Outcomes and costs of open, robotic, and laparoscopic radical hysterectomy for stage IB1 cervical cancer.

摘要

5502 Background: Surgery is the primary treatment modality for early cervical cancer. Compared to open (ORH), a robotic (RRH) or laparoscopic (LRH) approach to radical hysterectomy may have decreased morbidity, but the influence of surgical approach on survival, specific perioperative complications, and costs is unknown. Methods: The 2010-2013 National Cancer Database (NCDB) was used to evaluate the 5-year survival (5YS) of women with stage IB1 cervical squamous cell carcinoma or adenocarcinoma after radical hysterectomy performed open or by minimally invasive surgery (MIS). Survival times were estimated with the Kaplan-Meier method. Multivariable Cox proportional-hazards model (CPH) was used to adjust for measured confounders. The 2010-2015 Premier Healthcare Database was used to compare complications, length of stay (LOS), readmission rates, and hospitalization costs between ORH, RRH, and LRH. All p-values are two-sided. Results: From the NCDB, 982 and 910 women underwent ORH versus MIS radical hysterectomy, respectively. Women with a tumor size ≥ 2 cm who underwent MIS radical hysterectomy had decreased survival compared to women who underwent ORH (5YS (95% CI): 81.3% (75.6%-87.3%) versus 90.8% (87.7%-93.9%); hazard ratio (95% CI) 2.14 (1.36-3.38), P < 0.001). From Premier, 2830 women had radical hysterectomy: 45.1% (1277) ORH, 48.9% (1384) RRH, and 6% (169) LRH. ORH was associated with longer LOS compared to RRH or LRH (days, median (IQR): ORH 3 (3-5); RRH 1 (0-2); LRH 0 (0-2), P < 0.001). ORH also had a higher composite complication rate than RRH or LRH (ORH 44.9%; RRH 13.9%; LRH; 12.4%, P < 0.001), with increased bowel injuries, infections, electrolyte or fluid disorders, transfusions, and ileus (all P ≤ 0.001) associated with ORH. Thirty-day readmission rates were similar (ORH 2.3%; RRH 1.4%; LRH 1.8%, P = 0.17). Total surgical hospitalization costs favored MIS (P < 0.001 between groups) with median (IQR) values: ORH $12080 (8957-16052); RRH $11562 (8636-14600); LRH $9649 (7478- 13010). Conclusions: MIS is associated with decreased morbidity and costs. However, among women with ≥ 2 cm stage IB1 cervical cancer, MIS was associated with significantly decreased survival.