BACKGROUND Minimally invasive surgery was adopted as an alternative to laparotomy (open surgery) for radical hysterectomy in patients with early-stage cervical cancer before high-quality evidence regarding its effect on survival was available. We sought to determine the effect of minimally invasive surgery on all-cause mortality among women undergoing radical hysterectomy for cervical cancer. METHODS We performed a cohort study involving women who underwent radical hysterectomy for stage IA2 or IB1 cervical cancer during the 2010–2013 period at Commission on Cancer–accredited hospitals in the United States. The study used inverse probability of treatment propensity-score weighting. We also conducted an interrupted time-series analysis involving women who underwent radical hysterectomy for cervical cancer during the 2000–2010 period, using the Surveillance, Epidemiology, and End Results program database. RESULTS In the primary analysis, 1225 of 2461 women (49.8%) underwent minimally invasive surgery. Women treated with minimally invasive surgery were more often white, privately insured, and from ZIP Codes with higher socioeconomic status, had smaller, lower-grade tumors, and were more likely to have received a diagnosis later in the study period than women who underwent open surgery. Over a median follow-up of 45 months, the 4-year mortality was 9.1% among women who underwent minimally invasive surgery and 5.3% among those who underwent open surgery (hazard ratio, 1.65; 95% confidence interval [CI], 1.22 to 2.22; P = 0.002 by the log-rank test). Before the adoption of minimally invasive radical hysterectomy (i.e., in the 2000–2006 period), the 4-year relative survival rate among women who underwent radical hysterectomy for cervical cancer remained stable (annual percentage change, 0.3%; 95% CI, −0.1 to 0.6). The adoption of minimally invasive surgery coincided with a decline in the 4-year relative survival rate of 0.8% (95% CI, 0.3 to 1.4) per year after 2006 (P = 0.01 for change of trend). CONCLUSIONS In an epidemiologic study, minimally invasive radical hysterectomy was associated with shorter overall survival than open surgery among women with stage IA2 or IB1 cervical carcinoma. (Funded by the National Cancer Institute and others.)

No abstract

Objective: To estimate the associations between race, route of hysterectomy and postoperative complications among women undergoing benign hysterectomy. Methods: A cohort study was performed. All patients undergoing benign hysterectomy, recorded in the National Surgical Quality Improvement Program (NSQIP) and its targeted hysterectomy file in 2015, were identified. The primary exposure was patient race. The primary outcome was route of hysterectomy and the secondary outcome was postoperative complication. Associations were examined using both bivariable tests and logistic regression. Results: Of 15,136 women who underwent benign hysterectomy, 75% were white and 25% were black. Black women were more likely to undergo an open hysterectomy than white women (50.1% vs. 22.9%; OR: 3.36, 95%CI: 3.11–3.64). Black women had larger uteri (median 262g vs. 123g; 60.7% vs. 25.6% with uterus >250g), more prior pelvic surgery (58.5% vs. 53.2%) and higher BMIs (32.7 vs. 30.4). After adjusting for these and other clinical factors, black women remained more likely to undergo an open hysterectomy (aOR: 2.02, 95%CI: 1.85–2.20). Black women experienced more major complications than white women (4.1% vs. 2.3%; p<0.001) and more minor complications (11.4% vs. 6.7%; OR: 1.78, p<0.001). Again these disparities persisted with adjustment (major aOR: 1.56, 95%CI: 1.25–1.95; minor aOR: 1.27, 95%CI: 1.11–1.47). Conclusions: Back women have a higher proportion of open hysterectomy and experience more major and minor postoperative complications. These differences persisted even after adjusting for confounding medical, surgical, and gynecologic factors.