Use of minimally invasive hysterectomy in patients with endometrial cancer, on the rise since 2007, has long-term survival rates comparable to those of abdominal hysterectomy, and a favorable morbidity profile.
Minimally invasive hysterectomy had similar overall mortality (hazard ratio[HR], 0.89; 95% CI, 0.75 to 1.04) and cancer-specific mortality (HR, 0.83; 95% CI, 0.59-1.16), compared with abdominal hysterectomy. Robot-assisted hysterectomy, compared with laparoscopic, had similar overall and cancer-specific mortality.
Adjuvant radiation was increased in women who underwent minimally invasive compared with abdominal hysterectomy (for pelvic radiation 34.3% vs. 31.3%; odds ratio[OR], 1.14; 95% CI, 1.04-1.26; for brachytherapy 33.6% vs. 31.0%; OR, 1.13; 95% CI, 1.03-1.24).
“The mechanism underlying the need for increased use of adjuvant therapy after minimally invasive hysterectomy remains unclear ... Particularly for women with large uteri, manipulation at the time of surgery or disruption or spillage of tumor from the uterine cavity may prompt use of radiation. This phenomenon warrants further investigation and careful monitoring,” wrote Dr. Jason Wright, chief of gynecologic oncology at Columbia University College of Physicians and Surgeons, New York, and colleagues (J Clin Oncol. 2016 Feb 1. doi: 10.1200/JCO.2015.65.3212).
Dr. Jason Wright
The population-based analysis used SEER-Medicare data of 6,305 patients aged 65 years and greater with stage I-III uterine cancer who underwent hysterectomy from 2006 to 2011. In total, 4,139 (65.7%) underwent abdominal hysterectomy and 2,165 (34.3%) underwent minimally invasive surgery.
Results showed that the use of minimally invasive hysterectomy has increased from 9.3% in 2006 to 61.7% in 2011, and over 60% of the minimally invasive surgeries were robot-assisted.
Minimally invasive hysterectomy had fewer complications than did abdominal hysterectomy (22.7% vs. 39.7%; OR, 0.46; 95% CI, 0.41-0.51), including lower rates of surgical site complications, medical complications, transfusions, and perioperative mortality.
Robot-assisted hysterectomy had a slightly higher complication rate than did laparoscopic hysterectomy (23.7% vs. 19.5%; OR 1.28; 95% CI, 1.03-1.59), due to postoperative medical complications. Respiratory and renal failure were higher after robot-assisted surgery, as was bacteremia. The complications may be a result of longer operative times, as reported in previous studies.