Laparoscopic hysterectomy remains the standard treatment option globally, for early-stage endometrial cancer. However, the literature on long-term survival, particularly when no lymphadenectomy is performed, is lacking. 

A Follow-up, multi-centre, randomized controlled trial study compared the survival outcomes of total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH), both without lymphadenectomy, for early-stage endometrial cancer up to 5 years postoperatively.

The participants of the study saw 2:1 randomization to TLH or TAH. Outcomes assessed were disease-free survival (DFS), overall survival (OS), disease-specific survival (DSS), and primary site of recurrence. 

The following observations were made-

• 279 women underwent a surgical procedure, among whom 94% had follow-up data. 
• TLH and TAH groups reported DFS (90.3% vs 84.1%), OS (89.2% vs 82.8%), and DSS (95.0% vs 89.8%) respectively, in 5 years.
• All three outcomes rejected the null hypothesis of inferiority. 
• No port-site or wound metastases were reported
• Local recurrence rates were comparable.

Thus the Disease recurrence and 5-year survival rates are identical between the TLH and TAH groups. These are also comparable to studies with lymphadenectomy, backing the overall use of TLH without lymphadenectomy as the primary treatment for early-stage, low-grade endometrial cancer.

Source- Gynecol Oncol. 2021 Dec 23; S0090-8258(21)01676-0.