Endometrial Cancer: Minimally Invasive vs Abdominal Hysterectomy

Minimally invasive hysterectomy does not appear to compromise long-term survival compared with abdominal hysterectomy.
Minimally invasive hysterectomy does not appear to compromise long-term survival compared with abdominal hysterectomy.

Minimally invasive hysterectomy does not appear to compromise long-term survival compared with abdominal hysterectomy in women with endometrial cancer, a study published in the Journal of Clinical Oncology has shown.1

Despite the potential benefits of minimally invasive hysterectomy for endometrial cancer, there is a lack of population-level data surrounding the procedure's safety in unselected patients. Therefore, researchers at Columbia University and New York Presbyterian Hospital in New York sought to examine the use of minimally invasive surgery and the impact of the route of the procedure on long-term survival.

For the study, researchers analyzed data from 6304 women with stage 1 to 3 uterine cancer from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Of those, 4139 underwent abdominal hysterectomy and 2165 underwent minimally invasive laproscopic or robot-assisted hysterectomy.

Results showed that performance of minimally invasive hysterectomy increased from 9.3% in 2006 to 61.7% in 2011, of which robot-assisted procedures accounted for 62.3%.

Researchers found that minimally invasive hysterectomy was associated with a lower overall complication rate (22.7% vs 39.7%; P<.001) and lower perioperative mortality (0.6% vs 1.1%) than abdominal hysterectomy; however, women who underwent the minimally invasive operation were more likely to receive adjuvant pelvic radiotherapy (34.3% vs 31.3%) and brachytherapy (33.6% vs 31.0%; P<.05).

When looking specifically at minimally invasive procedures, researchers observed the complication rate to be higher after robot-assisted hysterectomy compared with laparoscopic hysterectomy (23.7% vs 31.3%; P=.03).

The study also demonstrated that there was no association between the use of minimally invasive hysterectomy and either overall or cancer-specific mortality.

REFERENCE

1. Wright JD, Burke WM, Tergas AI, et al. Comparative effectiveness of minimally invasive hysterectomy for endometrial cancer [published online ahead of print February 1, 2016]. J Clin Oncol. doi:10.1200/JCO.2015.65.3212.

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