title: The trend towards minimally invasive surgery (MIS) for endometrial cancer: an ACS-NSQIP evaluation of surgical outcomes.
abstract: OBJECTIVE
  Our objective was to evaluate the surgical trend towards increased MIS in the management of endometrial cancer in regard to improvements in patient outcomes.
  
  
  METHODS
  Using the American College of Surgeons-National Surgical Quality Improvement Project's database, patients who underwent hysterectomy for endometrial cancer from 2006-2010 were identified and categorized into exploratory laparotomy (XLAP) or MIS. Comparative analyses were performed and stratified by year of surgery to evaluate demographics, surgical outcomes, and 30-day surgical morbidity.
  
  
  RESULTS
  A total of 2076 patients (1269 XLAP and 807 MIS) underwent hysterectomy for endometrial cancer between 2006 and 2010. Longer operative times were seen in MIS compared to XLAP (192 vs. 148 min; p<0.001) as well as significant increase in mean hospital stay in the XLAP group of 3.8 days compared to 1.6 days in MIS (p<0.0001). When controlling for preoperative comorbidities, significant increases in postoperative complications were observed in XLAP compared to MIS group (total 396 vs. 91; p<0.0001). MIS increased from 16% in 2006 to 48% in 2010, which correlated to decreases in complications and hospital stays. Each 10% increase in MIS would save $2.8 million and 41 postoperative complications. If used exclusively, MIS would save 6434 hospital days and 416 complications.
  
  
  CONCLUSIONS
  Despite increases in operative times, MIS for the treatment of endometrial cancer significantly reduces perioperative complications and hospital stay. Considering the improvements in patient outcomes and the potential savings to the health care system, MIS should be the preferred route for the surgical treatment of this disease when feasible.
authors.affiliation: University of South Alabama Mitchell Cancer Institute, Mobile, AL, United States.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Scalici
authors.affiliation: University of South Alabama Mitchell Cancer Institute, Mobile, AL, United States.
authors.forename: Brittney B
authors.initials: BB
authors.lastname: Laughlin
authors.affiliation: University of South Alabama Mitchell Cancer Institute, Mobile, AL, United States.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Finan
authors.affiliation: Department of Mathematics and Statistics, University of South Alabama, Mobile, AL, United States.
authors.forename: Bin
authors.initials: B
authors.lastname: Wang
authors.affiliation: University of South Alabama Mitchell Cancer Institute, Mobile, AL, United States. Electronic address: rocconi@health.southalabama.edu.
authors.forename: Rodney P
authors.initials: RP
authors.lastname: Rocconi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D016889:Endometrial Neoplasms / Q000191:economics / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs; D006801:Humans; D007044:Hysterectomy / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data / Q000639:trends; D010535:Laparoscopy / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D007813:Laparotomy / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D061646:Operative Time; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology*; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D012371:Robotics / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D016896:Treatment Outcome; D014481:United States
keywords: Complications; Endometrial cancer; Minimally invasive surgery; NSQIP; Surgical outcome research