Originally published as JCO Early Release 10.1200/JCO.2009.22.3529 on October 5 2009

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Quality of Life of Patients With Endometrial Cancer Undergoing Laparoscopic International Federation of Gynecology and Obstetrics Staging Compared With Laparotomy: A Gynecologic Oncology Group Study

From the Division of Women's Cancers, Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; Gynecology Oncology Group Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY; Department of Obstetrics and Gynecology, Oklahoma University of Health Science Center, Oklahoma City, OK; Women's Cancer Center of Nevada, University of Nevada School of Medicine, Las Vegas, NV; Gynecologic Oncology Associates, Rush-Presbyterian-St Luke's Medical Center, Chicago; and Center on Outcomes, Research and Education, Evanston Northwestern Healthcare, Evanston, IL.

Corresponding author: Alice B. Kornblith, PhD, Division of Women's Cancers, Dana-Farber Cancer Institute, 44 Binney St, LW 231, Boston, MA 02115; e-mail: alice_kornblith{at}dfci.harvard.edu.

Purpose The study's objective was to compare the quality of life (QoL) of patients with endometrial cancer undergoing surgical staging via laparoscopy versus laparotomy.

Patients and Methods The first 802 eligible patients (laparoscopy, n = 535; laparotomy, n = 267) participated in the QoL study in a Gynecologic Oncology Group (GOG) randomized trial of laparoscopy versus laparotomy (GOG 2222). Patients completed QoL assessments at baseline; at 1, 3, and 6 weeks; and at 6 months postsurgery.

Results In an intent-to-treat analysis, laparoscopy patients reported significantly higher Functional Assessment of Cancer Therapy–General (FACT-G) scores (P = .001), better physical functioning (P = .006), better body image (BI; P < .001), less pain (P < .001) and its interference with QoL (P < .001), and an earlier resumption of normal activities (P = .003) and return to work (P = .04) over the 6-week postsurgery period, as compared with laparotomy patients. However, the differences in BI and return to work between groups were modest, and the adjusted FACT-G scores did not meet the minimally important difference (MID) between the two surgical arms over 6 weeks. By 6 months, except for better BI in laparoscopy patients (P < .001), the difference in QoL between the two surgical techniques was not statistically significant.

Conclusion Although the FACT-G did not show a MID between the two surgical groups, and only modest differences in return to work and BI were found between the two groups, statistically significantly better QoL across many parameters in the laparoscopy arm at 6 weeks provides modest support for the QoL advantage of using laparoscopy to stage patients with early endometrial cancer.

See accompanying editorial on page 5305 and article on page 5331

Supported by National Cancer Institute grants to the Gynecologic Oncology Group (GOG) Administrative Office (Grant No. CA 27469) and the GOG Statistical and Data Center (Grant No. CA 37517). J.L.W. was supported by GOG.

Presented in part at the Society of Gynecologic Oncology 37th Annual Meeting on Women's Cancer, March 22-26, 2006, Palm Springs, CA.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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