Minimally Invasive Cancer Surgery Less Expensive But Decreases Survival

A study presented at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting found that although minimally invasive hysterectomy surgery for ovarian cancer reduced costs and morbidity, it also significantly decreased survival among a certain subset of patients.

“Surgery is the primary treatment modality for early cervical cancer,” Daniel Jacob Margul, PhD, of the department of biomedical engineering at Northwestern University, and colleagues wrote. “Compared to open, a robotic or laparoscopic approach to radical hysterectomy may have decreased morbidity, but the influence of surgical approach on survival, specific perioperative complications, and costs is unknown.”

The researchers used data from the National Cancer Database and the Premier Healthcare Database to identify 43,000 patients with cervical cancer treated between 2010 and 2015. They measured for complications, length of stay, readmission rates, hospitalization costs, and survival. Within the study cohort, 982 patients underwent open surgery and 910 underwent robotic surgery.

Study results showed that patients with 2cm stage IB1 cervical cancer who underwent minimally invasive surgery had decreased survival compare with women who underwent open surgery. The researchers also found that open surgery was associated with longer length of stay, higher complication rate—including higher incidences of bowel injuries, infections, fluid disorders, transfusions, and ileus.

Additionally, the researchers found that total surgical costs were lower among patients who underwent minimally invasive surgery, with median surgical hospitalization costs of $9649 for laparoscopic surgery and $11,562 for robotic surgery, compared to $12,080 for open surgery.

The researchers also noted that 30-day readmission rates were similar in all study groups.

“Minimally invasive surgery is associated with decreased morbidity and costs,” Dr Margul and colleagues concluded. “However, among women with less than or equal to 2cm stage IB1 cervical cancer, minimally invasive surgery was associated with significantly decreased survival.”

—David Costill

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