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Keyhole surgery better for cancer hysterectomies: global survival study

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Posted March 31, 2017

A 10-year global study involving QUT has found that survival outcomes after hysterectomies performed by keyhole surgery are just as good – and safer – for women with endometrial cancer as the more invasive total abdominal hysterectomy.

The study monitored 760 women in Australia, New Zealand and Hong Kong who had undergone either a total abdominal hysterectomy (TAH), involving an incision in the abdomen, or a total laparoscopic hysterectomy (TLH) performed through three or four small incisions.

QUT researcher Professor Monika Janda (pictured below) is lead author of an article on the findings of the LACE trial (Laparoscopic Approach to Cancer of the Endometrium) released in JAMA (Journal of the American Medical Association).

Professor Monika Janda. Credit: QUT

She said women had traditionally been told a TAH was a safer operation with better long-term outcomes, even though a TLH had quicker recovery time due to its less invasive nature.

“This is the end of a 10-year study and it really does give reassurance to women who have to have a hysterectomy,” she said.

“When we started our research back in 2005 there were strong opinions against total laparoscopic hysterectomies, with some clinicians warning that women would suffer harm from this new surgical technique.

“This study has now proven that a woman with endometrial cancer can have a total laparoscopic hysterectomy through keyhole surgery, have much better short-term results and her long-term outcome is just as good as a woman who has a total abdominal hysterectomy.

“The five-year post-operation survival rates are virtually identical. Of the women who completed the study, 81.6 per cent who had a laparoscopic hysterectomy were disease-free four-and-a-half years later, compared to 81.3 per cent of women who had an abdominal hysterectomy.

“Our previous ‘quality of life’ study released in 2010 has already found that the short-term, quality of life benefits of TLH surgery are much better when compared to TAH because women returned to physical and function wellbeing quicker.

“Taken together, these two key papers show women that if they have a laparoscopic hysterectomy they can have an excellent outcome.

“Given its better short-term outcomes, combined with the equivalent survival rates, total laparoscopic hysterectomies should be considered the standard of care for patients with early endometrial cancer.”

Endometrial cancer is the most common gynaecological malignancy in developed countries, and 80 per cent of cases are diagnosed at early stages.  The main treatment of early-stage endometrial cancer is surgery.

The clinical leader of the study, Professor Andreas Obermair from the Queensland Centre for Gynaecological Cancer at The University of Queensland, said the study had already made an impact in the operating theatre.  He said it had helped increase the number of laparoscopic hysterectomies being performed because results had filtered down through the 27 surgeons who took part, and their colleagues, as the trial progressed.

“In part because of this trial, now almost every gynaecological cancer unit in Australia is offering laparoscopic hysterectomies,” he said.

QUT health economist Professor Nick Graves, who was also an author on the new LACE paper, said the university had previously shown there were tangible economic benefits via a linked study that he led researching the cost for hysterectomies.

“The results of that study were released in 2013 found that although the initial surgery costs for laparoscopic hysterectomies were higher, we found the overall cost to the health system was less because patients needed fewer hospital bed days and had higher quality-adjusted life years after surgery,” Professor Graves said.

“There was a $3000 saving for every surgery performed as a total laparoscopic hysterectomy compared to a total abdominal hysterectomy.”

Professor Janda and Professor Graves are both members of QUT’s Institute of Health and Biomedical Innovation and QUT’s School of Public Health and Social Work.

Professor Obermair said the study was a success for Australian women and thanked his colleagues from around Australia, New Zealand and Hong Kong, the study funders, as well as all those patients who volunteered to be part of the research.

“Only through the generosity of these women can we can reassure patients that they receive optimal treatment for their cancer through a laparoscopic procedure,” he said.

Source: QUT

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