Survival after minimally invasive surgery in elderly women patients with endometrial carcinoma

Objectives: The number of women over 65 years is increasing, and new cases of endometrial cancer are predicted to increase. Data is lacking on the best surgical approach to improve oncologic outcomes for women at or above age 65. Objective: To analyze the impact of minimally invasive surgery for endometrial cancer on overall survival for women over 65 years. Methods: Retrospective cohort study of women 65 years and older who underwent hysterectomy upon diagnosis of endometrial cancer from 2010 to 2015 from the U.S. National Cancer Data Base (NCDB). Data collected included demographics, tumor characteristics, perioperative outcomes, adjuvant treatment, and survival. Inverse probability of treatment propensity-score weighting was used. Kaplan-Meier curves with log-rank test and multivariable Cox proportional hazard models were used to evaluate the impact of surgical approach on survival. Results: Of 243,601 patients with endometrial cancer, 42,458 met inclusion criteria. Open surgery was performed on 12,099 (28.5%), laparoscopic surgery on 7,898 (18.6%), and robotic surgery on 22,461 (52.9%). Laparoscopic approach showed better survival outcomes by 12% (HR = 0.88; 95% CI: 0.82-0.95; p=0.001) and robotic approaches showed better survival outcomes by 15% (HR = 0.85; 95% CI: 0.8-0.9; p<0.0001), compared to open approach. The 30-day and 90-day mortality rate favored laparoscopic and robotic approach. 30-day mortality rate was 1.2%, 0.7%, and 0.5%for open, laparoscopic, and robotic surgery, respectively (p<0.001). Similarly, the 5-year overall survival was monotonically superior outcomes with 73.1% (95% CI: 72%-74.2%), 76.4% (95% CI: 75.1-77.7%), and 75.5% (95% CI: 74.7-76.4%) for open, laparoscopic, and robotic approaches, respectively (p<0.001). Factors associated with lower survival were older age, Black race, longer interval between diagnosis and surgical intervention, higher Charlson/Deyo score, higher tumor stage, poor social economic status and lack of adjuvant therapy. All these were adjusted for the multivariable model as confounding factors. Conclusions: Minimally invasive surgery improved overall survival in women over 65 years with endometrial cancer. The number of women over 65 years is increasing, and new cases of endometrial cancer are predicted to increase. Data is lacking on the best surgical approach to improve oncologic outcomes for women at or above age 65. Objective: To analyze the impact of minimally invasive surgery for endometrial cancer on overall survival for women over 65 years. Retrospective cohort study of women 65 years and older who underwent hysterectomy upon diagnosis of endometrial cancer from 2010 to 2015 from the U.S. National Cancer Data Base (NCDB). Data collected included demographics, tumor characteristics, perioperative outcomes, adjuvant treatment, and survival. Inverse probability of treatment propensity-score weighting was used. Kaplan-Meier curves with log-rank test and multivariable Cox proportional hazard models were used to evaluate the impact of surgical approach on survival. Of 243,601 patients with endometrial cancer, 42,458 met inclusion criteria. Open surgery was performed on 12,099 (28.5%), laparoscopic surgery on 7,898 (18.6%), and robotic surgery on 22,461 (52.9%). Laparoscopic approach showed better survival outcomes by 12% (HR = 0.88; 95% CI: 0.82-0.95; p=0.001) and robotic approaches showed better survival outcomes by 15% (HR = 0.85; 95% CI: 0.8-0.9; p<0.0001), compared to open approach. The 30-day and 90-day mortality rate favored laparoscopic and robotic approach. 30-day mortality rate was 1.2%, 0.7%, and 0.5%for open, laparoscopic, and robotic surgery, respectively (p<0.001). Similarly, the 5-year overall survival was monotonically superior outcomes with 73.1% (95% CI: 72%-74.2%), 76.4% (95% CI: 75.1-77.7%), and 75.5% (95% CI: 74.7-76.4%) for open, laparoscopic, and robotic approaches, respectively (p<0.001). Factors associated with lower survival were older age, Black race, longer interval between diagnosis and surgical intervention, higher Charlson/Deyo score, higher tumor stage, poor social economic status and lack of adjuvant therapy. All these were adjusted for the multivariable model as confounding factors. Minimally invasive surgery improved overall survival in women over 65 years with endometrial cancer.