Determinants of Surgical Approach and Survival Among Women with Endometrial Carcinoma

Abstract

Study objective: To investigate determinants of surgical approach among women with endometrial carcinoma (EC) and associations between surgical approach and overall survival (OS).

Design: Retrospective cohort.

Setting: The National Cancer Database, 2010 to 2015.

Patients: A total of 140 470 patients with histologically confirmed EC who underwent hysterectomy.

Interventions: Patients were grouped according to surgical approach.

Measurements and main results: A total of 140 470 patients with EC were included. Robotic-assisted laparoscopy (RAL) was the most common surgical approach (48.8%), followed by laparotomy (33.6%) and traditional laparoscopy (17.6%). Use of RAL increased over the study period, and the percentages of cases managed by laparotomy decreased. Older women, those with insurance, residing in ZIP codes with lower proportions of individuals who did not graduate from high school, and those treated at noncommunity cancer programs were less likely to undergo laparotomy than RAL, and non-white women, those diagnosed with high-grade histology, and those with advanced-stage EC were more likely to undergo laparotomy than RAL. Compared with RAL, all other surgical approaches were associated with worse OS (laparotomy: hazard ratio 1.21; 95% confidence interval, 1.18-1.25; traditional laparoscopy: hazard ratio 1.06; 95% confidence interval, 1.02-1.09). Significant effect modification of the surgical approach and OS relationship according to age, race, histology, stage, and adjuvant treatment was observed.

Conclusion: RAL increased in frequency over the study period and was associated with improved OS, supporting the continued use of RAL for EC management.

Keywords: Effect modification; Endometrial carcinoma; Laparoscopic surgery; Robotic surgery.