Determinants of Surgical Approach and Survival Among Women with Endometrial Carcinoma.

Autor:	Bixel K; Division of Gynecologic Oncology (Drs. Bixel and Barrington). Electronic address: Kristin.bixel@osumc.edu., Barrington DA; Division of Gynecologic Oncology (Drs. Bixel and Barrington)., Vetter MH; Division of Gynecologic Oncology, Baptist Health Medicine Group, Lexington, Kentucky (Dr. Vetter)., Suarez AA; Division of Surgical Pathology (Dr. Suarez), College of Medicine., Felix AS; Division of Epidemiology, College of Public Health (Dr. Felix), The Ohio State University, Columbus, Ohio.
Jazyk:	angličtina
Zdroj:	Journal of minimally invasive gynecology [J Minim Invasive Gynecol] 2022 Feb; Vol. 29 (2), pp. 219-230. Date of Electronic Publication: 2021 Aug 01.
DOI:	10.1016/j.jmig.2021.07.018
Abstrakt:	Study Objective: To investigate determinants of surgical approach among women with endometrial carcinoma (EC) and associations between surgical approach and overall survival (OS). Design: Retrospective cohort. Setting: The National Cancer Database, 2010 to 2015. Patients: A total of 140 470 patients with histologically confirmed EC who underwent hysterectomy. Interventions: Patients were grouped according to surgical approach. Measurements and Main Results: A total of 140 470 patients with EC were included. Robotic-assisted laparoscopy (RAL) was the most common surgical approach (48.8%), followed by laparotomy (33.6%) and traditional laparoscopy (17.6%). Use of RAL increased over the study period, and the percentages of cases managed by laparotomy decreased. Older women, those with insurance, residing in ZIP codes with lower proportions of individuals who did not graduate from high school, and those treated at noncommunity cancer programs were less likely to undergo laparotomy than RAL, and non-white women, those diagnosed with high-grade histology, and those with advanced-stage EC were more likely to undergo laparotomy than RAL. Compared with RAL, all other surgical approaches were associated with worse OS (laparotomy: hazard ratio 1.21; 95% confidence interval, 1.18-1.25; traditional laparoscopy: hazard ratio 1.06; 95% confidence interval, 1.02-1.09). Significant effect modification of the surgical approach and OS relationship according to age, race, histology, stage, and adjuvant treatment was observed. Conclusion: RAL increased in frequency over the study period and was associated with improved OS, supporting the continued use of RAL for EC management. (Copyright © 2021 AAGL. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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