Columbia University College of Physicians and Surgeons, New York, NY; New York Presbyterian Hospital, New York, NY.
Columbia University College of Physicians and Surgeons, New York, NY.
Am J Obstet Gynecol. 2018 Nov;219(5):463.e1-463.e12. doi: 10.1016/j.ajog.2018.07.028. Epub 2018 Aug 4.
Minimally invasive hysterectomy is now used routinely for women with uterine cancer. Most studies of minimally invasive surgery for endometrial cancer have focused on low-risk endometrioid tumors, with few reports of the safety of the procedure for women with higher risk histologic subtypes.
The purpose of this study was to examine the use of and survival associated with minimally invasive hysterectomy for women with uterine cancer and high-risk histologic subtypes.
We used the National Cancer Database to identify women with stages I-III uterine cancer who underwent hysterectomy from 2010-2014. Women with serous carcinomas, clear cell carcinomas, and sarcomas were examined. Women who had laparoscopic or robotic-assisted hysterectomy were compared with those who underwent open abdominal hysterectomy. After a propensity score inverse probability of treatment weighted analysis, the effect of minimally invasive hysterectomy on overall, 30-day, and 90-day mortality rates was examined for each histologic subtype of uterine cancer.
Of 94,507 patients who were identified, 64,417 patients (68.2%) underwent minimally invasive hysterectomy. Among women with endometrioid tumors (n=81,115), 70.8% underwent minimally invasive hysterectomy. The rates of minimally invasive surgery in those women with nonendometrioid tumors (n=13,392) was 57.6% for serous carcinomas, 57.0% for clear cell tumors, 47.3% for sarcomas, 32.2% for leiomyosarcomas, 47.9% for stromal sarcomas, and 48.5% for carcinosarcomas. Performance of minimally invasive surgery increased across all histologic subtypes between 2010 and 2014. For nonendometrioid subtypes, robotic-assisted procedures accounted for 47.9-75.7% of minimally invasive hysterectomies by 2014. In a multivariable model, women with nonendometrioid tumors were less likely to undergo minimally invasive surgery than those with endometrioid tumors (P<.05). There was no association between route of surgery and 30-day, 90-day, or overall mortality rates for any of the nonendometrioid histologic subtypes.
The use of minimally invasive surgery is increasing rapidly for women with stage I-III nonendometrioid uterine tumors. Performance of minimally invasive surgery does not appear to impact survival adversely.
微创子宫切除术现在已常规用于患有子宫癌的女性。大多数子宫内膜癌微创手术的研究都集中在低危子宫内膜样肿瘤上，很少有关于该手术对高危组织学亚型女性安全性的报道。
本研究旨在检查微创子宫切除术在患有子宫癌和高危组织学亚型的女性中的应用和生存情况。
我们使用国家癌症数据库确定了 2010 年至 2014 年期间接受子宫切除术的 I-III 期子宫癌女性。检查了浆液性癌、透明细胞癌和肉瘤患者。比较了接受腹腔镜或机器人辅助子宫切除术的女性与接受开腹子宫切除术的女性。在进行倾向评分逆概率治疗加权分析后，检查了每种子宫癌组织学亚型微创子宫切除术对总死亡率、30 天死亡率和 90 天死亡率的影响。
在确定的 94507 名患者中，有 64417 名（68.2%）接受了微创子宫切除术。在子宫内膜样肿瘤患者（n=81115）中，有 70.8%接受了微创子宫切除术。在非子宫内膜样肿瘤患者（n=13392）中，微创手术的比例为浆液性癌 57.6%、透明细胞癌 57.0%、肉瘤 47.3%、平滑肌肉瘤 32.2%、间质肉瘤 47.9%和癌肉瘤 48.5%。2010 年至 2014 年间，所有组织学亚型的微创手术率均有所增加。对于非子宫内膜样肿瘤，到 2014 年，机器人辅助手术占微创子宫切除术的 47.9-75.7%。在多变量模型中，与子宫内膜样肿瘤患者相比，非子宫内膜样肿瘤患者接受微创手术的可能性较低（P<.05）。对于任何非子宫内膜样组织学亚型，手术途径与 30 天、90 天或总死亡率均无关联。
对于 I-III 期非子宫内膜样子宫肿瘤女性，微创子宫切除术的应用正在迅速增加。微创手术的实施似乎不会对生存产生不利影响。
