A Comparison of Outcomes Between Open Hysterectomy and Robotic-Assisted Hysterectomy for Endometrial Cancer Using the National Cancer Database

作者：Safdieh Joseph; Lee Yi Chun; Wong Andrew; Lee Anna; Weiner Joseph P; Schwartz David; Schreiber David

来源：International Journal of Gynecological Cancer, 2017, 27(7): 1508-1516.

DOI：10.1097/IGC.0000000000001034

<jats:sec><jats:title>Purpose</jats:title><jats:p>The purpose of this study is to evaluate usage patterns and outcomes of women who underwent open hysterectomy (OH) versus robotic assisted-hysterectomy (RAH) for the treatment of endometrial cancer.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Women with nonmetastatic endometrial adenocarcinoma diagnosed between 2010 and 2012, who either underwent an OH or RAH, were selected from the National Cancer Database. The <jats:italic>χ<jats:sup>2</jats:sup></jats:italic>, Fisher exact, or Mann-Whitney <jats:italic>U</jats:italic> tests were used where appropriate to compare outcomes between groups. Multivariable logistic regression was used to analyze for predictors for RAH and other outcome variables.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>A total of 43,985 women were included in this study with a median age of 61 years. Of these, 23,872 (54.3%) underwent RAH and 20,113 (45.7%) underwent OH. The usage of RAH increased from 43.0% in 2010 to 63.8% in 2012 (<jats:italic>P</jats:italic> &lt; 0.001). Women receiving RAH were more commonly found to have a Charlson comorbidity score of 0 to 1, lower pathologic stage, nonblack race, treatment at a comprehensive center, and had insurance other than Medicaid. Robotic-assisted hysterectomy was associated with a shorter inpatient stay, lower readmission rates, and lower 30- and 90-day mortality rates (<jats:italic>P</jats:italic> &lt; 0.001 for all comparisons). There was a significant improvement in overall survival favoring RAH, 96.1% versus 94.0%, which persisted on multivariable logistic regression (<jats:italic>P</jats:italic> &lt; 0.001).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In this large, hospital-based analysis, RAH was associated with decreased length of stay, lower readmission rates, and less perioperative mortality. However, socioeconomic status continues to remain a barrier to equal treatment allocation. Overall survival was improved with RAH, but the follow-up is limited, and this finding must be interpreted with caution.</jats:p></jats:sec>

• 出版日期2017-9