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Objectives . We compared postoperative analgesic requirements between women with early stage endometrial cancer treated by total abdominal hysterectomy (TAH) or total laparoscopic hysterectomy (TLH).  Methods . 760 patients with apparent stage I endometrial cancer were treated in the international, multicentre, prospective randomised trial (LACE) by TAH ( n  = 353) or TLH ( n  = 407) (2005–2010). Epidural, opioid, and nonopioid analgesic requirements were collected until ten months after surgery.  Results . Baseline demographics and analgesic use were comparable between treatment arms. TAH patients were more likely to receive epidural analgesia than TLH patients (33% versus 0.5%,  P  < 0.001) during the early postoperative phase. Although opioid use was comparable in the TAH versus TLH groups during postoperative 0–2 days (99.7% versus 98.5%,  P  = 0.09), a significantly higher proportion of TAH patients required opioids 3–5 days (70% versus 22%,  P  < 0.0001), 6–14 days (35% versus 15%,  P  < 0.0001), and 15–60 days (15% versus 9%,  P  = 0.02) after surgery. Mean pain scores were significantly higher in the TAH versus TLH group one (2.48 versus 1.62,  P  < 0.0001) and four weeks (0.89 versus 0.63,  P  = 0.01) following surgery.  Conclusion . Treatment of early stage endometrial cancer with TLH is associated with less frequent use of epidural, lower post-operative opioid requirements, and better pain scores than TAH.

minimally invasive surgery

Differences in Epidural and Analgesic Use in Patients with Apparent Stage I Endometrial Cancer Treated by Open versus Laparoscopic Surgery: Results from the Randomised LACE Trial