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Original research
Trends and survival outcomes of robotic, laparoscopic, and open surgery for stage II uterine cancer
  1. Mary Kathryn Abel1,
  2. John K Chan2,
  3. Stephanie Chow3,
  4. Kathleen Darcy4,5,
  5. Chunqiao Tian4,5,
  6. Daniel S Kapp6,
  7. Amandeep K Mann7 and
  8. Cheng-I Liao8
  1. 1School of Medicine, University of California San Francisco, San Francisco, California, USA
  2. 2Division of Gynecologic Oncology, Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, California, USA
  3. 3Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
  4. 4Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
  5. 5Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA
  6. 6Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California, USA
  7. 7Division of Gynecologic Oncology, Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA
  8. 8Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
  1. Correspondence to Dr John K Chan, Division of Gynecologic Oncology, Palo Alto Medical Foundation, California Pacific Medical Center, Sutter Health, San Francisco, CA 94109, USA; chanjohn{at}sutterhealth.org

Abstract

Introduction A recent randomized clinical trial showed that minimally invasive surgery led to poorer survival compared with open surgery in early stage cervical cancer. We determined the trends in adoption of minimally invasive surgery and 5-year overall survival outcomes after open, laparoscopic-assisted, and robotic-assisted hysterectomy for stage II uterine cancer with cervical stromal involvement.

Methods Data for patients with stage II uterine cancer were acquired from the National Cancer Database from 2010 to 2015. χ2 testing, Kaplan–Meier methods, and Cox models were used for statistical analyses.

Results Of 2949 patients, 44.3% underwent open hysterectomy, 13.9% underwent laparoscopic hysterectomy, and 41.8% underwent robotic hysterectomy. The proportion of robotic cases increased from 26.8% in 2010 to 48.3% in 2015 (annual percent change 10.1%), with a decrease in open hysterectomy from 63.3% to 34.3% (annual percent change –12.5%). The overall 5-year survival was 77.6% in robotic, 76.8% in laparoscopic, and 72.5% in open hysterectomy (p=0.045); however, after adjusting for known prognostic factors, robotic (HR 1.00, 95% CI 0.82 to 1.21; p=0.97) and laparoscopic hysterectomy (HR 1.09, 95% CI 0.83 to 1.44; p=0.54) did not portend for improved survival compared with open hysterectomy. Black women (HR 1.59, 95% CI 1.25 to 2.02; p<0.001) and individuals with co-morbidities (HR 1.45, 95% CI 1.21 to 1.75, p<0.001) had worse adjusted survival and the highest rates of open hysterectomy.

Conclusion The use of minimally invasive surgery for stage II uterine cancer has increased over time, with comparable adjusted 5-year survival after robotic or laparoscopic hysterectomy compared with open hysterectomy. Black women and those with co-morbidities had lowest rates of minimally invasive surgery and the poorest adjusted survival.

  • uterine cancer

https://doi.org/10.1136/ijgc-2020-001646

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    Footnotes

    • Contributors MKA: methodology; writing original draft; writing review and editing; visualization. JKC: conceptualization; writing review and editing; visualization; supervision; project administration; funding acquisition. SC: conceptualization; writing review and editing. KD: writing review and editing. CT: writing review and editing. DSK: conceptualization; writing review and editing. AKM: methodology; writing review and editing. C-IL: methodology; software; formal analysis; investigation; resources; writing review and editing.

    • Funding We would like to acknowledge The Fisher Family Fund and Denise Cobb Hale for their generous administrative support.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available. The data for this study was obtained with permission from the National Cancer Database.