Long-term uterine cancer survival similar with laparoscopic, open hysterectomy

Last Updated: 2016-02-05

By Anne Harding

NEW YORK (Reuters Health) - Long-term overall and cancer-specific survival is similar for endometrial cancer patients who undergo minimally invasive hysterectomy and those treated with abdominal hysterectomy, a large population-based study shows.

The result "suggests for the long run it's a safe operation from a cancer standpoint," Dr. Jason D. Wright of Columbia University in New York City, the first author of the new study, told Reuters Health. The study also showed a "fairly dramatic" increase in the use of the procedure since 2006, Dr. Wright added.

The findings were published online February 1 in the Journal of Clinical Oncology.

Laparoscopic hysterectomy, introduced in the 1990s, and robot-assisted hysterectomy, which entered clinical practice in the mid-2000s, appear to have a lower risk of morbidity compared to traditional abdominal hysterectomy, Dr. Wright and his team note in their report. But risks of these less-invasive procedures could include metastases to port sites and disruption of the uterus during surgery, they add.

To compare long-term, real-world outcomes of the different approaches, the researchers used SEER-Medicare data on more than 6,300 women who underwent hysterectomy for stage I-III uterine cancer from 2006 to 2011. About two-thirds underwent abdominal hysterectomy, and the remaining third had minimally invasive hysterectomy.

The percentage of minimally invasive hysterectomies jumped from 9.3% in 2006 to 61.7% in 2011, the researchers found. Most of the minimally invasive procedures (62.3%) were robot-assisted.

Overall complication rates were 22.7% for minimally invasive procedures versus 39.7% for abdominal hysterectomy (p<0.001). Perioperative mortality was 0.6% and 1.1%, respectively. However, the researchers found, more women treated with minimally invasive surgery had adjuvant pelvic radiotherapy (34.3% vs. 31.3%) and brachytherapy (33.6% vs. 31.0%).

Complication rates with robot-assisted hysterectomy were 23.7% with robot-assisted surgery, versus 19.5% for laparoscopic hysterectomy (p=0.03). Rates of intraoperative complications, surgical complications, and transfusions were similar for the two groups, but medical complications were significantly higher for robot-assisted surgery (14.1% vs. 10.0%).

The researchers found no increased risk of cancer-specific or overall mortality with minimally invasive hysterectomy, and overall and cancer-specific survival were also similar for robot-assisted versus laparoscopic procedures.

The analysis also identified disparities with minimally invasive surgery use. Higher socioeconomic status and treatment at a larger or intermediate-volume hospital were associated with greater use of minimally invasive hysterectomy, while patients treated in the Midwest, those with higher-stage tumors, and those with more medical comorbidities were less likely to receive minimally invasive treatment.

The small increased risk of medical complications with robot-assisted surgery should be monitored moving forward, Dr. Wright said. This could reflect the fact that robot-assisted procedures are technically more challenging, he added.

He and his colleagues also plan to investigate why patients treated with minimally invasive surgery were more likely to have radiation.

SOURCE: bit.ly/1L32gvM

J Clin Oncol 2016.