Venous Thromboembolism in Minimally Invasive Compared With Open Hysterectomy for Endometrial Cancer.
OBJECTIVE
To evaluate whether minimally invasive surgery for endometrial cancer is independently associated with a decreased odds of venous thromboembolism compared with open surgery.


METHODS
We performed a secondary analysis cohort study of prospectively collected quality improvement data and examined patients undergoing hysterectomy for endometrial cancer from 2008 to 2013 recorded in the National Surgical Quality Improvement Program database. Patients undergoing minimally invasive (laparoscopic or robotic) surgery were compared with those undergoing open surgery with respect to 30-day postoperative venous thromboembolism. Demographic and procedure variables were examined as potential confounders. Data regarding receipt of perioperative venous thromboembolism prophylaxis were not available. Bivariable tests and logistic regression were used for analysis.


RESULTS
Of 9,948 patients who underwent hysterectomy for the treatment of endometrial cancer, 61.9% underwent minimally invasive surgery and 38.1% underwent open surgery. Patients undergoing minimally invasive surgery had a lower venous thromboembolism incidence (0.7%, n=47) than patients undergoing open surgery (2.2%, n=80) (P<.001). In a multivariate model adjusting for age, body mass index, race, operative time, Charlson comorbidity score, and surgical complexity, minimally invasive surgery remained associated with decreased odds of venous thromboembolism (adjusted odds ratio 0.36, 95% confidence interval 0.24-0.53) compared with open surgery.


CONCLUSIONS
Minimally invasive surgery for the treatment of endometrial cancer is independently associated with decreased odds of venous thromboembolism compared with open surgery.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and the Lineberger Clinical Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
Emma L
EL
Barber
Paola A
PA
Gehrig
Daniel L
DL
Clarke-Pearson
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D057186:Comparative Effectiveness Research; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D009367:Neoplasm Staging; D009657:North Carolina / Q000453:epidemiology; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D058996:Quality Improvement; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*