The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Original Article

Surgical Outcomes of Total Laparoscopic Hysterectomies Based on Uterine Cancer Staging

Authors: Katherine R. Cuyar, BS, Satyam K. Ghodasara, BS, Jana K. Elsawwah, BA, Daniel H. Tobias, MD, Zoltan H. Nemeth, MD, PhD

Abstract

Objectives: Minimally invasive surgery is effective for early-stage uterine cancer due to its confinement to the corpus uteri. Stage 1 endometrial cancer has two subgroups: stage 1A (<50% myometrium invasion) and stage 1B (≥50% myometrium invasion). We compared outcomes of total laparoscopic hysterectomies (TLHs) based on these distinct stages.

Methods: We analyzed TLHs using the 2021 American College of Surgeons National Surgery Quality Improvement Program targeted hysterectomy database, including only stage 1A and stage 1B corpus uteri cancer cases.

Results: From the database, 1287 patients with stage 1A and 403 patients with stage 1B classification were identified. Patients with stage 1B were older (68.28 vs 62.78 years), had a lower body mass index (34.42 vs 37.21 kg/m2), and had a higher proportion of hypertension (63.77% vs 57.42%) than stage 1A. The stage 1B cohort had higher hospital readmission rates (4.71% vs 2.49%) and a higher risk of returning to the operating room (2.73% vs 0.70%). Multivariate logistic regression indicated that stage 1B was independently associated with higher rates of hospital readmission (odds ratio 1.995) and a higher risk of returning to the operating room (odds ratio 3.830). All P values were statistically significant (<0.05).

Conclusions: Stage 1B uterine cancer was independently associated with higher rates of return to the operating room and hospital readmission. These data show that diagnosing and surgically treating uterine cancer earlier through a TLH procedure resulted in fewer complications.
Posted in: Obstetrics and Gynecology94 Uterine Disorders3

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References

1. Capozzi VA, Rosati A, Uccella S, et al. Role of uterine manipulator during laparoscopic endometrial cancer treatment. Transl Cancer Res 2020;9:7759–7766.
 
2. Sheffler SJ. Uterine cancer. Nursing 2010;40:31.
 
3. Berek JS, Matias-Guiu X, Creutzberg C, et al. FIGO staging of endometrial cancer: 2023. J Gynecol Oncol 2023;34:e85.
 
4. Ocak B, Sahin AB, Oz Atalay F, et al. Why do some patients with stage 1A and 1B endometrial endometrioid carcinoma experience recurrence? A retrospective study in search of prognostic factors. Ginekol Pol 2021 [online ahead of print] DOI: 10.5603/GP. a2021.0093.
 
5. Kohut AY, Kuhn T, Conrad LB, et al. Thirty-day postoperative adverse events in minimally invasive versus open abdominal radical hysterectomy for early-stage cervical cancer. J Minim Invasive Gynecol 2022;29:840–847.
 
6. Lin CH, Long CY, Huang KH, et al. Surgical trend and volume effect on the choice of hysterectomy benign gynecologic conditions. Gynecol Minim Invasive Ther 2021;10:1–9.
 
7. Jin YM, Liu SS, Chen J, et al. Robotic radical hysterectomy is superior to laparoscopic radical hysterectomy and open radical hysterectomy in the treatment of cervical cancer. PLoS One 2018;13:e0193033.
 
8. Permpongkosol S, Bagga HS, Romero FR, et al. Laparoscopic versus open partial nephrectomy for the treatment of pathological T1N0M0 renal cell carcinoma: a 5-year survival rate. J Urol 2006;176:1984–1989.
 
9. Sobh O, O’Sullivan K, Vargas MV, et al. Impact of age on postoperative complications following laparoscopic hysterectomy [abstract]. J Minim Invasive Gynecol 2018;25:S148.
 
10. O’Hanlan KA, Emeney PL, Frank MI, et al. Total laparoscopic hysterectomy: making it safe and successful for obese patients. JSLS 2021;25:e2020.00087.