Minimally invasive hysterectomy surgery rates for endometrial cancer performed at National Comprehensive Cancer Network (NCCN) Centers |
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Authors: | Jennifer Bergstrom Alessia Aloisi Shannon Armbruster Ting-Tai Yen Jvan Casarin Mario M. Leitao Edward J. Tanner Rayna Matsuno Karime Kalil Machado Sean C. Dowdy Pamela T. Soliman Stephanie L. Wethington Rebecca L. Stone Kimberly L. Levinson Amanda N. Fader |
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Affiliation: | 1. Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA;2. Department of Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA;3. Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA;4. Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, USA;5. Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA;6. Moores Cancer Center, University of California, San Diego, La Jolla, CA, USA |
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Abstract: | ObjectivesMinimally invasive surgery (MIS) is a quality measure for endometrial cancer (EC) established by the Society of Gynecologic Oncology and the American College of Surgeons. Our study objective was to assess the proportion of EC cases performed by MIS at National Comprehensive Cancer Network (NCCN) centers and evaluate perioperative outcomes.MethodsA retrospective cohort study of women who underwent surgical treatment for EC from 2013 to 2014 was conducted at four NCCN centers. Multivariable mixed logistic regression models analyzed factors associated with failure to perform MIS and perioperative complications.ResultsIn total 1621 patients were evaluated; 86.5% underwent MIS (robotic-assisted 72.5%, laparoscopic 20.9%, vaginal 6.6%). On multivariable analysis, factors associated with failure to undergo MIS were uterine size > 12 cm (Odds Ratio [OR]: 0.17, 95% CI 0.03–0.9), stage III (OR: 0.16, 95% CI 0.05–0.49) and IV disease (OR: 0.07, 95% CI 0.02–0.22). For stage I/II disease, complications occurred in 5.1% of MIS and 21.7% of laparotomy cases (p < 0.01). Laparotomy was associated with increases in any complication (OR: 6.0, 95% CI 3.3–10.8), gastrointestinal (OR: 7.2, 95% CI 2.6–19.5), wound (OR: 3.7, 95% CI 1.5–9.2), respiratory (OR 37.5, 95% CI 3.9–358.0), VTE (OR 10.5, 95% CI 1.3–82.8) and 30-day readmission (OR: 2.6, 95% CI 1.4–4.9) compared to MIS.ConclusionsAt NCCN-designated centers, the MIS hysterectomy rate in EC is higher than the published national average, with low perioperative complications. Previously identified disparities of age, race, and BMI were not observed. A proposed MIS hysterectomy benchmark of > 80% in EC care is feasible when performed at high volume centers. |
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Keywords: | Corresponding author at: Johns Hopkins University School of Medicine 600 N. Wolfe St Phipps 287 Baltimore MD 21287 USA. |
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