A Comparison of Outcomes Between Open Hysterectomy and Robotic-Assisted Hysterectomy for Endometrial Cancer Using the National Cancer Database. Issue 7 (1st September 2017)

• Record Type: Journal Article
• Authors: Safdieh, Joseph; Lee, Yi-Chun; Wong, Andrew; Lee, Anna; Weiner, Joseph P.; Schwartz, David; Schreiber, David
• Is Part Of: International journal of gynecological cancer. Volume 27:Issue 7(2017)
• Page Start: 1508
• Page End: 1516
• Publication Date: 2017-09-01
• Subjects: Endometrial cancer -- Robotic surgery -- National Cancer Database; Generative organs, Female -- Cancer -- Periodicals; 616.99465
• DOI: 10.1097/IGC.0000000000001034
• Languages: English
• ISSNs: 1048-891X

Abstract

Abstract : Purpose: The purpose of this study is to evaluate usage patterns and outcomes of women who underwent open hysterectomy (OH) versus robotic assisted-hysterectomy (RAH) for the treatment of endometrial cancer. Methods: Women with nonmetastatic endometrial adenocarcinoma diagnosed between 2010 and 2012, who either underwent an OH or RAH, were selected from the National Cancer Database. The χ 2, Fisher exact, or Mann-Whitney U tests were used where appropriate to compare outcomes between groups. Multivariable logistic regression was used to analyze for predictors for RAH and other outcome variables. Results: A total of 43, 985 women were included in this study with a median age of 61 years. Of these, 23, 872 (54.3%) underwent RAH and 20, 113 (45.7%) underwent OH. The usage of RAH increased from 43.0% in 2010 to 63.8% in 2012 ( P < 0.001). Women receiving RAH were more commonly found to have a Charlson comorbidity score of 0 to 1, lower pathologic stage, nonblack race, treatment at a comprehensive center, and had insurance other than Medicaid. Robotic-assisted hysterectomy was associated with a shorter inpatient stay, lower readmission rates, and lower 30- and 90-day mortality rates ( P < 0.001 for all comparisons). There was a significant improvement in overall survival favoring RAH, 96.1% versus 94.0%, which persisted on multivariable logistic regression ( P < 0.001). Conclusions: In this large, hospital-based analysis, RAH was associated with decreased length of stay, lower readmission rates, and less perioperative mortality. However, socioeconomic status continues to remain a barrier to equal treatment allocation. Overall survival was improved with RAH, but the follow-up is limited, and this finding must be interpreted with caution.