Reijntjes, B. (Bianca) (2019) A Total Laparoscopic Hysterectomy is equally safe in terms of long-term survival outcomes and recurrence rates for women with early-stage, low risk Endometrial Cancer in comparison to a Total Abdominal Hysterectomy. thesis, Medicine.
Full text available on request.Abstract
Purpose: Endometrial cancer is the most common gynaecologic malignancy. Laparoscopy has been proven to be a safe surgical procedure for the treatment of early-stage endometrial cancer with respect to short-term survival outcomes. It has become the standard treatment for early-stage disease, although little evidence exists over the patterns of recurrence and long-term survival outcomes. The purpose of this study is to provide more qualified evidence concerning the long-term oncological outcomes of a total laparoscopic hysterectomy (TLH) in comparison to a total abdominal hysterectomy (TAH). Methods: This is a 10-year follow-up study of an earlier performed Dutch multi-centre randomised trial; the TLH-TAH study. This study enrolled 279 women with stage I endometrial cancer in a 2:1 randomisation (TLH 185; TAH 94). Due to limited amount of time, 221 out of the 279 women were included. The primary outcome was disease-free survival. Secondary outcomes were patterns of recurrence, overall and disease-specific survival. The Kaplan-Meier method was used to calculate the survival curves and the log-rank test to assess possible differences between survival curves. Hazard ratios (HR) for pre-specified prognostic factors for disease-free and overall survival for surgical technique were evaluated by performing Cox regression analyses. Results: Patients were followed up for a median of 9.2 years, 210/221 women were included in the survival analyses and eleven patients were excluded due to withdrawal of informed consent or missing follow-up data. At 10-years of follow-up the disease-free survival rate was 89.1% in the TLH-group versus 85.2% in the TAH-group; P = 0.39; HR 0.70 (95% CI 0.32, 1.57). No significant differences were found for overall survival (TLH 76.4%, TAH 73.9%; P = 0.46 ) or disease-specific survival rate (TLH 92.6%, TAH 90.8%; P =0.62). After adjustment for one the pre-specified prognostic factors no significant difference was found between the surgical procedures for the disease-free and overall survival. Conclusion: For women with early-stage endometrial cancer TLH is for the long-term survival outcomes an equally safe procedure in comparison to TAH. Our data support the widespread use of the TLH as primary treatment for early-stage, low risk endometrial cancer.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Mourits, Prof. dr. M.J.E. and Bock, Prof. dr. G.H. de |
| Faculty: | Medical Sciences |
| Keywords: | Gynecology, Endometrial neoplasms, Hysterectomy, Long-term outcomes |
| Date Deposited: | 06 Jul 2020 11:50 |
| Last Modified: | 06 Jul 2020 11:55 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2739 |
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