Minimally invasive hysterectomy surgery rates for endometrial cancer performed at National Comprehensive Cancer Network (NCCN) Centers

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

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

Objectives: Minimally 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. Methods: A 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. Results: In 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. Conclusions: At 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.

Original languageEnglish (US)
Pages (from-to)480-484
Number of pages5
JournalGynecologic oncology
Volume148
Issue number3
DOIs
StatePublished - Mar 2018

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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