Department of Obstetrics and Gynecology, Tokai University School of Medicine, Kanagawa, Japan.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
J Gynecol Oncol. 2023 May;34(3):e56. doi: 10.3802/jgo.2023.34.e56. Epub 2023 Mar 10.
Owing to the potential benefits of minimally invasive hysterectomy for endometrial cancer, the practice pattern has recently shifted in Japan. This study examined the trends in minimally invasive surgery (MIS) in patients with endometrial cancer in Japan.
This retrospective observational study examined the Japan Society of Obstetrics and Gynecology Tumor Registry database between 2015-2019. This study examined the time-specific proportion change and predictors of MIS use in initial endometrial cancer treatment in Japan, and compared it with the use of abdominal surgery. Additionally, the association between hospital surgical treatment volume and MIS use was examined.
A total of 14,059 patients (26.5%) underwent minimally invasive hysterectomy, and 39,070 patients (73.5%) underwent abdominal hysterectomy in the study period. Patients who underwent MIS were more likely to be treated at high-volume centers, younger, central, or western Japan residents, registered in recent years, and had a tumor with stage I disease, type 1 histology, and less myometrial invasion (all adjusted p<0.05). The proportion of MIS treatments increased from 19.1% in 2015 to 34.3% in 2019 (p<0.001). On multivariable analysis, treatment at high-volume centers was a contributing factor for MIS (adjusted odds ratio=3.85; 95% confidence interval=3.44-4.30). MIS at high-volume centers increased significantly from 24.8% to 41.0% (p<0.001) during the study period, whereas MIS at low-volume centers remained at median 8.8%.
MIS has increased significantly in recent years, accounting for nearly 34% of surgical management of endometrial cancer in Japan. High-volume treatment centers take the lead in performing MIS.
由于微创子宫切除术治疗子宫内膜癌具有潜在益处，因此日本最近改变了手术方式。本研究旨在探讨日本子宫内膜癌患者微创治疗的趋势。
本回顾性观察性研究分析了日本妇产科协会肿瘤登记数据库 2015 年至 2019 年的数据。本研究考察了日本子宫内膜癌初始治疗中微创手术（MIS）的时间特异性比例变化及其预测因素，并与腹部手术进行了比较。此外，还分析了医院手术治疗量与 MIS 使用之间的关联。
在研究期间，共有 14059 例（26.5%）患者接受了微创子宫切除术，39070 例（73.5%）患者接受了剖腹子宫切除术。接受 MIS 治疗的患者更可能在高容量中心接受治疗，年龄较小，来自中心或西部日本，登记时间较晚，且肿瘤处于 I 期、组织学类型为 1 型、肌层浸润程度较低（所有调整后的 p 值均<0.05）。2015 年 MIS 治疗比例为 19.1%，2019 年增至 34.3%（p<0.001）。多变量分析显示，高容量中心治疗是 MIS 的一个促成因素（调整后比值比=3.85；95%置信区间=3.44-4.30）。在此期间，高容量中心的 MIS 比例从 2015 年的 24.8%显著增加至 41.0%（p<0.001），而低容量中心的 MIS 比例保持在中位数 8.8%。
近年来，MIS 显著增加，占日本子宫内膜癌手术治疗的近 34%。高容量治疗中心率先开展 MIS。
