Use and Benefits of Laparoscopic Hysterectomy for Stage I Endometrial Cancer Among Medicare Beneficiaries
- 1 September 2012
- journal article
- health care-delivery
- Published by American Society of Clinical Oncology (ASCO) in Journal of Oncology Practice
- Vol. 8 (5), e89-e99
- https://doi.org/10.1200/jop.2011.000484
Abstract
Purpose: Laparoscopic hysterectomy is associated with shorter hospital stays, less postoperative pain, and earlier resumption of activity. We analyzed predictors of access to laparoscopy and compared the outcomes of laparoscopic and open hysterectomy for stage I endometrial cancer. Methods: Using the SEER-Medicare database we examined women 65 years of age with stage I endometrial cancer who underwent hysterectomy between 1997 and 2005. The associations of patient, tumor, and physician-related factors with use of laparoscopic hysterectomy were analyzed. Surgical quality, morbidity, and survival were compared. Results: We identified 8,545 patients, including 8,018 (93.8%) who underwent abdominal hysterectomy and 527 (6.2%) who had a laparoscopic hysterectomy. Performance of laparoscopic hysterectomy increased from 3.9% in 1997 to 8.5% in 2005. More recent year of diagnosis, younger age, white race, fewer comorbidities, higher socioeconomic status, lower tumor grade and stage, and residence in a metropolitan area were associated with use of laparoscopy (P < .05 for each). Physician characteristics associated with performance of laparoscopy included training in the United States, specialization in gynecologic oncology, academic practice, and later year of graduation (P < .05 for all). Surgical site complications (odds ratio [OR] = 0.46; 95% CI, 0.30 to 0.71) and medical complications (OR = 0.67; 95% CI, 0.47 to 0.95) were less common in patients who underwent laparoscopy. The route of hysterectomy had no effect on cancer-specific survival (OR = 0.74; 95% CI, 0.38 to 1.44). Conclusion: Despite the fact that laparoscopic hysterectomy for endometrial cancer results in fewer complications, uptake has been slow.Keywords
This publication has 36 references indexed in Scilit:
- Comparative Effectiveness of Robotic Versus Laparoscopic Hysterectomy for Endometrial CancerJournal of Clinical Oncology, 2012
- Quality of Life of Patients With Endometrial Cancer Undergoing Laparoscopic International Federation of Gynecology and Obstetrics Staging Compared With Laparotomy: A Gynecologic Oncology Group StudyJournal of Clinical Oncology, 2009
- Laparoscopy Compared With Laparotomy for Comprehensive Surgical Staging of Uterine Cancer: Gynecologic Oncology Group Study LAP2Journal of Clinical Oncology, 2009
- Patterns of Use and Risks Associated With Erythropoiesis-Stimulating Agents Among Medicare Patients With CancerJNCI Journal of the National Cancer Institute, 2009
- No surgical innovation without evaluation: the IDEAL recommendationsThe Lancet, 2009
- Diffusion of surgical innovation among patients with kidney cancerCancer, 2008
- The use of adjuvant radiation therapy in early endometrial cancer by members of the Society of Gynecologic Oncologists in 2005Gynecologic Oncology, 2007
- How to teach an old dog new tricks and how to teach a new dog old tricks: bridging the generation gap to push the envelope of advanced laparoscopySurgical Endoscopy, 2006
- Ten-year experience with laparoscopy on a gynecologic oncology service: Analysis of risk factors for complications and conversion to laparotomyAmerican Journal of Obstetrics and Gynecology, 2004
- Total laparoscopic hysterectomy for endometrial cancer: patterns of recurrence and survivalGynecologic Oncology, 2004