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Laparoscopy gets qualified nod in uterine cancer.(Gynecologic Surgery)
PALM SPRINGS, CALIF. -- Laparoscopic surgical staging of uterine cancer is feasible for most patients with clinical stage I-IIA uterine cancer, Dr. Joan L. Walker reported at the annual meeting of the Society of Gynecologic Oncologists.
Compared with laparotomy, the laparoscopy technique resulted in a shorter median hospital length of stay and fewer complications rated as grade 2 or higher, as well as significant reductions in pneumonia, cardiac arrhythmia, ileus, and treatment with antibiotics.
The findings come from a large trial launched in 1996 to compare the operative outcomes for 1,969 patients with stage I-IIA uterine cancer randomized to laparoscopy and 920 randomized to laparotomy Enrollment for the National Cancer Institute-funded study closed in September 2005, said Dr. Walker, chief of the section of gynecologic oncology at the University of Oklahoma Health Sciences Center, Oklahoma City.
Patients randomized to receive laparoscopy were required to undergo laparotomy if surgical staging could not be completed. Successful surgical staging was defined as cytology sent, with lymph nodes identified histologically in each group: left paraaortic, right paraaortic, left pelvic, and right pelvic. The researchers then compared several short-term outcomes between the two groups.
For staging to be completed in nearly one-quarter (434) of the women, they had to be converted to laparotomy, mainly because of poor visibility at the cancer site, the presence of metastatic cancer, or bleeding. On average, the women who required conversion were older, weighed more, and had a higher body mass index than the other study participants. Complete surgical staging occurred in 86% of patients in the laparotomy group and 78% of patients in the laparoscopy group.
The researchers found that 8% of patients in the laparotomy group had intra-operative injuries, compared with 10% of patients in the laparoscopy group, a difference that was not statistically significant overall. ...
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