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A Comparison of Outcomes Between Open Hysterectomy and Robotic-Assisted Hysterectomy for Endometrial Cancer Using the National Cancer Database
  1. Joseph Safdieh, MD*,,,
  2. Yi-Chun Lee, MD,,
  3. Andrew Wong, MD,,
  4. Anna Lee, MD,,
  5. Joseph P. Weiner, MD*,,
  6. David Schwartz, MD*, and
  7. David Schreiber, MD*,
  1. * Department of Veterans Affairs, NY Harbor Campus;
  2. SUNY Downstate Medical Center; and
  3. Kings County Hospital Center, Brooklyn, NY.
  1. Address correspondence and reprint requests to Joseph Safdieh, MD, Department of Veterans Affairs, NY Harbor Healthcare System, 800 Poly Pl, Brooklyn, NY 11209. E-mail: Safdiehj1{at}nychhc.org.

Abstract

Purpose The purpose of this study is to evaluate usage patterns and outcomes of women who underwent open hysterectomy (OH) versus robotic assisted-hysterectomy (RAH) for the treatment of endometrial cancer.

Methods Women with nonmetastatic endometrial adenocarcinoma diagnosed between 2010 and 2012, who either underwent an OH or RAH, were selected from the National Cancer Database. The χ2 , Fisher exact, or Mann-Whitney U tests were used where appropriate to compare outcomes between groups. Multivariable logistic regression was used to analyze for predictors for RAH and other outcome variables.

Results A total of 43,985 women were included in this study with a median age of 61 years. Of these, 23,872 (54.3%) underwent RAH and 20,113 (45.7%) underwent OH. The usage of RAH increased from 43.0% in 2010 to 63.8% in 2012 (P < 0.001). Women receiving RAH were more commonly found to have a Charlson comorbidity score of 0 to 1, lower pathologic stage, nonblack race, treatment at a comprehensive center, and had insurance other than Medicaid. Robotic-assisted hysterectomy was associated with a shorter inpatient stay, lower readmission rates, and lower 30- and 90-day mortality rates (P < 0.001 for all comparisons). There was a significant improvement in overall survival favoring RAH, 96.1% versus 94.0%, which persisted on multivariable logistic regression (P < 0.001).

Conclusions In this large, hospital-based analysis, RAH was associated with decreased length of stay, lower readmission rates, and less perioperative mortality. However, socioeconomic status continues to remain a barrier to equal treatment allocation. Overall survival was improved with RAH, but the follow-up is limited, and this finding must be interpreted with caution.

  • Endometrial cancer
  • Robotic surgery
  • National Cancer Database

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Footnotes

  • The authors declare no conflicts of interest.

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