title: Laparoscopic versus abdominal hysterectomy for endometrial cancer: comparison of patient outcomes.
abstract: OBJECTIVE
  To compare the demographics, cancer characteristics, and hospital outcomes of endometrial cancer patients undergoing a laparoscopically assisted vaginal hysterectomy (LAVH) versus a total abdominal hysterectomy (TAH).
  
  
  METHODS
  Two California population databases (Office of Statewide Health Planning and Development and the California Cancer Registry) were linked using patient identifiers. Patients who underwent endometrial cancer surgery from 1997 to 2001 were identified. The combined database was queried for type of surgery, patient demographics, hospital outcomes, comorbidities, and cancer characteristics. Statistical analyses included the t test, chi2 test, and logistic regression.
  
  
  RESULTS
  In this study, 978 endometrial cancer patients (7.7%) had an LAVH and 11,765 (92.3%) had a TAH. The mean ages for the 2 groups were 63.3 and 64.8 years, respectively. Lymphadenectomy was performed more frequently in LAVH patients compared with TAH patients (45.6 vs 41.1%; P = 0.006). Patients undergoing LAVH were more likely to be younger and healthier and have stage I or grade 1 disease (P < 0.0001). Total abdominal hysterectomy patients were more likely to have significant medical comorbidities. Mean length of stay for LAVH was 2.40 versus 4.36 days for TAH (P < 0.001), but mean hospital charges were comparable. Perioperative complications such as vascular and bowel injuries, pulmonary embolism, wound problems, and transfusions were significantly more common in TAH patients.
  
  
  CONCLUSIONS
  Surgeons seem to carefully select endometrial cancer patients for laparoscopic surgery. Although surgical staging was performed in less than 50% of endometrial cancer patients, the rate was not worse in laparoscopic procedures. Short-term hospital complications were less common in the laparoscopy group.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Davis, Medical Center, CA, USA. gsleiserowitz@ucdavis.edu
authors.forename: Gary S
authors.initials: GS
authors.lastname: Leiserowitz
authors.forename: Guibo
authors.initials: G
authors.lastname: Xing
authors.forename: Arti
authors.initials: A
authors.lastname: Parikh-Patel
authors.forename: Rosemary
authors.initials: R
authors.lastname: Cress
authors.forename: Alireza
authors.initials: A
authors.lastname: Abidi
authors.forename: Anne O
authors.initials: AO
authors.lastname: Rodriguez
authors.forename: John L
authors.initials: JL
authors.lastname: Dalrymple
mesh_terms: D000368:Aged; D002140:California / Q000453:epidemiology; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D010535:Laparoscopy; D008197:Lymph Node Excision; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome