Comparative effectiveness of minimally invasive hysterectomy for endometrial cancer

Purpose: Despite the potential benefits of minimally invasive hysterectomy for uterine cancer, populationlevel data describing the procedure's safety in unselected patients are lacking.Weexamined the use of minimally invasive surgery and the association between the route of the procedure and long-term survival. Methods: We used the SEER-Medicare database to identify women with stage I-III uterine cancer who underwent hysterectomy from 2006 to 2011. Patients who underwent abdominal hysterectomy were compared with those who had minimally invasive hysterectomy (laparoscopic and robotassisted). Perioperative morbidity, use of adjuvant therapy, and long-term survival were examined after propensity score balancing. Results: We identified 6,304 patients, including 4,139 (65.7%) who underwent abdominal hysterectomy and 2,165 (34.3%) who underwent minimally invasive hysterectomy; performance of minimally invasive hysterectomy increased from 9.3% in 2006 to 61.7% in 2011. Robot-assisted procedures accounted for 62.3% of the minimally invasive operations. Compared with women who underwent abdominal hysterectomy, minimally invasive hysterectomy was associated with a lower overall complication rate (22.7% v 39.7%; P <.001), and lower perioperative mortality (0.6% v 1.1%), but these women were more likely to receive adjuvant pelvic radiotherapy (34.3% v 31.3%) and brachytherapy (33.6% v 31.0%; P <.05). The complication rate was higher after robot-assisted hysterectomy compared with laparoscopic hysterectomy (23.7% v 19.5%; P =.03). There was no association between the use of minimally invasive hysterectomy and either overall (HR, 0.89; 95% CI, 0.75 to 1.04) or cancerspecific (HR, 0.83; 95% CI, 0.59 to 1.16) mortality. Conclusion: Minimally invasive hysterectomy does not appear to compromise long-term survival for women with endometrial cancer.