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<h5 class="section-title" id="d442577e233">Background</h5>
<p id="P1">Minimally invasive hysterectomy is now routinely used for women with uterine
cancer.
Most studies of minimally invasive surgery (MIS) for endometrial cancer have focused
on low-risk, endometrioid tumors with few reports of the safety of the procedure for
women with higher risk histologic subtypes.
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<h5 class="section-title" id="d442577e238">Objective</h5>
<p id="P2">To examine the utilization and survival associated with minimally invasive
hysterectomy
for women with uterine cancer and high-risk histologic subtypes.
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<h5 class="section-title" id="d442577e243">Study Design</h5>
<p id="P3">We used the National Cancer Database was used to identify women with stages
I-III
uterine cancer who underwent hysterectomy from 2010-2014. Women with serous, clear
cell carcinomas and sarcomas were examined. Women who had laparoscopic or robotic-assisted
hysterectomy were compared to those who underwent open abdominal hysterectomy. After
a propensity score inverse probability of treatment weighted analysis, the effect
of MIS hysterectomy on overall, 30-day, and 90-day mortality was examined for each
histologic subtype of uterine cancer.
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<h5 class="section-title" id="d442577e248">Results</h5>
<p id="P4">Of 94,507 patients identified, 64,417 (68.2%) underwent minimally invasive
hysterectomy.
Among women with endometrioid tumors (n=81,115), 70.8% underwent MIS hysterectomy.
The rates of MIS in those with non-endometrioid tumors (n=13,392) was 57.6% for serous
carcinomas, 57.0% for clear cell tumors, 47.3% for sarcomas, 32.2% for leiomyosarcomas,
47.9% for stromal sarcomas and 48.5% for carcinosarcomas. Performance of MIS increased
across all histologic subtypes between 2010 and 2014. For non-endometrioid subtypes,
robotic-assisted procedures accounted for 47.9%-75.7% of MIS hysterectomies by 2014.
In a multivariable model, women with non-endometrioid tumors were less likely to undergo
MIS than those with endometrioid tumors (P<0.05). There was no association between
route of surgery and 30-day, 90-day, or overall mortality for any of the non-endometrioid
histologic subtypes.
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<h5 class="section-title" id="d442577e253">Conclusions</h5>
<p id="P5">The use of minimally invasive surgery is increasing rapidly for women with
stage I-III
non-endometrioid uterine tumors. Performance of minimally invasive surgery does not
appear to adversely impact survival.
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<h5 class="section-title" id="d442577e258">Condensation</h5>
<p id="P6">The use of minimally invasive surgery for women with stage I-III non-endometrioid
uterine tumors does not appear to adversely impact survival.
</p>
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