title: Comparative Effectiveness of Minimally Invasive Hysterectomy for Endometrial Cancer.
abstract: OBJECTIVE
  Despite the potential benefits of minimally invasive hysterectomy for uterine cancer, population-level data describing the procedure's safety in unselected patients are lacking. We examined the use of minimally invasive surgery and the association between the route of the procedure and long-term survival.
  
  
  METHODS
  We used the SEER-Medicare database to identify women with stage I-III uterine cancer who underwent hysterectomy from 2006 to 2011. Patients who underwent abdominal hysterectomy were compared with those who had minimally invasive hysterectomy (laparoscopic and robot-assisted). Perioperative morbidity, use of adjuvant therapy, and long-term survival were examined after propensity score balancing.
  
  
  RESULTS
  We identified 6,304 patients, including 4,139 (65.7%) who underwent abdominal hysterectomy and 2,165 (34.3%) who underwent minimally invasive hysterectomy; performance of minimally invasive hysterectomy increased from 9.3% in 2006 to 61.7% in 2011. Robot-assisted procedures accounted for 62.3% of the minimally invasive operations. Compared with women who underwent abdominal hysterectomy, minimally invasive hysterectomy was associated with a lower overall complication rate (22.7% v 39.7%; P < .001), and lower perioperative mortality (0.6% v 1.1%), but these women were more likely to receive adjuvant pelvic radiotherapy (34.3% v 31.3%) and brachytherapy (33.6% v 31.0%; P < .05). The complication rate was higher after robot-assisted hysterectomy compared with laparoscopic hysterectomy (23.7% v 19.5%; P = .03). There was no association between the use of minimally invasive hysterectomy and either overall (HR, 0.89; 95% CI, 0.75 to 1.04) or cancer-specific (HR, 0.83; 95% CI, 0.59 to 1.16) mortality.
  
  
  CONCLUSIONS
  Minimally invasive hysterectomy does not appear to compromise long-term survival for women with endometrial cancer.
authors.affiliation: Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY. jw2459@columbia.edu.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
authors.affiliation: Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY.
authors.forename: William M
authors.initials: WM
authors.lastname: Burke
authors.affiliation: Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY.
authors.forename: Ana I
authors.initials: AI
authors.lastname: Tergas
authors.affiliation: Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY.
authors.forename: June Y
authors.initials: JY
authors.lastname: Hou
authors.affiliation: Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY.
authors.forename: Yongmei
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY.
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
authors.affiliation: Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY.
authors.forename: Grace Clarke
authors.initials: GC
authors.lastname: Hillyer
authors.affiliation: Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY.
authors.forename: Cande V
authors.initials: CV
authors.lastname: Ananth
authors.affiliation: Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY.
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.affiliation: Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Yongmei Huang, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Columbia University College of Physicians and Surgeons; Ana I. Tergas, Grace Clarke Hillyer, Cande V. Ananth, Alfred I. Neugut, and Dawn L. Hershman, Mailman School of Public Health; Jim C. Hu, Weill Cornell Medical College; and Jason D. Wright, William M. Burke, Ana I. Tergas, June Y. Hou, Jim C. Hu, Alfred I. Neugut, and Dawn L. Hershman, New York Presbyterian Hospital, New York, NY.
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000706:statistics & numerical data*; D057186:Comparative Effectiveness Research; D015986:Confounding Factors, Epidemiologic; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000706:statistics & numerical data; D006278:Medicare; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data; D065287:Robotic Surgical Procedures; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
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