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Grand Rounds

Comparing Minimally Invasive to Open Surgery for Endometrial Cancer

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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 

METHODS: 

  • 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 

RESULTS: 

  • 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 

CONCLUSION: 

  • 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 

Learn More – Primary Sources: 

Adoption of Minimally Invasive Surgery and Decrease in Surgical Morbidity for Endometrial Cancer Treatment in the United States

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Related ObG Topics:

Ovarian or Endometrial Cancer? Consider Lynch Syndrome
Endometrial Cancer: Beyond The Basics
TLH vs. TAH for Endometrial Cancer – Results from the LACE trial  
ProMisE Study: Genetic Basis for Classifying Endometrial Cancer
Is Progesterone Therapy an Effective Treatment for Endometrial Cancer?

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