title: Trends over time in the use of laparoscopic hysterectomy for the treatment of endometrial cancer.
abstract: OBJECTIVE
  To determine the rates of laparoscopy compared to laparotomy over time for the treatment of endometrial cancer in the province of Ontario, Canada, and to determine factors associated with having laparoscopic surgery.
  
  
  METHODS
  This was a population-based retrospective cohort study using healthcare administrative databases. Incident cases of endometrial cancer from April 2002-March 2011 were identified in the provincial cancer registry. Record linkages were made with other healthcare databases to determine type of hysterectomy (laparoscopic or abdominal±staging), year of diagnosis, comorbidities, location of residence, surgeon and hospital type.
  
  
  RESULTS
  12,104 patients with endometrial cancer treated with hysterectomy were identified, of which 2116 had laparoscopic surgery (17.5%). Rates of laparoscopy increased over time from 6.5% in 2002 to 30.2% in 2011 (p<0.0001). The median length of hospital stay after abdominal hysterectomy was significantly longer (3 days vs 1 day, p<0.0001). Adjusting for age, comorbidity score, income quintile and type of hospital (community versus academic), the probability of admission or emergency room visit within 30 days of surgery was significantly higher in patients with abdominal surgery (OR 1.61) (95% CI 1.36-1.92) (p<0.0001). The odds of having laparoscopic surgery was higher with a gynecologic oncologist (OR 2.85, 95% CI 1.61-5.85) or a general gynecologist at an academic hospital (OR 2.07, 95% CI 1.09-3.95) compared to a general gynecologist at a community hospital.
  
  
  CONCLUSIONS
  This population-based cohort study confirms the increased use over time of laparoscopic surgery to treat endometrial cancers in Ontario, and demonstrates the benefits of decreased hospital stay and decreased patient morbidity.
authors.affiliation: Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, Ontario M4N 3M5, Canada. Electronic address: Jamie.kroft@utoronto.ca.
authors.forename: Jamie
authors.initials: J
authors.lastname: Kroft
authors.affiliation: The Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Ave., Veterans Hill Trail, Toronto, Ontario M4N 3M5, Canada.
authors.forename: Qing
authors.initials: Q
authors.lastname: Li
authors.affiliation: The Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Ave., Veterans Hill Trail, Toronto, Ontario M4N 3M5, Canada.
authors.forename: Refik
authors.initials: R
authors.lastname: Saskin
authors.affiliation: Department of Obstetrics and Gynaecology, McMaster University, Health Sciences Centre, 1280 Main St. W, 2F43, Hamilton, Ontario L8S 4K1, Canada.
authors.forename: Laurie
authors.initials: L
authors.lastname: Elit
authors.affiliation: Division of Gynaecologic Oncology, Princess Margaret Hospital, 610 University Ave., Toronto, Ontario M5G 2M9, Canada.
authors.forename: Marcus Q
authors.initials: MQ
authors.lastname: Bernardini
authors.affiliation: Division of Gynecologic Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, Ontario M4N 3M5, Canada; The Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Ave., Veterans Hill Trail, Toronto, Ontario M4N 3M5, Canada.
authors.forename: Lilian T
authors.initials: LT
authors.lastname: Gien
mesh_terms: D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data* / Q000639:trends; D010535:Laparoscopy / Q000706:statistics & numerical data* / Q000639:trends; D008875:Middle Aged; D009864:Ontario; D012189:Retrospective Studies
keywords: Endometrial cancer; Hysterectomy; Laparoscopy; Minimally invasive surgery; Uterine cancer