Use and outcomes of minimally invasive hysterectomy for women with nonendometrioid endometrial cancers

Abstract

Background: Minimally invasive hysterectomy is now used routinely for women with uterine cancer. Most studies of minimally invasive surgery for endometrial cancer have focused on low-risk endometrioid tumors, with few reports of the safety of the procedure for women with higher risk histologic subtypes.

Objective: The purpose of this study was to examine the use of and survival associated with minimally invasive hysterectomy for women with uterine cancer and high-risk histologic subtypes.

Study design: We used the National Cancer Database to identify women with stages I-III uterine cancer who underwent hysterectomy from 2010-2014. Women with serous carcinomas, clear cell carcinomas, and sarcomas were examined. Women who had laparoscopic or robotic-assisted hysterectomy were compared with those who underwent open abdominal hysterectomy. After a propensity score inverse probability of treatment weighted analysis, the effect of minimally invasive hysterectomy on overall, 30-day, and 90-day mortality rates was examined for each histologic subtype of uterine cancer.

Results: Of 94,507 patients who were identified, 64,417 patients (68.2%) underwent minimally invasive hysterectomy. Among women with endometrioid tumors (n=81,115), 70.8% underwent minimally invasive hysterectomy. The rates of minimally invasive surgery in those women with nonendometrioid tumors (n=13,392) was 57.6% for serous carcinomas, 57.0% for clear cell tumors, 47.3% for sarcomas, 32.2% for leiomyosarcomas, 47.9% for stromal sarcomas, and 48.5% for carcinosarcomas. Performance of minimally invasive surgery increased across all histologic subtypes between 2010 and 2014. For nonendometrioid subtypes, robotic-assisted procedures accounted for 47.9-75.7% of minimally invasive hysterectomies by 2014. In a multivariable model, women with nonendometrioid tumors were less likely to undergo minimally invasive surgery than those with endometrioid tumors (P<.05). There was no association between route of surgery and 30-day, 90-day, or overall mortality rates for any of the nonendometrioid histologic subtypes.

Conclusion: The use of minimally invasive surgery is increasing rapidly for women with stage I-III nonendometrioid uterine tumors. Performance of minimally invasive surgery does not appear to impact survival adversely.

Keywords: cancer; endometrial hysterectomy; laparoscopic; robotic-assisted; uterine.