Maimonides Evening of Research
Resident Winner
Qi Zhang, MMed
Minimally Invasive Surgery Versus Open Surgery for Type II endometrial cancer
Objectives
To use the National Cancer Database to compare outcomes in women with Type II endometrial cancer (EC) who underwent surgical staging via minimally invasive surgery (MIS) versus laparotomy.
Methods
Patients with Type II endometrial cancer between January 2010 and December 2014 were identified in the National Cancer Database and stratified into two cohorts: (1) patients who underwent surgical staging by MIS (2) those who underwent surgical staging by laparotomy. Surgical variables and survival were analyzed in a pseudo population created by inverse propensity weighting.
Results
We identified 12905 patients that underwent hysterectomy for Type II uterine cancer. 7123 women (55%) underwent MIS, the rate of which increased from 39% in 2010 to 64% in 2014. In propensity-score–weighted analyses, MIS was associated with superior overall survival (102 vs 87 months, P=0.003 by the long-rank test) which corresponds to a 10% lower risk of death from any cause ( HR 0.9; CI 0.857-0.954, p=0.0002). MIS was associated with better survival outcomes across all three histology types and stages. MIS was associated with superior perioperative outcomes. The mean length of stay was shorter in the MIS group (1 vs. 4 days with p-value <0.001). The 30-day readmission rate was higher in the open group (5% vs 2.5% with p-value<0.001). Furthermore, MIS was associated with lower 30 and 90-day postoperative mortality (0.5% vs 1.3% and 1.5% vs 3.6%, respectively) (p-value<0.001). The time interval between surgery and initiation of chemotherapy was shorter in the MIS group (38 vs. 41 days, p<0.001).
Conclusion And Implication
Women with Type II endometrial cancers staged by MIS demonstrated superior survival and perioperative outcomes compared to those staged by laparotomy. This is the first study that demonstrates survival benefit of MIS in Type II uterine cancer using a large cohort of patients from the National Cancer Database. With the assessment of several potential confounding factors between the study groups, MIS is an independent prognostic factor for improved survival in patients with Type II uterine cancer.