Laparoscopic hysterectomy is preferred over laparotomy in early endometrial cancer patients, however not cost effective in the very obese

Bijen, Claudia B M; Bock, Geertruida H. de; Vermeulen, Karin M.; Arts, Henriëtte J.G.; Brugge, Henk G. ter; Sijde, Rob van der; Kraayenbrink, A; Bongers, Marlies Y.; Zee, Ate G.J. van der; Mourits, Marian J.E.

doi:10.1016/j.ejca.2011.04.035

Cited by 51 publications

(35 citation statements)

References 24 publications

(30 reference statements)

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“…Further analysis of trial data found TLH cost-effective for patients >70 years of age, but not for very obese patients with body mass index > 35. 18 In another clinical trial of hysterectomy for benign diagnoses, Garry et al 19 not only reported higher complication rates for LH but also confirmed a shorter hospital stay and faster postoperative recovery compared to TAH. Sculpher et al 20 found higher costs of laparoscopic hysterectomy compared to abdominal hysterectomy (£186) with similar QALYs resulting in incremental costs of £26 571 for each QALY gained.…”

Section: Discussionmentioning

confidence: 92%

The cost-effectiveness of total laparoscopic hysterectomy compared to total abdominal hysterectomy for the treatment of early stage endometrial cancer

et al. 2013

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ObjectiveTo summarise how costs and health benefits will change with the adoption of total laparoscopic hysterectomy compared to total abdominal hysterectomy for the treatment of early stage endometrial cancer.DesignCost-effectiveness modelling using the information from a randomised controlled trial.ParticipantsTwo hypothetical modelled cohorts of 1000 individuals undergoing total laparoscopic hysterectomy and total abdominal hysterectomy.Outcome measuresSurgery costs; hospital bed days used; total healthcare costs; quality-adjusted life years; and net monetary benefits.ResultsFor 1000 individuals receiving total laparoscopic hysterectomy surgery, the costs were $509 575 higher, 3548 hospital fewer bed days were used and total health services costs were reduced by $3 746 221. There were 39.13 more quality-adjusted life years for a 5 year period following surgery.ConclusionsThe adoption of total laparoscopic hysterectomy is almost certainly a good decision for health services policy makers. There is 100% probability that it will be cost saving to health services, a 86.8% probability that it will increase health benefits and a 99.5% chance that it returns net monetary benefits greater than zero.

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Section: Discussionmentioning

confidence: 92%

The cost-effectiveness of total laparoscopic hysterectomy compared to total abdominal hysterectomy for the treatment of early stage endometrial cancer

et al. 2013

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“…Many authors concluded that it is not effective to perform laparoscopic hysterectomy in high-body mass index (BMI) women [31–34]. Bijen et al noted that the risk of conversion from laparoscopy to laparotomy increases with BMI, with a rapid rise in women with a BMI >35 [31].…”

Section: Surgical Approach With Eec (Stage I Figo2009)mentioning

confidence: 99%

“…Bijen et al noted that the risk of conversion from laparoscopy to laparotomy increases with BMI, with a rapid rise in women with a BMI >35 [31]. …”

Section: Surgical Approach With Eec (Stage I Figo2009)mentioning

confidence: 99%

Surgical Management of Early Endometrial Cancer: An Update and Proposal of a Therapeutic Algorithm

et al. 2014

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In the last few years technical improvements have produced a dramatic shift from traditional open surgery towards a minimally invasive approach for the management of early endometrial cancer. Advancement in minimally invasive surgical approaches has allowed extensive staging procedures to be performed with significantly reduced patient morbidity. Debate is ongoing regarding the choice of a minimally invasive approach that has the most effective benefit for the patients, the surgeon, and the healthcare system as a whole.Surgical treatment of women with presumed early endometrial cancer should take into account the features of endometrial disease and the general surgical risk of the patient. Women with endometrial cancer are often aged, obese, and with cardiovascular and metabolic comorbidities that increase the risk of peri-operative complications, so it is important to tailor the extent and the radicalness of surgery in order to decrease morbidity and mortality potentially derivable from unnecessary procedures. In this regard women with negative nodes derive no benefit from unnecessary lymphadenectomy, but may develop short- and long-term morbidity related to this procedure. Preoperative and intraoperative techniques could be critical tools for tailoring the extent and the radicalness of surgery in the management of women with presumed early endometrial cancer. In this review we will discuss updates in surgical management of early endometrial cancer and also the role of preoperative and intraoperative evaluation of lymph node status in influencing surgical options, with the aim of proposing a management algorithm based on the literature and our experience.

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“…Obesity has been associated with a worse prognosis of endometrial carcinoma in several published studies, although there was no association in other and in Korean population studies (10)(11)(12)(13)(14). Obesity was once a contraindication for advanced laparoscopic procedures (15,16), although this has recently been reconsidered (17). Improved instrumentation and techniques have allowed the safe use of many advanced laparoscopic procedures in women with a high BMI (18)(19)(20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

Feasibility and Safety of Laparoscopic Surgery for Obese Korean Women with Endometrial Cancer: Long-Term Results at a Single Institution

Baek

Suk

Jung

et al. 2014

Journal of Minimally Invasive Gynecology

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The purpose of this study was to evaluate the surgical feasibility of and survival outcome after laparoscopy in obese Korean women with endometrial cancer which has recently been increasing. We reviewed the medical records of the patients treated at our medical institution between 1999 and 2012. The patients were divided into three groups, nonobese (Body Mass Index [BMI] < 25.0), overweight (BMI 25-27.99), and obese (BMI ≥ 28.0). These patient groups were compared in terms of their clinical characteristics, treatment methods, as well as surgical and survival outcomes. In total, 55 of the 278 eligible patients were obese women. There were no differences in the three groups in terms of the proportion of patients who underwent lymphadenectomy, their cancer stage, histologic type, type of adjuvant treatment administered, intra-, post-operative, and longterm complications, operative time, number of removed lymph nodes, blood loss, and duration of hospitalization (P = 0.067, 0.435, 0.757, 0.739, 0.458, 0.173, 0.076, 0.124, 0.770, 0.739, and 0.831, respectively). The Disease-Free Survival (DFS) times were 139.1 vs. 121.6 vs. 135.5 months (P = 0.313), and the Overall Survival (OS) times were 145.2 vs. 124.8 vs. 139.5 months (P = 0.436) for each group, respectively. Obese women with endometrial cancer can, therefore, be as safely managed using laparoscopy as women with normal BMIs.

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Laparoscopic hysterectomy is preferred over laparotomy in early endometrial cancer patients, however not cost effective in the very obese

Cited by 51 publications

References 24 publications

The cost-effectiveness of total laparoscopic hysterectomy compared to total abdominal hysterectomy for the treatment of early stage endometrial cancer

The cost-effectiveness of total laparoscopic hysterectomy compared to total abdominal hysterectomy for the treatment of early stage endometrial cancer

Surgical Management of Early Endometrial Cancer: An Update and Proposal of a Therapeutic Algorithm

Feasibility and Safety of Laparoscopic Surgery for Obese Korean Women with Endometrial Cancer: Long-Term Results at a Single Institution

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