Grand Rounds

Comparing Minimally Invasive to Open Surgery for Endometrial Cancer

BACKGROUND AND PURPOSE:

Benefits associated with minimally invasive surgery (benign and malignant) include
- Less blood loss and need for transfusion
- Decreased postoperative pain
- Shorter hospital stay
- Better quality of life
Casarin et al. (Obstetrics & Gynecology, 2018) examined how the widespread adoption of minimally invasive surgery in the US has affected 30-day morbidity and mortality related to endometrial cancer treatment

Retrospective cohort study
Patients undergoing hysterectomy for early-stage endometrial cancer were collected from the American College of Surgeons’ National Surgical Quality Improvement Project
The following endometrial cancer treatment approaches were analyzed
- Laparotomy
- Vaginal surgery
- Minimally invasive surgery
30-day outcomes were compared between patients who had minimally invasive surgery and open surgery

Data was collected from 12,283 patients
There was a significant implementation of minimally invasive surgery (24.2-71.4%) and decrease in open surgery through laparotomy (71.1-26.4%) between 2008 and 2014 (bothP<.001)
Rate of vaginal surgery remained constant over time (1.5–2.2%,P=.06)
After adjusting for possible confounders, open surgery compared to minimally invasive surgery was independently associated with
- Increased odds of major complications
  - Adjusted odds ratio (OR) 2.4; 95% CI 2.0–2.8
- Readmission
  - Adjusted OR 2.2;95% CI 1.8–2.6
- Reoperation
  - Adjusted OR 1.5; 95% CI 1.2–2.1
- Superficial surgical site infection
  - Adjusted OR 6.8; 95% CI 5.0–9.2
- Perioperative transfusion
  - Adjusted OR 5.9; 95% CI 4.8–7.1
- Death
  - Adjusted OR 3.8; 95% CI 2.2–6.6

The use of minimally invasive surgery in the treatment for endometrial cancer has been associated with decreased 30-day morbidity and mortality
The increased use of minimally invasive surgery can be attributed to increased knowledge and also availability of robotics

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