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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2017

01-06-2017 | Gynecologic Oncology

Minimally Invasive Staging Surgery in Women with Early-Stage Endometrial Cancer: Analysis of the National Cancer Data Base

Authors: Amy J. Bregar, MD, Alexander Melamed, MD, MPH, Elisabeth Diver, MD, Joel T. Clemmer, MA, Shitanshu Uppal, MBBS, John O. Schorge, MD, Laurel W. Rice, MD, Marcela G. del Carmen, MD, MPH, J. Alejandro Rauh-Hain, MD

Published in: Annals of Surgical Oncology | Issue 6/2017

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Abstract

Purpose

The aim of this study was to determine factors associated with the adoption of minimally invasive surgery (MIS) compared with laparotomy in the treatment of endometrial cancer and to compare surgical outcomes and survival between these two surgical modalities.

Methods

We utilized the National Cancer Data Base (NCDB) to identify women diagnosed with presumed early-stage endometrial cancer between 2010 and 2012. We also identified factors associated with the performance of MIS and utilized propensity score matching to create a matched cohort of women who underwent minimally invasive staging surgery or laparotomy for surgical staging.

Results

Overall, 20,346 women were eligible for inclusion in the study; 12,604 (61.9%) had MIS, while 7742 (38.1%) had a laparotomy. African American race (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.49–0.60], Hispanic ethnicity (OR 0.70, 95% CI 0.61–0.80), Charlson score >2 (OR 0.79, 95% CI 0.69–0.91), high-grade histology (OR 0.63, 95% CI 0.59–0.68), presumed clinical stage II disease (OR 0.53, 95% CI 0.46–0.60), and surgery at a community cancer program (OR 0.46, 95% CI 0.39–0.55) or in the Midwest region (OR 0.70, 95% CI 0.64–0.76) were associated with a decreased likelihood of having MIS, while private insurance (OR 1.69, 95% CI 1.45–1.97) and highest quartile median household income (OR 1.13, 95% CI 1.03–1.24) were associated with an increased likelihood of having MIS. After propensity score matching, there was no association between minimally invasive staging surgery and 3-year overall survival (hazard ratio 1.03, 95% CI 0.92–1.16).

Conclusion

There are notable racial, ethnic, socioeconomic, and geographic variations in the utilization of MIS for endometrial cancer staging in the US. After controlling for the aforementioned factors, MIS had a similar 3-year survival compared with laparotomy in women undergoing staging surgery for endometrial cancer.
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Metadata
Title
Minimally Invasive Staging Surgery in Women with Early-Stage Endometrial Cancer: Analysis of the National Cancer Data Base
Authors
Amy J. Bregar, MD
Alexander Melamed, MD, MPH
Elisabeth Diver, MD
Joel T. Clemmer, MA
Shitanshu Uppal, MBBS
John O. Schorge, MD
Laurel W. Rice, MD
Marcela G. del Carmen, MD, MPH
J. Alejandro Rauh-Hain, MD
Publication date
01-06-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 6/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5752-8

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