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.
Aged
Cohort Studies
Disease-Free Survival
Endometrial Neoplasms
/ pathology
Female
Humans
Kaplan-Meier Estimate
Laparoscopy
/ methods
Lymph Node Excision
/ methods
Lymph Nodes
/ pathology
Middle Aged
Neoplasm Staging
Propensity Score
Proportional Hazards Models
Retrospective Studies
Treatment Outcome
Cancer registry study
Endometrial cancer
Laparoscopy
Laparotomy
Observational study
Overall survival
Pelvic and paraaortic lymphadenectomy
Journal
Journal of cancer research and clinical oncology
ISSN: 1432-1335
Titre abrégé: J Cancer Res Clin Oncol
Pays: Germany
ID NLM: 7902060
Informations de publication
Date de publication:
Apr 2020
Apr 2020
Historique:
received:
12
12
2019
accepted:
26
12
2019
pubmed:
7
1
2020
medline:
4
4
2020
entrez:
6
1
2020
Statut:
ppublish
Résumé
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. 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). 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). 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.
Identifiants
pubmed: 31901975
doi: 10.1007/s00432-019-03122-8
pii: 10.1007/s00432-019-03122-8
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
961-969Références
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