Skip to main content

Advertisement

Log in

Long-term outcome of patients with intermediate- and high-risk endometrial cancer after pelvic and paraaortic lymph node dissection: a comparison of laparoscopic vs. open procedure

  • Original Article – Clinical Oncology
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Objective

The primary therapy for intermediate- and high-risk endometrial cancer includes pelvic and paraaortic lymph node evaluation. Laparoscopic surgery is an increasingly popular intervention due to decreased risk and better short-term morbidity; however, a recent study casts doubt on the benefit of this approach in terms of oncological safety. In this cancer registry study, we sought to evaluate the benefit of laparoscopy versus laparotomy and retrospectively compared overall survival, recurrence rates, and recurrence-free survival among patients with intermediate- and high-risk endometrial cancer who underwent either laparoscopic or open surgery.

Methods

This observational study included 419 patients who have been treated from 2011 to 2017. We employed Kaplan–Meier method, and univariable and multivariable Cox-regression to compare overall survival, recurrence rates, and recurrence-free survival in 110 patients, who underwent laparoscopic, with 309 patients, who underwent open surgery. To address the confounding bias in this retrospective study, we also performed a propensity score matching (PSM) analysis including 357 patients (laparoscopy: n = 107; open surgery: n = 250).

Results

We found a benefit for laparoscopic over open surgery in patients with intermediate- and high-risk endometrial cancer for overall survival in both univariable (p = 0.002; PSM: p = 0.016) and multivariable analyses (p = 0.019; PSM: p = 0.007). In contrast, there was no statistically significant difference between both patient groups regarding the cumulative recurrence rates. A univariable analysis identified a significant benefit for laparoscopy regarding recurrence-free survival (p = 0.003; PSM: p = 0.029) but a multivariable analysis failed to confirm this finding (p = 0.108; PSM: p = 0.118).

Conclusions

Our study provides evidence that laparoscopic systematic lymphadenectomy does not present a lower oncological efficacy than open surgery in the treatment of patients with endometrial cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  • Bregar AJ, Melamed A, Diver E, Clemmer JT, Uppal S, Schorge JO, Rice LW, Del Carmen MG, Rauh-Hain JA (2017) Minimally invasive staging surgery in women with early-stage endometrial cancer: analysis of the national cancer data base. Ann Surg Oncol 24(6):1677–1687

    Article  Google Scholar 

  • Coker AL, DeSimone CP, Eggleston KS, Hopenhayn C, Nee J, Tucker T (2009) Smoking and survival among Kentucky women diagnosed with invasive cervical cancer: 1995–2005. Gynecol Oncol 112(2):365–369

    Article  Google Scholar 

  • Draeger T, Völkel V, Schnitzbauer V, Gerken M, Benz S, Klinkhammer-Schalke M, Fürst A (2019) Laparoscopic and open resection of rectal cancer-is age an effect modifier for short- and long-term survival? Int J Colorectal Dis 34(5):821–828

    Article  Google Scholar 

  • Dryden-Peterson S, Bvochora-Nsingo M, Suneja G, Efstathiou JA, Grover S, Chiyapo S, Ramogola-Masire D, Kebabonye-Pusoentsi M, Clayman R, Mapes AC, Tapela N, Asmelash A, Medhin H, Viswanathan AN, Russell AH, Lin LL, Kayembe MKA, Mmalane M, Randall TC, Chabner B, Lockman S (2016) HIV infection and survival among women with cervical cancer. J Clin Oncol 34(31):3749–3757

    Article  CAS  Google Scholar 

  • Ferguson SE, Panzarella T, Lau S, Gien LT, Samouëlian V, Giede C, Steed H, Le T, Renkosinski B, Bernardini MQ (2018) Prospective cohort study comparing quality of life and sexual health outcomes between women undergoing robotic, laparoscopic and open surgery for endometrial cancer. Gynecol Oncol 149(3):476–483

    Article  Google Scholar 

  • Kilger E, Weis FC, Goetz AE, Frey L, Kesel L, Schütz A, Lamm P, Uberfuhr P, Knoll A, Felbinger TW, Peter K (2001) Intensive care after minimally invasive and conventional coronary surgery: a prospective comparison. Intensive Care Med 27(3):534–539

    Article  CAS  Google Scholar 

  • Kyrgiou M, Swart AM, Qian W, Warwick J (2015) A Comparison of outcomes following laparoscopic and open hysterectomy with or without lymphadenectomy for presumed early-stage endometrial cancer: results from the medical research council ASTEC trial. Int J Gynecol Cancer 25(8):1424–1436

    Article  Google Scholar 

  • Lin F, Pan L, Li L, Li D, Mo L (2014) Effects of a simulated CO2 pneumoperitoneum environment on the proliferation, apoptosis, and metastasis of cervical cancer cells in vitro. Med Sci Monit 20:2497–2503

    Article  Google Scholar 

  • Melamed A, Keating NL, Clemmer JT, Bregar AJ, Wright JD, Boruta DM, Schorge JO, Del Carmen MG, Rauh-Hain JA (2017) Laparoscopic staging for apparent stage I epithelial ovarian cancer. Am J Obstet Gynecol 216(1):50.e1–50.e12

    Article  Google Scholar 

  • Melamed A, Margul DJ, Chen L, Keating NL, Del Carmen MG, Yang J, Seagle BL, Alexander A, Barber EL, Rice LW, Wright JD, Kocherginsky M, Shahabi S, Rauh-Hain JA (2018) Survival after minimally invasive radical hysterectomy for early-stage cervical cancer. N Engl J Med 379(20):1905–1914

    Article  Google Scholar 

  • Mourits MJ, Bijen CB, Arts HJ, ter Brugge HG, van der Sijde R, Paulsen L, Wijma J, Bongers MY, Post WJ, van der Zee AG, de Bock GH (2010) Safety of laparoscopy versus laparotomy in early-stage endometrial cancer: a randomised trial. Lancet Oncol 11(8):763–771

    Article  Google Scholar 

  • Park DA, Lee DH, Kim SW, Lee SH (2016) Comparative safety and effectiveness of robot-assisted laparoscopic hysterectomy versus conventional laparoscopy and laparotomy for endometrial cancer: a systematic review and meta-analysis. Eur J Surg Oncol 42(9):1303–1314

    Article  CAS  Google Scholar 

  • Peng Y, Zheng M, Ye Q, Chen X, Yu B, Liu B (2009) Heated and humidified CO2 prevents hypothermia, peritoneal injury, and intra-abdominal adhesions during prolonged laparoscopic insufflations. The Journal of Surgical Research. 151(1):40–47

    Article  CAS  Google Scholar 

  • Ramirez PT, Frumovitz M, Pareja R, Lopez A, Vieira M, Ribeiro R, Buda A, Yan X, Shuzhong Y, Chetty N, Isla D, Tamura M, Zhu T, Robledo K, Gebski V, Asher R, Behan V, Nicklin JL, Coleman RL, Obermair A (2018) Minimally invasive versus abdominal radical hysterectomy for cervical cancer. N Engl J Med 379(20):1895–1904

    Article  Google Scholar 

  • Rosenbaum PR, Rubin DB (1983) The central role of the propensity score in observational studies for causal effects. Biometrika 70(1):41–55

    Article  Google Scholar 

  • Safdieh J, Lee YC, Wong A, Lee A, Weiner JP, Schwartz D, Schreiber D (2017) A comparison of outcomes between open hysterectomy and robotic-assisted hysterectomy for endometrial cancer using the national cancer database. Int J Gynecol Cancer 27(7):1508–1516

    Article  Google Scholar 

  • Volz J, Köster S, Spacek Z, Paweletz N (1999) The influence of pneumoperitoneum used in laparoscopic surgery on an intraabdominal tumor growth. Cancer 86(5):770–774

    Article  CAS  Google Scholar 

  • Zullo F, Palomba S, Falbo A, Russo T, Mocciaro R, Tartaglia E, Tagliaferri P, Mastrantonio P (2009) Laparoscopic surgery vs laparotomy for early stage endometrial cancer: long-term data of a randomized controlled trial. Am J Obstet Gynecol 200(3):296.e1-9

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Thomas Papathemelis.

Ethics declarations

Conflict of interest

Thomas Papathemelis, Helen Oppermann, Stella Grafl, Michael Gerken, Armin Pauer, Sophia Scharl, Anton Scharl, Elisabeth Inwald, Atanas Ignatov, Olaf Ortmann, Monika Klinkhammer-Schalke, Alexander Hein, Matthias W. Beckmann and Michael P. Lux declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 18 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Papathemelis, T., Oppermann, H., Grafl, S. et al. Long-term outcome of patients with intermediate- and high-risk endometrial cancer after pelvic and paraaortic lymph node dissection: a comparison of laparoscopic vs. open procedure . J Cancer Res Clin Oncol 146, 961–969 (2020). https://doi.org/10.1007/s00432-019-03122-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-019-03122-8

Keywords

Navigation