Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Medicine, Baltimore, MD, USA.
Department of Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Gynecol Oncol. 2018 Mar;148(3):480-484. doi: 10.1016/j.ygyno.2018.01.002. Epub 2018 Jan 12.
Minimally invasive surgery (MIS) is a quality measure for endometrial cancer (EC) established by the Society of Gynecologic Oncology and the American College of Surgeons. Our study objective was to assess the proportion of EC cases performed by MIS at National Comprehensive Cancer Network (NCCN) centers and evaluate perioperative outcomes.
A retrospective cohort study of women who underwent surgical treatment for EC from 2013 to 2014 was conducted at four NCCN centers. Multivariable mixed logistic regression models analyzed factors associated with failure to perform MIS and perioperative complications.
In total 1621 patients were evaluated; 86.5% underwent MIS (robotic-assisted 72.5%, laparoscopic 20.9%, vaginal 6.6%). On multivariable analysis, factors associated with failure to undergo MIS were uterine size >12cm (Odds Ratio [OR]: 0.17, 95% CI 0.03-0.9), stage III (OR: 0.16, 95% CI 0.05-0.49) and IV disease (OR: 0.07, 95% CI 0.02-0.22). For stage I/II disease, complications occurred in 5.1% of MIS and 21.7% of laparotomy cases (p<0.01). Laparotomy was associated with increases in any complication (OR: 6.0, 95% CI 3.3-10.8), gastrointestinal (OR: 7.2, 95% CI 2.6-19.5), wound (OR: 3.7, 95% CI 1.5-9.2), respiratory (OR 37.5, 95% CI 3.9-358.0), VTE (OR 10.5, 95% CI 1.3-82.8) and 30-day readmission (OR: 2.6, 95% CI 1.4-4.9) compared to MIS.
At NCCN-designated centers, the MIS hysterectomy rate in EC is higher than the published national average, with low perioperative complications. Previously identified disparities of age, race, and BMI were not observed. A proposed MIS hysterectomy benchmark of >80% in EC care is feasible when performed at high volume centers.
微创外科（MIS）是妇科肿瘤学会和美国外科医师学会为子宫内膜癌（EC）制定的一项质量指标。我们的研究目的是评估在国家综合癌症网络（NCCN）中心进行的 EC 病例中 MIS 的比例，并评估围手术期结果。
在四个 NCCN 中心对 2013 年至 2014 年接受手术治疗的 EC 女性进行了回顾性队列研究。多变量混合逻辑回归模型分析了无法进行 MIS 和围手术期并发症的相关因素。
共评估了 1621 例患者；86.5%的患者接受了 MIS（机器人辅助 72.5%，腹腔镜 20.9%，阴道 6.6%）。多变量分析显示，无法行 MIS 的相关因素包括子宫大小>12cm（优势比[OR]：0.17，95%CI 0.03-0.9）、III 期（OR：0.16，95%CI 0.05-0.49）和 IV 期疾病（OR：0.07，95%CI 0.02-0.22）。对于 I/II 期疾病，MIS 和剖腹手术病例的并发症发生率分别为 5.1%和 21.7%（p<0.01）。与 MIS 相比，剖腹手术与任何并发症（OR：6.0，95%CI 3.3-10.8）、胃肠道（OR：7.2，95%CI 2.6-19.5）、伤口（OR：3.7，95%CI 1.5-9.2）、呼吸（OR 37.5，95%CI 3.9-358.0）、VTE（OR 10.5，95%CI 1.3-82.8）和 30 天再入院（OR：2.6，95%CI 1.4-4.9）的风险增加相关。
在 NCCN 指定的中心，EC 中 MIS 子宫切除术的比例高于已公布的全国平均水平，且围手术期并发症较低。以前确定的年龄、种族和 BMI 差异并未观察到。当在高容量中心进行时，EC 护理中 >80%的拟议 MIS 子宫切除术基准是可行的。
