Minimally invasive hysterectomies did not appear to compromise the long-term survival of women with endometrial cancer, according to results of an analysis of the SEER–Medicare database.
“This study adds to the literature that suggests that minimally invasive hysterectomy is associated with fewer perioperative complications than open hysterectomy for endometrial cancer,” Jason D. Wright, MD, chief of the division of gynecologic oncology and the Sol Goldman associate professor of obstetrics and gynecology at Columbia University College of Physicians and Surgeons and NewYork-Presbyterian Hospital, told HemOnc Today. “Importantly, we also found that long-term outcomes are not compromised with minimally invasive hysterectomy — survival was similar for women whether they underwent an open or minimally invasive hysterectomy.”
Jason D. Wright
Surgical management is the standard for endometrial cancer. Most patients have a hysterectomy combined with a salpingo-oophorectomy and sometimes a lymphadenectomy. These procedures are often performed through an abdominal laparotomy, which is associated with perioperative morbidity and mortality.
Laparoscopic hysterectomies — and especially robot-assisted hysterectomies — are alternative surgical options associated with decreased morbidity. However, because these surgeries are challenging and due to the risk for metastases at port sites and disruption of the uterus, uptake of minimally invasive surgery has been slow in this setting.
Wright and colleagues conducted a population-based analysis comparing minimally invasive surgery to abdominal hysterectomy for uterine cancer. They examined trends in the use of minimally invasive surgery as well as the association between the procedure and long-term survival.
Using the SEER–Medicare database, the investigators identified 6,304 women aged 65 years or older with stage I to stage III uterine cancer who underwent a hysterectomy between 2006 and 2011. Overall, 65.7% underwent an abdominal hysterectomy and 34.3% underwent a minimally invasive hysterectomy.
The researchers noted that the rate of minimally invasive hysterectomies increased from 9.3% (95% CI, 7.6-11) in 2006 to 61.7% (95% CI, 58.7-64.8) in 2011. Further, robot-assisted hysterectomies accounted for 62.3% of the minimally invasive surgeries.
The minimally invasive procedures had a lower overall complication rate than the abdominal hysterectomies (22.7% vs. 39.7%; OR = 0.46; 95% CI, 0.41-0.51). Likewise, they were associated with a lower risk for perioperative mortality (OR = 0.57; 95% CI, 0.34-0.95).
A greater proportion of women undergoing a minimally invasive procedure also received adjuvant radiotherapy to the pelvis (34.3% vs. 31.3%; OR = 1.14; 95% CI, 1.04-1.26) and/or brachytherapy (33.6% vs. 31%; OR = 1.13; 95% CI, 1.03-1.24).
The complication rate appeared higher among those undergoing the robot-assisted procedure than laparoscopic hysterectomy (23.7% vs. 19.5%; OR = 1.28; 95% CI, 1.03-1.59).
There was no association between the minimally invasive procedure and overall mortality (HR = 0.89; 95% CI, 0.75-1.04) or cancer-specific mortality (HR = 0.83; 95% CI, 0.59-1.16).
This study had several limitations. Claims data undercaptures complications, which presents a selection bias. Secondly, the analysis is limited to Medicare beneficiaries and may not be generalizable to all women.
Additionally, because survival is favorable for early-stage endometrial cancer, the study was not powered to detect small survival differences between groups.
“These data are reassuring and support that minimally invasive surgery for uterine cancer offers superior short-term outcomes without compromising survival for women,” Wright said. – by Anthony SanFilippo
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Jason D. Wright, MD, can be reached at email@example.com.
Disclosure: Wright reports no relevant financial disclosures. Two researchers report consultant/advisory roles with EHE International, Helomics, Otsuka, Pfizer, Teva and United Biosource Cooperation and stock or other ownership in Stemline Therapeutics.