Laparoscopy or laparotomy for endometrial cancer? A review of three prospective randomised trials

The incidence of endometrial cancer is increasing throughout the world, and an appropriate safe and cost-effective surgical management is debated between traditional laparotomy and laparoscopy. Recently, three large prospective randomised controlled trials have been published comparing both modalities. The inclusion criteria for these studies are quite different, and whilst many of the outcomes reported are similar, some such as blood loss, complications, length of stay and quality of life (QoL) may have suffered as a result of selection bias. Some of these biases include differences in the stage of patients included, tumour grade, tumour histology, performance status, the requirement to undertake and complete surgical staging and the methodology of QoL assessment. An overall analysis of these studies shows that whilst there are advantages (and disadvantages) to both surgical approaches, overall there is no convincing evidence of the superiority of one surgical approach over the other. What is probably more important for the individual surgeon consenting a patient for surgery is to offer an approach consistent with good oncological outcomes.