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Laparoscopic Versus Abdominal Hysterectomy for Endometrial Cancer: Comparison of Patient Outcomes
  1. Gary S. Leiserowitz, MD*,
  2. Guibo Xing, PhD*,
  3. Arti Parikh-Patel, PhD,
  4. Rosemary Cress, DrPH,
  5. Alireza Abidi, MD*,
  6. Anne O. Rodriguez, MD* and
  7. John L. Dalrymple, MD*
  1. *Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Davis, Medical Center; and
  2. California Cancer Registry, Public Health Institute, Sacramento, CA.
  1. Address correspondence and reprint requests to Gary S. Leiserowitz, MD, 4860 Y St, Suite 2500, Sacramento, CA 95817. E-mail: gsleiserowitz{at}ucdavis.edu.

Abstract

Objective: To compare the demographics, cancer characteristics, and hospital outcomes of endometrial cancer patients undergoing a laparoscopically assisted vaginal hysterectomy (LAVH) versus a total abdominal hysterectomy (TAH).

Methods: Two California population databases (Office of Statewide Health Planning and Development and the California Cancer Registry) were linked using patient identifiers. Patients who underwent endometrial cancer surgery from 1997 to 2001 were identified. The combined database was queried for type of surgery, patient demographics, hospital outcomes, comorbidities, and cancer characteristics. Statistical analyses included the t test, χ 2 test, and logistic regression.

Results: In this study, 978 endometrial cancer patients (7.7%) had an LAVH and 11,765 (92.3%) had a TAH. The mean ages for the 2 groups were 63.3 and 64.8 years, respectively. Lymphadenectomy was performed more frequently in LAVH patients compared with TAH patients (45.6 vs 41.1%; P = 0.006). Patients undergoing LAVH were more likely to be younger and healthier and have stage I or grade 1 disease (P < 0.0001). Total abdominal hysterectomy patients were more likely to have significant medical comorbidities. Mean length of stay for LAVH was 2.40 versus 4.36 days for TAH (P < 0.001), but mean hospital charges were comparable. Perioperative complications such as vascular and bowel injuries, pulmonary embolism, wound problems, and transfusions were significantly more common in TAH patients.

Conclusion: Surgeons seem to carefully select endometrial cancer patients for laparoscopic surgery. Although surgical staging was performed in less than 50% of endometrial cancer patients, the rate was not worse in laparoscopic procedures. Short-term hospital complications were less common in the laparoscopy group.

  • Laparoscopy
  • Abdominal hysterectomy
  • Endometrial cancer
  • Patient outcomes

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Footnotes

  • The collection of cancer incidence data used in this study was supported bythe California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute's Surveillance, Epidemiology, and End Results Program under contract N01-PC-35136 awarded to the Northern California Cancer Center, contract N01-PC-35139 awarded to the University of Southern California, and contract N02-PC-15105 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention's National Program of Cancer Registries, under agreement no. U55/CCR921930-02 awarded to the Public Health Institute.

  • Presented at the 38th Annual Meeting of the Society of Gynecologic Oncologists; March 2007; San Diego, CA.

  • The ideas and opinions expressed herein are those of the author(s), and endorsement by the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors is not intended nor should be inferred.

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