Highlights
- •Long-term outcomes of TLH vs TAH without lymphadenectomy in early EC are reported.
- •There were no significant differences in DFS, OS and DSS, 5 years postoperatively.
- •No port-site or wound metastases were found after TLH or TAH.
- •Our findings support the widespread use of TLH without lymphadenectomy for early EC.
Abstract
Background
Laparoscopic hysterectomy is accepted worldwide as the standard treatment option for
early-stage endometrial cancer. However, there are limited data on long-term survival,
particularly when no lymphadenectomy is performed. We compared the survival outcomes
of total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH), both
without lymphadenectomy, for early-stage endometrial cancer up to 5 years postoperatively.
Methods
Follow-up of a multi-centre, randomised controlled trial comparing TLH and TAH, without
routine lymphadenectomy, for women with stage I endometrial cancer. Enrolment was
between 2007 and 2009 by 2:1 randomisation to TLH or TAH. Outcomes were disease-free
survival (DFS), overall survival (OS), disease-specific survival (DSS), and primary
site of recurrence. Multivariable Cox regression analyses were adjusted for age, stage,
grade, and radiotherapy with adjusted hazard ratios (aHR) and 95% confidence intervals
(95%CI) reported. To test for significance, non-inferiority margins were defined.
Results
In total, 279 women underwent a surgical procedure, of whom 263 (94%) had follow-up
data. For the TLH (n = 175) and TAH (n = 88) groups, DFS (90.3% vs 84.1%; aHR[recurrence], 0.69; 95%CI, 0.31–1.52), OS (89.2%
vs 82.8%; aHR[death], 0.60; 95%CI, 0.30–1.19), and DSS (95.0% vs 89.8%; aHR[death],
0.62; 95%CI, 0.23–1.70) were reported at 5 years. At a 10% significance level, and
with a non-inferiority margin of 0.20, the null hypothesis of inferiority was rejected
for all three outcomes. There were no port-site or wound metastases, and local recurrence
rates were comparable.
Conclusion
Disease recurrence and 5-year survival rates were comparable between the TLH and TAH
groups and comparable to studies with lymphadenectomy, supporting the widespread use
of TLH without lymphadenectomy as the primary treatment for early-stage, low-grade
endometrial cancer.
Keywords
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Article info
Publication history
Published online: December 23, 2021
Accepted:
December 13,
2021
Received in revised form:
December 11,
2021
Received:
August 3,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
