title: Use and benefits of laparoscopic hysterectomy for stage I endometrial cancer among medicare beneficiaries.
abstract: OBJECTIVE
  Laparoscopic hysterectomy is associated with shorter hospital stays, less postoperative pain, and earlier resumption of activity. We analyzed predictors of access to laparoscopy and compared the outcomes of laparoscopic and open hysterectomy for stage I endometrial cancer.
  
  
  METHODS
  Using the SEER-Medicare database we examined women 65 years of age with stage I endometrial cancer who underwent hysterectomy between 1997 and 2005. The associations of patient, tumor, and physician-related factors with use of laparoscopic hysterectomy were analyzed. Surgical quality, morbidity, and survival were compared.
  
  
  RESULTS
  We identified 8,545 patients, including 8,018 (93.8%) who underwent abdominal hysterectomy and 527 (6.2%) who had a laparoscopic hysterectomy. Performance of laparoscopic hysterectomy increased from 3.9% in 1997 to 8.5% in 2005. More recent year of diagnosis, younger age, white race, fewer comorbidities, higher socioeconomic status, lower tumor grade and stage, and residence in a metropolitan area were associated with use of laparoscopy (P < .05 for each). Physician characteristics associated with performance of laparoscopy included training in the United States, specialization in gynecologic oncology, academic practice, and later year of graduation (P < .05 for all). Surgical site complications (odds ratio [OR] = 0.46; 95% CI, 0.30 to 0.71) and medical complications (OR = 0.67; 95% CI, 0.47 to 0.95) were less common in patients who underwent laparoscopy. The route of hysterectomy had no effect on cancer-specific survival (OR = 0.74; 95% CI, 0.38 to 1.44).
  
  
  CONCLUSIONS
  Despite the fact that laparoscopic hysterectomy for endometrial cancer results in fewer complications, uptake has been slow.
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. jw2459@columbia.edu
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Wilde
authors.forename: Donna L
authors.initials: DL
authors.lastname: Buono
authors.forename: Wei-Yann
authors.initials: WY
authors.lastname: Tsai
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000191:economics / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data; D009367:Neoplasm Staging; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology