New York University School of Medicine, Division of Gynecologic Oncology, 240 East 38th Street, New York, NY, USA.
New York University School of Medicine, Division of Gynecologic Oncology, 240 East 38th Street, New York, NY, USA.
Gynecol Oncol. 2018 Apr;149(1):22-27. doi: 10.1016/j.ygyno.2017.10.033.
Black race has been associated with increased 30-day morbidity and mortality following surgery for endometrial cancer. Black women are also less likely to undergo laparoscopy when compared to white women. With the development of improved laparoscopic techniques and equipment, including the robotic platform, we sought to evaluate whether there has been a change in surgical approach for black women, and in turn, improvement in perioperative outcomes.
Using the American College of Surgeons' National Surgical Quality Improvement Project's database, patients who underwent hysterectomy for endometrial cancer from 2010 to 2015 were identified. Comparative analyses stratified by race and hysterectomy approach were performed to assess the relationship between race and perioperative outcomes.
A total of 17,692 patients were identified: of these, 13,720 (77.5%) were white and 1553 (8.8%) were black. Black women were less likely to undergo laparoscopic hysterectomy compared to white women (49.3% vs 71.3%, p<0.0001). Rates of laparoscopy in both races increased over the 6-year period; however these consistently remained lower in black women each year. Black women had higher 30-day postoperative complication rates compared to white women (22.5% vs 13.6%, p<0.0001). When laparoscopic hysterectomies were isolated, there was no difference in postoperative complication rates between black and white women (9.2% vs 7.5%, p=0.1).
Overall black women incur more postoperative complications compared to white women undergoing hysterectomy for endometrial cancer. However, laparoscopy may mitigate this disparity. Efforts should be made to maximize the utilization of minimally invasive surgery for the surgical management of endometrial cancer.
黑种人在接受子宫内膜癌手术后的 30 天内，发病率和死亡率更高。与白人女性相比，黑人女性接受腹腔镜手术的可能性也更低。随着腹腔镜技术和设备的不断发展，包括机器人平台，我们试图评估黑人女性的手术方法是否发生了变化，以及由此带来的围手术期结果是否有所改善。
利用美国外科医师学会国家外科质量改进计划数据库，确定了 2010 年至 2015 年间因子宫内膜癌接受子宫切除术的患者。对按种族和子宫切除术方法分层的患者进行了比较分析，以评估种族与围手术期结果之间的关系。
共确定了 17692 例患者：其中 13720 例（77.5%）为白人，1553 例（8.8%）为黑人。与白人女性相比，黑人女性接受腹腔镜子宫切除术的比例较低（49.3% vs 71.3%，p<0.0001）。两种族的腹腔镜手术比例在 6 年期间均有所增加；然而，黑人女性每年的比例始终较低。与白人女性相比，黑人女性的 30 天术后并发症发生率更高（22.5% vs 13.6%，p<0.0001）。当单独分析腹腔镜子宫切除术时，黑人女性与白人女性的术后并发症发生率没有差异（9.2% vs 7.5%，p=0.1）。
与接受子宫内膜癌子宫切除术的白人女性相比，黑人女性总体上术后并发症更多。然而，腹腔镜手术可能会减轻这种差异。应努力最大限度地利用微创手术来治疗子宫内膜癌。
