NEW YORK (Reuters Health) – Intraoperative complications are similar whether staging of endometrial cancer is performed laparoscopically or by laparotomy, but laparoscopy has the advantage when it comes to postoperative complications.
That finding comes from a meta-analysis performed by an Italian group and reported in the American Journal of Obstetrics and Gynecology online January 16.
“While it remains to be determined whether long-term oncologic data will confirm the equivalence of the two surgical techniques, laparoscopic surgery should be considered as the gold standard procedure for staging endometrial cancer,” conclude Dr. Stefano Palomba, at the University “Magna Graecia” of Catanzaro, and colleagues .
They note that surgery is the treatment of choice in most cases of endometrial cancer, and that pelvic lymphadenectomy for staging the disease is standard in many centers. However, results of small studies on the role of laparoscopy for staging have varied.
In order to obtain “updated and conclusive evidence” on the safety of laparoscopic versus abdominal surgery for staging patients with endometrial cancer, the team identified eight relevant randomized controlled trials.
Based on seven of the studies, the rate of intraoperative complications was not different between laparoscopy and laparotomy (relative risk 1.25; p=0.062). On the other hand, data from all of the studies indicated that postoperative complications were significantly lower with laparoscopy than laparotomy (RR 0.71; p=0.016), the authors found.
Operative time was significantly longer with the laparoscopic rather than open procedure (weighted mean difference 51.46 minutes; p<0.001). While blood loss was significantly less with laparoscopy, the difference was not considered clinically meaningful, the report indicates.
Furthermore, pelvic node yields were not significantly different between the two approaches, Dr. Palomba and colleagues note.
“In conclusion,” they write, “although the variability of the different protocols made the combination of the studies difficult, our meta-analytic data clearly demonstrate that the laparoscopic approach is safer than the traditional abdominal approach with particular regard for postoperative complications.”
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