Improved surgical safety after laparoscopic compared to open surgery for apparent early stage endometrial cancer: Results from a randomised controlled trial

被引：87

作者：

Obermair, Andreas ^{[1
,5
]}

Janda, Monika ^{[2
]}

Baker, Jannah ^{[2
]}

Kondalsamy-Chennakesavan, Srinivas ^{[1
]}

Brand, Alison ^{[3
]}

Hogg, Russell ^{[3
]}

Jobling, Thomas W. ^{[4
]}

Land, Russell ^{[5
]}

Manolitsas, Tom ^{[4
]}

Nascimento, Marcelo ^{[5
]}

Neesham, Deborah ^{[6
]}

Nicklin, James L. ^{[5
]}

Oehler, Martin K. ^{[7
]}

Otton, Geoff ^{[8
]}

Perrin, Lewis ^{[5
]}

Salfinger, Stuart ^{[9
]}

Hammond, Ian ^{[10
]}

Leung, Yee ^{[11
]}

Sykes, Peter ^{[12
]}

Ngan, Hextan ^{[13
]}

Garrett, Andrea ^{[5
]}

Laney, Michael ^{[12
]}

Ng, Tong Yow ^{[13
]}

Tam, Karfai ^{[13
]}

Chan, Karen ^{[13
]}

Wrede, David H. ^{[6
]}

Pather, Selvan ^{[14
]}

Simcock, Bryony ^{[12
]}

Farrell, Rhonda ^{[15
]}

Robertson, Gregory ^{[15
]}

Walker, Graeme ^{[16
]}

McCartney, Anthony ^{[10
]}

Gebski, Val ^{[17
]}

机构：

[1] Univ Queensland, Sch Med, Brisbane, Qld 4072, Australia

[2] Queensland Univ Technol, Sch Publ Hlth, Inst Hlth & Biomed Innovat, Brisbane, Qld 4001, Australia

[3] Westmead Hosp, Dept Gynaecol Oncol, Sydney, NSW, Australia

[4] Monash Med Ctr, Dept Gynaecol Oncol, Melbourne, Vic, Australia

[5] Royal Brisbane & Womens Hosp, Queensland Ctr Gynaecol Canc, Herston, Qld 4029, Australia

[6] Royal Womens Hosp, Melbourne, Vic, Australia

[7] Royal Adelaide Hosp, Adelaide, SA 5000, Australia

[8] John Hunter Hosp, Newcastle, NSW, Australia

[9] King Edward Hosp, Subiaco, WA, Australia

[10] St John God Hosp, Perth, WA, Australia

[11] Univ Western Australia, Sch Womens & Infants Hlth, Nedlands, WA 6009, Australia

[12] Christchurch Womens Hosp, Christchurch, New Zealand

[13] Queen Mary Hosp, Dept Obstet & Gynecol, Hong Kong, Hong Kong, Peoples R China

[14] Royal Prince Alfred Hosp, Sydney, NSW, Australia

[15] Royal Hosp Women, Randwick, NSW, Australia

[16] Royal Infirm Edinburgh NHS Trust, Edinburgh, Midlothian, Scotland

[17] Univ Sydney, NHMRC Clin Trials Ctr, Sydney, NSW 2006, Australia

来源：

EUROPEAN JOURNAL OF CANCER | 2012年 / 48卷 / 08期

基金：

澳大利亚国家健康与医学研究理事会;

关键词：

Endometrial cancer; Safety; Surgery;

D O I：

10.1016/j.ejca.2012.02.055

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Aim: To compare Total Laparoscopic Hysterectomy (TLH) and Total Abdominal Hysterectomy (TAH) with regard to surgical safety. Methods: Between October 2005 and June 2010, 760 patients with apparent early stage endometrial cancer were enroled in a multicentre, randomised clinical trial (LACE) comparing outcomes following TLH or TAH. The main study end points for this analysis were surgical adverse events (AE), hospital length of stay, conversion from laparoscopy to laparotomy, including 753 patients who completed at least 6 weeks of follow-up. Postoperative AEs were graded according to Common Toxicity Criteria (V3), and those immediately life-threatening, requiring inpatient hospitalisation or prolonged hospitalisation, or resulting in persistent or significant disability/incapacity were regarded as serious AEs. Results: The incidence of intra-operative AEs was comparable in either group. The incidence of post-operative AE CTC grade 3+ (18.6% in TAH, 12.9% in TLH, p 0.03) and serious AE (14.3% in TAH, 8.2% in TLH, p 0.007) was significantly higher in the TAH group compared to the TLH group. Mean operating time was 132 and 107 min, and median length of hospital stay was 2 and 5 days in the TLH and TAH group, respectively (p < 0.0001). The decline of haemoglobin from baseline to day 1 postoperatively was 2 g/L less in the TLH group (p 0.006). Conclusions: Compared to TAH, TLH is associated with a significantly decreased risk of major surgical AEs. A laparoscopic surgical approach to early stage endometrial cancer is safe. (C) 2012 Elsevier Ltd. All rights reserved.

引用

页码：1147 / 1153

页数：7

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