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 Christopher Dowdy, Pamela T. Soliman, Stephanie L. Wethington, Rebecca L. Stone, Kimberly L. Levinson, Amanda N. Fader

Research output: Contribution to journalArticle

13 Citations (Scopus)

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)
JournalGynecologic Oncology
DOIs
StateAccepted/In press - Jan 1 2018

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Minimally Invasive Surgical Procedures
Endometrial Neoplasms
Hysterectomy
Neoplasms
Odds Ratio
Logistic Models
Robotics
Laparotomy
Cohort Studies
Retrospective Studies

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Minimally invasive hysterectomy surgery rates for endometrial cancer performed at National Comprehensive Cancer Network (NCCN) Centers. / Bergstrom, Jennifer; Aloisi, Alessia; Armbruster, Shannon; Yen, Ting Tai; Casarin, Jvan; Leitao, Mario M.; Tanner, Edward J.; Matsuno, Rayna; Machado, Karime Kalil; Dowdy, Sean Christopher; Soliman, Pamela T.; Wethington, Stephanie L.; Stone, Rebecca L.; Levinson, Kimberly L.; Fader, Amanda N.

In: Gynecologic Oncology, 01.01.2018.

Research output: Contribution to journalArticle

Bergstrom, J, Aloisi, A, Armbruster, S, Yen, TT, Casarin, J, Leitao, MM, Tanner, EJ, Matsuno, R, Machado, KK, Dowdy, SC, Soliman, PT, Wethington, SL, Stone, RL, Levinson, KL & Fader, AN 2018, 'Minimally invasive hysterectomy surgery rates for endometrial cancer performed at National Comprehensive Cancer Network (NCCN) Centers', Gynecologic Oncology. https://doi.org/10.1016/j.ygyno.2018.01.002
Bergstrom, Jennifer ; Aloisi, Alessia ; Armbruster, Shannon ; Yen, Ting Tai ; Casarin, Jvan ; Leitao, Mario M. ; Tanner, Edward J. ; Matsuno, Rayna ; Machado, Karime Kalil ; Dowdy, Sean Christopher ; Soliman, Pamela T. ; Wethington, Stephanie L. ; Stone, Rebecca L. ; Levinson, Kimberly L. ; Fader, Amanda N. / Minimally invasive hysterectomy surgery rates for endometrial cancer performed at National Comprehensive Cancer Network (NCCN) Centers. In: Gynecologic Oncology. 2018.
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title = "Minimally invasive hysterectomy surgery rates for endometrial cancer performed at National Comprehensive Cancer Network (NCCN) Centers",
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.",
author = "Jennifer Bergstrom and Alessia Aloisi and Shannon Armbruster and Yen, {Ting Tai} and Jvan Casarin and Leitao, {Mario M.} and Tanner, {Edward J.} and Rayna Matsuno and Machado, {Karime Kalil} and Dowdy, {Sean Christopher} and Soliman, {Pamela T.} and Wethington, {Stephanie L.} and Stone, {Rebecca L.} and Levinson, {Kimberly L.} and Fader, {Amanda N.}",
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doi = "10.1016/j.ygyno.2018.01.002",
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journal = "Gynecologic Oncology",
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T1 - Minimally invasive hysterectomy surgery rates for endometrial cancer performed at National Comprehensive Cancer Network (NCCN) Centers

AU - Bergstrom, Jennifer

AU - Aloisi, Alessia

AU - Armbruster, Shannon

AU - Yen, Ting Tai

AU - Casarin, Jvan

AU - Leitao, Mario M.

AU - Tanner, Edward J.

AU - Matsuno, Rayna

AU - Machado, Karime Kalil

AU - Dowdy, Sean Christopher

AU - Soliman, Pamela T.

AU - Wethington, Stephanie L.

AU - Stone, Rebecca L.

AU - Levinson, Kimberly L.

AU - Fader, Amanda N.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

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