Minimally Invasive Staging Surgery in Women with Early-Stage Endometrial Cancer: Analysis of the National Cancer Data Base

Bregar, Amy; Melamed, Alexander; Diver, Elisabeth; Clemmer, Joel; Uppal, Shitanshu; Schorge, John O.; Rice, Laurel W.; Carmen, Marcela G. del; Rauh‐Hain, J. Alejandro

doi:10.1245/s10434-016-5752-8

Cited by 31 publications

(12 citation statements)

References 37 publications

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“…In addition, previous National Cancer Database studies that compared minimally invasive surgery and open surgery in patients with early-stage ovarian or endometrial cancer did not show that minimally invasive surgery was associated with inferior survival, which suggests that the observed effect is unique to cervical cancer. 48,49 Finally, the interrupted time-series analysis, which showed that the adoption of minimally invasive techniques coincided with a decline in cancer-related survival, is not subject to a patient-selection bias.…”

Section: Discussionmentioning

confidence: 99%

Survival after Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer

et al. 2018

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BACKGROUND Minimally invasive surgery was adopted as an alternative to laparotomy (open surgery) for radical hysterectomy in patients with early-stage cervical cancer before high-quality evidence regarding its effect on survival was available. We sought to determine the effect of minimally invasive surgery on all-cause mortality among women undergoing radical hysterectomy for cervical cancer. METHODS We performed a cohort study involving women who underwent radical hysterectomy for stage IA2 or IB1 cervical cancer during the 2010–2013 period at Commission on Cancer–accredited hospitals in the United States. The study used inverse probability of treatment propensity-score weighting. We also conducted an interrupted time-series analysis involving women who underwent radical hysterectomy for cervical cancer during the 2000–2010 period, using the Surveillance, Epidemiology, and End Results program database. RESULTS In the primary analysis, 1225 of 2461 women (49.8%) underwent minimally invasive surgery. Women treated with minimally invasive surgery were more often white, privately insured, and from ZIP Codes with higher socioeconomic status, had smaller, lower-grade tumors, and were more likely to have received a diagnosis later in the study period than women who underwent open surgery. Over a median follow-up of 45 months, the 4-year mortality was 9.1% among women who underwent minimally invasive surgery and 5.3% among those who underwent open surgery (hazard ratio, 1.65; 95% confidence interval [CI], 1.22 to 2.22; P = 0.002 by the log-rank test). Before the adoption of minimally invasive radical hysterectomy (i.e., in the 2000–2006 period), the 4-year relative survival rate among women who underwent radical hysterectomy for cervical cancer remained stable (annual percentage change, 0.3%; 95% CI, −0.1 to 0.6). The adoption of minimally invasive surgery coincided with a decline in the 4-year relative survival rate of 0.8% (95% CI, 0.3 to 1.4) per year after 2006 (P = 0.01 for change of trend). CONCLUSIONS In an epidemiologic study, minimally invasive radical hysterectomy was associated with shorter overall survival than open surgery among women with stage IA2 or IB1 cervical carcinoma. (Funded by the National Cancer Institute and others.)

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Section: Discussionmentioning

confidence: 99%

Survival after Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer

et al. 2018

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“…Likewise, this study has found a decline in cervical cancer survival since the introduction of laparoscopy. The same type of study was carried out in endometrial cancer and it did not show this negative effect of laparoscopy [25]. This would be in favor of a specific effect in cervical cancer.…”

Section: Discussionmentioning

confidence: 78%

Comparison of survival outcomes between laparoscopic and abdominal radical hysterectomy for early-stage cervical cancer: A French multicentric study

Zaccarini

Santy

Dabi

et al. 2021

Journal of Gynecology Obstetrics and Human Reproduction

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Objectives: A recent randomized controlled trial has reconsidered the use of laparoscopy for treating patients with early-stage cervical cancer with radical hysterectomy (RH). We aimed to evaluate if surgical approach had an impact on surgical and oncological outcomes in these patients in a French setting.Methods: Data of 1706 patients with cervical cancer treated between 1996 and 2017 were extracted from maintained databases of 9 French University hospitals. Patients, with FIGO stage IA2 to IIB tumors, treated by radical hysterectomy were selected for further analysis. A propensity score matching was used with a ratio of 2:1 in favor of laparoscopic approach was used. The Kaplan Meier method was used to estimate the survival distribution.Results: 34 patients treated with laparotomy were matched with 61 patients treated by minimally invasive surgery (MIS). There was no difference regarding overall survival (91% vs 81%, p>0.05) or disease-free survival (82% vs 78%, p>0.05). There was no difference regarding surgical outcomes with no excess of postoperative complication in patients with MIS. Hospital stay was significantly longer in patients operated on laparotomy. Conclusion:In our study, there was no evidence of a difference in survival between minimally invasive surgery and laparotomy in patients treated with radical hysterectomy for early-stage cervical cancer.

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“…The goal of this study was to investigate if and how SES influences outcomes for the population of patients undergoing MIS in the form of RAVT pulmonary lobectomy. As mentioned earlier, studies have shown that patients of lower SES are less likely to undergo MIS [6][7][8][9]. Patients of low SES have been found to be less willing to undergo minimally invasive procedures and are less likely to receive novel therapies in the setting of MI and minimally invasive revascularization procedures [18,19].…”

Section: Discussionmentioning

confidence: 96%

“…Lower socioeconomic status (SES) has been shown to negatively influence outcomes in lung cancer patients undergoing lobectomy and other forms of surgical resection and has been associated with shorter median survival time and increased rates of in-hospital mortality and risk-adjusted mortality [3][4][5]. Patients with low SES demographics, such as low income, minority ethnicity, public insurance coverage, and lower levels of education, have been demonstrated to be less likely to undergo minimally invasive surgery (MIS) [6][7][8][9]. One study investigating the influence of insurance coverage on perioperative and long-term outcomes following robotic-assisted video thoracoscopic (RAVT) surgery, a form of MIS for lung cancer, found that patients with public insurance had less favorable outcomes compared to patients with private or combination insurance [10].…”

Section: Introductionmentioning

confidence: 99%

Effect of Socio-Economic Status on Perioperative Outcomes After Robotic-Assisted Pulmonary Lobectomy

Jermihov¹,

Chen²,

Echavarria³

et al. 2022

Cureus

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Background: Lower socioeconomic status (SES) has been correlated with poor survival rates and surgical outcomes following lung cancer resection. This study sought to determine whether this disparity exists perioperatively in lung cancer patients following robotic-assisted video-thoracoscopic pulmonary lobectomy.Methods: We retrospectively reviewed 447 consecutive patients who underwent robotic-assisted pulmonary lobectomy by one surgeon for known or suspected lung cancer. Ten patients were excluded due to incomplete data. We used median income by residential ZIP code as a surrogate for SES status and grouped patients based on whether ZIP-based median income was less than (Group 1) or greater than (Group 2) 300% of the federal poverty income level. The effects of SES status groups on incidence of postoperative complications, chest tube duration, hospital length of stay (LOS), and in-hospital mortality were evaluated by the logistic regression model and Inverse Gaussian regression model, respectively.Results: Without adjustment, Group 1 tended to have a higher rate of postoperative complications, with 54% of patients experiencing complications compared to 34% of patients in Group 2 (p=0.007). Median chest tube duration and hospital LOS were also significantly longer in Group 1 than in Group 2 (p=0.034). In multivariable logistical regression analysis, while controlling for covariates and considering effect modifications, lower SES was significantly and positively associated with postoperative complications (odds ratio (OR)=1.98, p=0.039). Preoperative chronic obstructive pulmonary disease (COPD) was also a positive and significant predictor of postoperative complications (OR=1.89, p=0.017), chest tube duration (p=0.020), and LOS (p=0.010).Conclusions: Lower median income is associated with a greater number of postoperative complications following pulmonary resection for lung cancer when controlling for covariates.

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Minimally Invasive Staging Surgery in Women with Early-Stage Endometrial Cancer: Analysis of the National Cancer Data Base

Cited by 31 publications

References 37 publications

Survival after Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer

Survival after Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer

Comparison of survival outcomes between laparoscopic and abdominal radical hysterectomy for early-stage cervical cancer: A French multicentric study

Effect of Socio-Economic Status on Perioperative Outcomes After Robotic-Assisted Pulmonary Lobectomy

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