Cancer Res Treat.  2019 Apr;51(2):788-796. 10.4143/crt.2018.120.

Comparative Effectiveness of Abdominal versus Laparoscopic Radical Hysterectomy for Cervical Cancer in the Postdissemination Era

Affiliations
  • 1Department of Nursing, Chosun University College of Medicine, Gwangju, Korea.
  • 2Department of Public Health, Korea University, Seoul, Korea.
  • 3Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea. jungyunlee@yuhs.ac
  • 4Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.
  • 5Division of Gynecologic Oncology, Obstetrics and Gynecology, Irvine Medical Center, University of California, Orange, CA, USA.
  • 6Center for Uterine Cancer and Center for Clinical Trials, Hospital, National Cancer Center, Goyang, Korea.
  • 7Cancer Healthcare Research Branch, Precision Medicine Branch, and Common Cancer Branch, Research Institute, National Cancer Center, Goyang, Korea.
  • 8Department of Cancer Control & Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.
  • 9Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
Despite the benefits of minimally invasive surgery for cervical cancer, there are a lack of randomized trials comparing laparoscopic radical hysterectomy and abdominal radical hysterectomy. We compared morbidity, cost of care, and survival between abdominal radical hysterectomy and laparoscopic radical hysterectomy for cervical cancer.
MATERIALS AND METHODS
We used the Korean nationwide database to identify women with cervical cancer who underwent radical hysterectomy from January 1, 2011 to December 31, 2014. Patients who underwent abdominal radical hysterectomy were compared to those who underwent laparoscopic radical hysterectomy. Perioperative morbidity, the use of adjuvant therapy, and survival were evaluated after propensity score balancing.
RESULTS
We identified 6,335 patients, including 3,235 who underwent abdominal radical hysterectomy and 3,100 who underwent laparoscopic radical hysterectomy. The use of laparoscopic radical hysterectomy increased from 46.1% in 2011 to 51.8% in 2014. Patients who were younger, had a more recent year of diagnosis, and were treated in the metropolitan area were more likely to undergo a laparoscopic procedure (p < 0.001). Compared to abdominal radical hysterectomy, laparoscopic radical hysterectomy was associated with lower rates of complication, fewertransfusions, a shorter hospital stay, less adjuvant therapy, and reduced total medical costs (p < 0.001). Laparoscopic surgery was associated with a better overall survival than abdominal operation (hazard ratio, 0.74; 95% confidence interval, 0.64 to 0.85).
CONCLUSION
In the postdissemination era, laparoscopic radical hysterectomy was associated with more favorable morbidity profiles, a lower cost of care, and comparable survival than abdominal radical hysterectomy.

Keyword

Uterine cervical neoplasms; Radical hysterectomy; Minimally invasive surgery; Laparoscopy
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