When compared to a total abdominal hysterectomy, minimally invasive laparoscopic surgery (MILS) for endometrial cancer minimizes operative morbidity. However, MILS is only used in a small percentage of women with early-stage endometrial cancer. For this study, the researchers wanted to see if there was a link between the Danish statewide use of minimally invasive robotic surgery (MIRS) and serious complications in patients with early-stage endometrial cancer.
Data from the Danish Gynecological Cancer Database were linked with national registers on socioeconomic status, deaths, hospital diagnoses, and hospital treatments in this nationwide prospective cohort study of 5654 women with early-stage endometrial cancer who had undergone surgery between January 1, 2005, and June 30, 2015. The women were separated into two groups: group 1 had surgery before MIRS was introduced in their location, and group 2 had surgery after MIRS was introduced. Those with an unclear illness stage, an unknown relationship with MIRS implementation, unknown histologic findings, sarcoma, or synchronous malignancy, as well as women who had vaginal or an unknown surgical kind of hysterectomy, were eliminated. From February 2, 2017, to May 4, 2018, statistical analysis was carried out. Severe complications were divided into two categories: mortality within 30 days after surgery and intraoperative and postoperative problems identified within 90 days.
About 3091 women (mean [SD] age, 67 [10] years) were assigned to group 1, and 2563 women (mean [SD] age, 68 [10] years) were assigned to group 2. The risks of serious complications were considerably greater in group 1 than in group 2 in multivariate logistic regression analysis (odds ratio [OR], 1.39; 95% CI, 1.11-1.74). In group 2, the proportion of women receiving MIRS was 50.0% (n = 1282). Multivariate logistic regression analysis in Group 2 revealed that a complete abdominal hysterectomy was linked with an increased risk of serious complications when compared to MILS (OR, 2.58; 95% CI, 1.80-3.70) and MIRS (OR, 3.87; 95% CI, 2.52-5.93). There was no distinction between MILS and MIRS (OR, 1.50; 95% CI, 0.99-2.27).
Reference:jamanetwork.com/journals/jamasurgery/fullarticle/2726601?resultClick=1
