Treatment of uterine (endometrial) cancer by laparoscopy gives better patient quality of life

Mar 27 2006

Laparoscopy proves safe, reduces hospital stay, and results in improved quality of life.

In a pair of studies presented today at the Society of Gynecologic Oncologists 37th Annual Meeting on Women's Cancer, researchers have found in a large randomized trial of laparoscopy versus laparotomy for surgical treatment of uterine (endometrial) cancer that laparoscopy is safe, and when successfully completed reduces hospital stay by 50 percent, and contributes to a better quality of life from the patient's perspective. Additionally, the study provided the best guidelines to date for predicting the likelihood of successful laparoscopic surgery, based on weight and Body Mass Index (BMI).

"Prospective Randomized Trial of Laparoscopy vs. Laparotomy for Comprehensive Surgical Staging of Uterine Cancer" and "Quality of Life of Patients with Endometrial Cancer Undergoing Laparoscopic FIGO Staging Compared to Laparotomy" are Gynecologic Oncology Group (GOG) supported studies, and are led by Joan L. Walker, M.D. of the University of Oklahoma Medical Center and Alice B. Kornblith, Ph.D. of the Dana-Farber Cancer Institute, respectively.

"We've found that a less invasive surgery like laparoscopy is as safe as the more traditional approach of laparotomy and also lessens the risk of serious complications," explained Dr. Walker. "While the operative time increased using laparoscopy, the significant reduction in hospital stay and the reduced risk of serious complications makes utilizing this procedure when feasible worthwhile."

"Additionally, patients treated by laparoscopy had a superior quality of life through six weeks post-surgery compared to the laparotomy patients," said Dr. Kornblith. "This was likely due to it being a less invasive procedure resulting in less pain, faster recovery and a reduced length of hospital stay."

Prospective Randomized Trial of Laparoscopy vs. Laparotomy for Comprehensive Surgical Staging of Uterine Cancer

The multi-institutional randomized trial was conducted nationwide by the GOG in over 30 institutions and multiple affiliate sites. Nearly one hundred participating gynecologic oncologists enrolled 2,616 participants. Prospective Randomized Trial of Laparoscopy vs. Laparotomy for Comprehensive Surgical Staging of Uterine Cancer study was initiated in May of 1996. Randomization was designed such that twice as many participants underwent laparoscopy compared to laparotomy, resulting in 1,696 randomized to laparoscopy and 920 to laparotomy. Study results reveal a lower incidence of serious complications (14 percent vs. 21 percent) and a 50 percent reduction (from four to two days) in hospital stay for patients completing their procedure laparoscopically.

The study also provides new weight and Body Mass Index (BMI) guidelines to better predict which patients will be good candidates for successful laparoscopy procedures. The BMI is a measure of body size based on height and weight. Traditional guidelines suggested patients with a BMI greater than 32 were not good candidates for laparoscopic procedures. A woman who is five-foot-three and 180 pounds would have a BMI of 32. This study found that patients with a BMI of 32 had a surgical staging success rate of 70 percent.

Quality of Life of Patients with Endometrial Cancer Undergoing Laparoscopic FIGO Staging Compared to Laparotomy

782 patients (524 laparoscopy and 258 laparotomy) who had participated in the clinical trial participated in this quality of life study. After the patients initial (baseline) assessment they were given follow-up assessment forms to be completed at one week, three weeks, six weeks and six months. Patients were assessed with the following questionnaires: overall quality of life (FACT-G), Physical Symptoms from Laparoscopy (PA), Brief Pain Inventory (BPI) items, MOS Physical Functioning (PF), Fear of Recurrence (FR), body image/Personal Appearance (PA), and resumption of normal activities.

The analysis of the results found that within the six week post-surgery period, laparoscopy patients had a better overall quality of life, physical functioning, personal appearance, and an earlier resumption to normal activities than did the laparotomy patients. At six months there were no quality of life differences between the two surgeries, with the exception of laparoscopy patients reporting better body image than the laparotomy patients.

"These studies are really exciting and could change the landscape of how uterine cancer surgical staging is taught and performed," said Dr. Walker. "For a physician to see the patient the next morning and find that she is sitting up, ready to go home--this is quite different from the traditional open surgery."

Uterine (endometrial) cancer is a common malignancy of the female reproductive tract. In 2005, the American Cancer Society estimated more than 40,000 cases of uterine cancer, and more than 7,000 deaths. The median age at diagnosis is in the early 60s and women who are obese or who have diabetes are at greater risk for developing the disease. The risk of dying of uterine cancer is increased by age and Black race.