Podcast: Laparoscopy versus laparotomy for the management of presumed early stage endometrial cancer

Recent decades have seen greater and greater use of laparoscopy, or keyhole surgery, when people need an operation on their abdomen. There are now dozens of Cochrane Reviews of this, for a wide variety of conditions and, in October 2018, the one for laparoscopy versus laparotomy, or open surgery, for women with early stage endometrial cancer was updated. The review is led by Khadra Galaal from the Royal Cornwall Hospital in Truro in the UK and she tells us the latest findings in this podcast.

"Worldwide, cancer of the womb or 'endometrial cancer' is the fifth most common cancer among women under 65 years of age, with a higher incidence in high income countries than in low and middle income countries. The current standard treatment is a hysterectomy to remove the woman’s womb and removal of her fallopian tubes and ovaries. Other treatments include radiotherapy and chemotherapy. Traditionally, the surgery has been done as a laparotomy, through an open cut in the abdomen, and our review compares this technique against laparoscopic or keyhole surgery.

We looked at the effects of the two types of surgery on how long women remained alive after the diagnosis of their cancer and the length of time that they remained disease‐free. We were able to use results from six randomised trials that had analysed data for nearly 4000 participants with early stage endometrial cancer. We found no significant difference in the risk of death between the women who underwent laparoscopy and those who underwent laparotomy. In addition, results from five randomised trials confirmed no difference in the risk of cancer recurrence if women had laparoscopy or laparotomy. Notably, laparoscopy was associated with less blood loss and earlier discharge from hospital.

In summary, this update confirms the findings of our previous review from six years ago, that laparoscopy is an effective and viable alternative to laparotomy for the treatment of women with early stage endometrial cancer. With regards to long term survival, outcomes for laparoscopy are comparable to laparotomy."