O007/#202 Recurrence and survival after laparoscopy versus laparotomy in early-stage endometrial cancer: long-term outcomes of a randomised trial

Objectives. We compared postoperative analgesic requirements between women with early stage endometrial cancer treated by total abdominal hysterectomy (TAH) or total laparoscopic hysterectomy (TLH).Methods. 760 patients with apparent stage I endometrial cancer were treated in the international, multicentre, prospective randomised trial (LACE) by TAH (n=353) or TLH (n=407) (2005–2010). Epidural, opioid, and nonopioid analgesic requirements were collected until ten months after surgery.Results. Baseline demographics and analgesic use were comparable between treatment arms. TAH patients were more likely to receive epidural analgesia than TLH patients (33% versus 0.5%,P<0.001) during the early postoperative phase. Although opioid use was comparable in the TAH versus TLH groups during postoperative 0–2 days (99.7% versus 98.5%,P=0.09), a significantly higher proportion of TAH patients required opioids 3–5 days (70% versus 22%,P<0.0001), 6–14 days (35% versus 15%,P<0.0001), and 15–60 days (15% versus 9%,P=0.02) after surgery. Mean pain scores were significantly higher in the TAH versus TLH group one (2.48 versus 1.62,P<0.0001) and four weeks (0.89 versus 0.63,P=0.01) following surgery.Conclusion. Treatment of early stage endometrial cancer with TLH is associated with less frequent use of epidural, lower post-operative opioid requirements, and better pain scores than TAH.

Download Full-text

Authors’ reply re: Patient-initiated follow-up affects fear of recurrence and health care use: a randomised trial in early-stage endometrial cancer

BJOG An International Journal of Obstetrics & Gynaecology ◽

10.1111/1471-0528.15447 ◽

2018 ◽

Vol 125 (13) ◽

pp. 1778-1779 ◽

Cited By ~ 1

Author(s):

Mette Moustgaard Jeppesen ◽

Pernille Tine Jensen ◽

Dorte Gilså Hansen ◽

René dePont Christensen ◽

Ole Mogensen

Keyword(s):

Health Care ◽

Endometrial Cancer ◽

Early Stage ◽

Randomised Trial ◽

Health Care Use ◽

Fear Of Recurrence ◽

Early Stage Endometrial Cancer

Download Full-text

Long-Term Outcomes After Pelvic Radiation for Early-Stage Endometrial Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2013.48.8023 ◽

2013 ◽

Vol 31 (31) ◽

pp. 3951-3956 ◽

Cited By ~ 49

Author(s):

Mathias Onsrud ◽

Milada Cvancarova ◽

Taran P. Hellebust ◽

Claes G. Tropé ◽

Gunnar B. Kristensen ◽

...

Keyword(s):

Overall Survival ◽

Endometrial Cancer ◽

Early Stage ◽

External Beam Radiation ◽

Secondary Cancer ◽

Pelvic Radiation ◽

Significant Difference ◽

Early Stage Endometrial Cancer

Purpose This follow-up of a randomized study was conducted to assess the long-term effects of external beam radiation therapy (EBRT) in the adjuvant treatment of early-stage endometrial cancer. Patients and Methods Between 1968 and 1974, 568 patients with stage I endometrial cancer were included. After primary surgery, patients were randomly assigned to either vaginal radium brachytherapy followed by EBRT (n = 288) or brachytherapy alone (n = 280). Overall survival was analyzed by using the Kaplan-Meier method. A Cox proportional hazards model was used to estimate hazard ratios (HRs) with 95% CIs. We also conducted analyses stratified by age groups. Results After median 20.5 years (range, 0 to 43.4 years) of follow-up, no statistically significant difference was revealed in overall survival (P = .186) between treatment groups. However, women younger than age 60 years had significantly higher mortality rates after EBRT (HR, 1.36; 95% CI, 1.06 to 1.76) than the control group. The risk of secondary cancer increased after EBRT, especially in women younger than age 60 years (HR, 2.02; 95% CI, 1.30 to 3.15). Conclusion We observed no survival benefit of external pelvic radiation in early-stage endometrial carcinoma. In women younger than age 60 years, pelvic radiation decreased survival and increased the risk of secondary cancer. Adjuvant EBRT should be used with caution, especially in women with a long life expectancy.

Download Full-text