Authors: Joan L Walker, Gregory Spiegel, Richard Barakat, Marion R Piedmonte, Scott M. Eisenkop, Nick M Spirtos, John B. Schlaerth, Robert S Mannel, Michael L Pearl, Sudarshan K. SharmaAbstract:Purpose The objective was to compare laparoscopy versus Laparotomy for comprehensive surgical staging of uterine cancer. Patients and Methods Patients 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. Results Laparoscopy 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...
Michael L Pearl - One of the best experts on this subject based on the ideXlab platform.
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recurrence and survival after random assignment to laparoscopy versus Laparotomy for comprehensive surgical staging of uterine cancer gynecologic oncology group lap2 study
Journal of Clinical Oncology, 2012Co-Authors: Joan L Walker, Marion R Piedmonte, Scott M. Eisenkop, Nick M Spirtos, Richard R Barakat, John B. Schlaerth, Robert S Mannel, Michael L Pearl, Sudarshan K. SharmaAbstract:Purpose The primary objective was to establish noninferiority of laparoscopy compared with Laparotomy for recurrence after surgical staging of uterine cancer. Patients and Methods Patients with clinical stages I to IIA disease were randomly allocated (two to one) to laparoscopy (n = 1,696) versus Laparotomy (n = 920) for hysterectomy, salpingo-oophorectomy, pelvic cytology, and pelvic and para-aortic lymphadenectomy. The primary study end point was noninferiority of recurrence-free interval defined as no more than a 40% increase in the risk of recurrence with laparoscopy compared with Laparotomy. Results With a median follow-up time of 59 months for 2,181 patients still alive, there were 309 recurrences (210 laparoscopy; 99 Laparotomy) and 350 deaths (229 laparoscopy; 121 Laparotomy). The estimated hazard ratio for laparoscopy relative to Laparotomy was 1.14 (90% lower bound, 0.92; 95% upper bound, 1.46), falling short of the protocol-specified definition of noninferiority. However, the actual recurrence ...
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laparoscopy compared with Laparotomy for comprehensive surgical staging of uterine cancer gynecologic oncology group study lap2
Obstetrical & Gynecological Survey, 2010Co-Authors: Joan L Walker, Gregory Spiegel, Richard Barakat, Marion R Piedmonte, Scott M. Eisenkop, Nick M Spirtos, John B. Schlaerth, Robert S Mannel, Michael L Pearl, Sudarshan K. SharmaAbstract:The conventional method for comprehensive surgical staging in endometrial cancer is open Laparotomy. Since the 1990s, minimally invasive laparoscopy has been investigated for comprehensive surgical staging in endometrial cancer in small efficacy and safety studies. This prospective randomized trial was designed to compare use of Laparotomy and laparoscopy for complete comprehensive surgical staging of uterine cancer. Between 1996 and 2005, a total of 2616 patients with clinical stage I to IIA uterine cancer were randomly assigned —920 to open Laparotomy and 1696 to laparoscopy. The procedures undertaken with both methods included hysterectomy, salpingo-oophorectomy, pelvic and paraaortic lymphadenectomy, and peritoneal cytology. The primary study end points were short-term (6 weeks) surgical outcomes, including recurrence-free survival, intraoperative complications, laparoscopy conversion to Laparotomy, length of hospital stay, operative time, patient-reported quality of life, and sites of recurrence. The data was adjusted for patient age, race/ethnicity, body mass index, and performance status. Laparoscopy was completed without conversion to open Laparotomy in 1248 patients (74.2%). Conversion to Laparotomy was required in 434 participants (25.8%). Reasons for conversion included poor exposure in 246 patients (14.6%), metastatic cancer in 69 patients (4.1%), excessive bleeding in 49 patients (2.9%), and other causes in 70 patients (4.2%). Fewer moderate-to-severe postoperative adverse events occurred with laparoscopy compared to Laparotomy (14% versus 21%; P < 0.001). Although the median operative time was shorter for open Laparotomy than laparoscopy (130 versus 204 minutes; P < 0.001), there was no statistical difference between the 2 treatment groups in rates of intraoperative complications (Laparotomy: 8% versus laparoscopy: 10%; P = 0.106). The percentage of patients requiring more than 2 days of hospitalization after surgery was significantly lower in patients receiving laparoscopy compared with Laparotomy (52% versus 94%; P < 0.001). Both pelvic and paraaortic nodes were not removed in 4% of Laparotomy patients and 8% of laparoscopy patients (P < 0.0001). The proportion of Laparotomy and laparoscopy patients found to have advanced surgical stage (FIGO stage IIIA, IIIC, or IV) was not significantly different (17% for each method; P = 0.851). The investigators conclude from these findings that laparoscopic comprehensive surgical staging for uterine cancer is feasible. Compared to Laparotomy, short-term outcomes of laparoscopy show fewer postoperative complications, and shorter hospital stay without increased intraoperative injuries.
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laparoscopy compared with Laparotomy for comprehensive surgical staging of uterine cancer gynecologic oncology group study lap2
Journal of Clinical Oncology, 2009Co-Authors: Joan L Walker, Gregory Spiegel, Richard Barakat, Marion R Piedmonte, Scott M. Eisenkop, Nick M Spirtos, John B. Schlaerth, Robert S Mannel, Michael L Pearl, Sudarshan K. SharmaAbstract:Purpose The objective was to compare laparoscopy versus Laparotomy for comprehensive surgical staging of uterine cancer. Patients and Methods Patients 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. Results Laparoscopy 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...
Marion R Piedmonte - One of the best experts on this subject based on the ideXlab platform.
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recurrence and survival after random assignment to laparoscopy versus Laparotomy for comprehensive surgical staging of uterine cancer gynecologic oncology group lap2 study
Journal of Clinical Oncology, 2012Co-Authors: Joan L Walker, Marion R Piedmonte, Scott M. Eisenkop, Nick M Spirtos, Richard R Barakat, John B. Schlaerth, Robert S Mannel, Michael L Pearl, Sudarshan K. SharmaAbstract:Purpose The primary objective was to establish noninferiority of laparoscopy compared with Laparotomy for recurrence after surgical staging of uterine cancer. Patients and Methods Patients with clinical stages I to IIA disease were randomly allocated (two to one) to laparoscopy (n = 1,696) versus Laparotomy (n = 920) for hysterectomy, salpingo-oophorectomy, pelvic cytology, and pelvic and para-aortic lymphadenectomy. The primary study end point was noninferiority of recurrence-free interval defined as no more than a 40% increase in the risk of recurrence with laparoscopy compared with Laparotomy. Results With a median follow-up time of 59 months for 2,181 patients still alive, there were 309 recurrences (210 laparoscopy; 99 Laparotomy) and 350 deaths (229 laparoscopy; 121 Laparotomy). The estimated hazard ratio for laparoscopy relative to Laparotomy was 1.14 (90% lower bound, 0.92; 95% upper bound, 1.46), falling short of the protocol-specified definition of noninferiority. However, the actual recurrence ...
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laparoscopy compared with Laparotomy for comprehensive surgical staging of uterine cancer gynecologic oncology group study lap2
Obstetrical & Gynecological Survey, 2010Co-Authors: Joan L Walker, Gregory Spiegel, Richard Barakat, Marion R Piedmonte, Scott M. Eisenkop, Nick M Spirtos, John B. Schlaerth, Robert S Mannel, Michael L Pearl, Sudarshan K. SharmaAbstract:The conventional method for comprehensive surgical staging in endometrial cancer is open Laparotomy. Since the 1990s, minimally invasive laparoscopy has been investigated for comprehensive surgical staging in endometrial cancer in small efficacy and safety studies. This prospective randomized trial was designed to compare use of Laparotomy and laparoscopy for complete comprehensive surgical staging of uterine cancer. Between 1996 and 2005, a total of 2616 patients with clinical stage I to IIA uterine cancer were randomly assigned —920 to open Laparotomy and 1696 to laparoscopy. The procedures undertaken with both methods included hysterectomy, salpingo-oophorectomy, pelvic and paraaortic lymphadenectomy, and peritoneal cytology. The primary study end points were short-term (6 weeks) surgical outcomes, including recurrence-free survival, intraoperative complications, laparoscopy conversion to Laparotomy, length of hospital stay, operative time, patient-reported quality of life, and sites of recurrence. The data was adjusted for patient age, race/ethnicity, body mass index, and performance status. Laparoscopy was completed without conversion to open Laparotomy in 1248 patients (74.2%). Conversion to Laparotomy was required in 434 participants (25.8%). Reasons for conversion included poor exposure in 246 patients (14.6%), metastatic cancer in 69 patients (4.1%), excessive bleeding in 49 patients (2.9%), and other causes in 70 patients (4.2%). Fewer moderate-to-severe postoperative adverse events occurred with laparoscopy compared to Laparotomy (14% versus 21%; P < 0.001). Although the median operative time was shorter for open Laparotomy than laparoscopy (130 versus 204 minutes; P < 0.001), there was no statistical difference between the 2 treatment groups in rates of intraoperative complications (Laparotomy: 8% versus laparoscopy: 10%; P = 0.106). The percentage of patients requiring more than 2 days of hospitalization after surgery was significantly lower in patients receiving laparoscopy compared with Laparotomy (52% versus 94%; P < 0.001). Both pelvic and paraaortic nodes were not removed in 4% of Laparotomy patients and 8% of laparoscopy patients (P < 0.0001). The proportion of Laparotomy and laparoscopy patients found to have advanced surgical stage (FIGO stage IIIA, IIIC, or IV) was not significantly different (17% for each method; P = 0.851). The investigators conclude from these findings that laparoscopic comprehensive surgical staging for uterine cancer is feasible. Compared to Laparotomy, short-term outcomes of laparoscopy show fewer postoperative complications, and shorter hospital stay without increased intraoperative injuries.
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laparoscopy compared with Laparotomy for comprehensive surgical staging of uterine cancer gynecologic oncology group study lap2
Journal of Clinical Oncology, 2009Co-Authors: Joan L Walker, Gregory Spiegel, Richard Barakat, Marion R Piedmonte, Scott M. Eisenkop, Nick M Spirtos, John B. Schlaerth, Robert S Mannel, Michael L Pearl, Sudarshan K. SharmaAbstract:Purpose The objective was to compare laparoscopy versus Laparotomy for comprehensive surgical staging of uterine cancer. Patients and Methods Patients 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. Results Laparoscopy 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...
