Study Finds No Adverse Impact of Minimally Invasive Hysterectomy on Long-Term Survival in Endometrial Cancer


Key Points

  • Minimally invasive hysterectomy was associated with a lower overall complication rate, according to a study of women with stage I to III uterine cancer.
  • No significant difference in overall or cancer-specific mortality was observed with minimally invasive vs abdominal hysterectomy.

Use of minimally invasive hysterectomy did not seem to have an adverse impact on long-term survival in women with endometrial cancer, according to an analysis reported in the Journal of Clinical Oncology by Wright et al.

Study Details

The study involved Surveillance, Epidemiology, and End Result (SEER)-Medicare data on 6,304 women with stage I to III uterine cancer who underwent hysterectomy from 2006 to 2011. Of them, 4,139 (66%) had abdominal hysterectomy and 2,165 had laparoscopic or robot-assisted (minimally invasive) hysterectomy. Use of minimally invasive procedures increased from 9.3% in 2006 to 61.7% in 2011, with robot-assisted procedures accounting for 62.3% of minimally invasive procedures overall.

Complications and Survival

In an analysis using propensity score balancing, compared with abdominal hysterectomy, minimally invasive hysterectomy was associated with a lower overall complication rate (22.7% vs 39.7%, P < .001) and a lower surgical complication rate (8.8% vs 23.1%, P < .001), lower perioperative mortality (0.6% vs 1.1%, P = .03), and greater use of adjuvant pelvic radiotherapy (34.3% vs 31.3%, P  = .01) and brachytherapy (33.6% vs 31.0%, P = .01). Compared with robot-assisted hysterectomy, the overall complication rate was lower with laparoscopic hysterectomy (19.5% vs 23.7%, P = .03).

There was no significant difference for minimally invasive vs abdominal hysterectomy in overall mortality (hazard ratio [HR] = 0.89, 95% confidence interval [CI] = 0.75–1.04) or cancer-specific mortality (HR = 0.83, 95% CI = 0.59–1.16) in an analysis with propensity score balancing or after additional adjustment for adjuvant treatment (HRs = 0.81, 95% CI = 0.58–1.14, and 0.88, 95% CI = 0.75–1.04).

The investigators concluded: “Minimally invasive hysterectomy does not appear to compromise long-term survival for women with endometrial cancer.”

The study was supported by grants from the National Cancer Institute.

Jason D. Wright, MD, of Columbia University College of Physicians and Surgeons, New York, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.