Minimally Invasive Endometrial Surgery Leads to Fewer Severe Complications

Implementation of minimally invasive robotic surgery (MIRS) for early stage endometrial cancer in Denmark was associated with an increased proportion of minimally invasive surgical procedures and a reduced risk for severe complications, according to a recent study by Siv Lykke Jørgensen, MD, Department of Gynecology and Obstetrics, Odense, University Hospital, Denmark, and colleagues (JAMA Surg. 2019 Feb 27. Epub ahead of print).

“Minimally invasive laparoscopic surgery (MILS) for endometrial cancer reduces surgical morbidity compared with a total abdominal hysterectomy. However, only a minority of women with early-stage endometrial cancer undergo MILS,” Dr Jørgensen and colleagues explained.

Seeking to determine the relationship between a nationwide implementation of MIRS and severe complications in patients with early-stage endometrial cancer, they conducted a prospective cohort study of 5654 women who had undergone surgery between January 1, 2005, and June 30, 2015. Data for these patients were taken from the Danish Gynecological Cancer Database and linked with national registers on socioeconomic status, deaths, hospital diagnoses, and therapies.

Participants were split into 2 groups—those in group 1 underwent surgery before the introduction of MIRS in their region (n = 3091; mean age, 67 years), and group 2 underwent surgery postintroduction of MIRS (n = 2563; mean age, 68 years). Women were excluded from the study if they had unknown disease stage, an unknown association with MIRS implementation, unknown histologic findings, sarcoma, or synchronous cancer; patients who underwent vaginal or unknown hysterectomy types were also excluded.

Dr Jørgensen and colleagues carried out a statistical analysis from February 2, 2017, to May 4, 2018.

The odds of severe complications were significantly higher for women in group 1 than for those in group 2 according to multivariate logistic regression analyses (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.11-1.74).

Ultimately, 436 (14.1%) women underwent MILS in group 1 versus 569 (22.2%) women in group 2. In addition, approximately half of all women in group 2 underwent MIRS.

According to multivariate logistic regression analyses, a total abdominal hysterectomy was associated with increased odds of severe complications compared with MILS (OR, 2.58; 95%CI, 1.80-3.70) and MIRS (OR, 3.87; 95%CI, 2.52-5.93), specifically in group 2. There were no differences observed between MILS and MIRS (OR, 1.50; 95%CI, 0.99-2.27).

“The national introduction of MIRS changed the surgical approach for early-stage endometrial cancer from open surgery to minimally invasive surgery,” Dr Jørgensen and colleagues concluded.

“This change in surgical approach was associated with a significantly reduced risk of severe complications,” they said.—Hina Khaliq