Highlights
- •A national adoption of minimally invasive surgery for endometrial cancer is associated with improved survival.
- •Minimally invasive techniques yield similar survival in endometrial cancer.
- •Survival benefit was found independent of histopathological risk group.
Abstract
Purpose
The purpose of the study was to evaluate the association between a nationwide introduction
of robotic minimally invasive surgery (RMIS) and survival in women with early-stage
endometrial cancer.
Materials and methods
Prospective data on consecutive women with early-stage endometrial cancer who underwent
surgery during January 2005 to June 2015 in Denmark were identified in the nationwide
Danish Gynaecological Cancer Database. Data were linked with national registries regarding
comorbidity, education, income and death. The cohort was divided according to the
time they underwent surgery: Group 1 before RMIS introduction in their respective
region and Group 2 after RMIS introduction. Five-year overall survival was compared
by multivariate Cox proportional hazards models stratified by histopathological risk
between Groups 1 and 2 and between surgical modalities within Group 2: total abdominal
hysterectomy (TAH), laparoscopic minimally invasive surgery (LMIS) and RMIS.
Results
Women in Group 1 (N = 3091) had significantly lower overall survival compared with
those in Group 2 (N = 2563; hazard ratio [HR], 1.22; 95% confidence interval [CI],
1.05–1.42). Age, smoking, socioeconomic status, American Society of Anaesthesiologists
(ASA) score, comorbidity and histopathological risk influenced the overall survival.
Following RMIS adoption, TAH was associated with higher mortality compared with LMIS
and RMIS (HR, 1.42; 95% CI 1.02–1.97 and HR, 1.70; 95% CI 1.31–2.19 for LMIS and RMIS,
respectively). There was no significant survival difference between RMIS and LMIS
(HR, 1.19; 95% CI 0.85–1.68).
Conclusion
The national introduction of robotic surgery for early-stage endometrial cancer was
associated with improved survival irrespective of age, body mass index, ASA score,
comorbidity, smoking, socioeconomic status and histopathological risk.
Keywords
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Article info
Publication history
Published online: January 14, 2019
Accepted:
December 12,
2018
Received in revised form:
December 10,
2018
Received:
September 6,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
