(Reg Anesth Pain Med. 2018;43:502–508) As the use of neuraxial anesthesia is potentially broadening, an increased understanding and prevention of postdural puncture headache (PDPH) is needed. While numerous studies have examined either needle gauge or design, there has not been a comprehensive study analyzing individual technical and patient-related factors. This meta-analysis aimed to examine the association between spinal needle characteristics and PDPH.

A significant relationship between needle gauge and subsequent rate of PDPH was noted in cutting needles, but not pencil-point needles.

OBJECTIVE: To compare disease-free survival between minimally invasive surgery and open surgery in patients with high-risk endometrial cancer. METHODS: We conducted a multicentric, propensity-matched study of patients with high-risk endometrial cancer who underwent hysterectomy, bilateral salpingo-oophorectomy, and staging between January 1999 and June 2016 at two centers. High-risk endometrial cancer included grade 3 endometrioid, serous, clear cell, undifferentiated carcinoma or carcinosarcoma with any myometrial invasion. Patients were categorized a priori into two groups based on surgical approach, propensity scores were calculated based on potential confounders and groups were matched 1:1 using nearest neighbor technique. Cox hazard regression analysis and Kaplan-Meier curves evaluated the association of surgical technique with survival. RESULTS: Of 626 eligible patients, 263 (42%) underwent minimally invasive surgery and 363 (58%) underwent open surgery. In the matched cohort, there were no differences in disease-free survival rates at 5 years between open (53.4% [95% CI 45.6–60.5%]) and minimally invasive surgery (54.6% [95% CI 46.6–61.8]; P=.82). Minimally invasive surgery was not associated with worse disease-free survival (hazard ratio [HR] 0.85, 95% CI 0.63–1.16; P=.30), overall survival (HR 1.04, 95% CI 0.73–1.48, P=.81), or recurrence rate (HR 0.99; 95% CI 0.69–1.44; P=.99) compared with open surgery. Use of uterine manipulator was not associated with worse disease-free survival (HR 1.01, 95% CI 0.65–1.58, P=.96), overall survival (HR 1.18, 95% CI 0.71–1.96, P=.53), or recurrence rate (HR 1.12, 95% CI 0.67–1.87; P=.66). CONCLUSION: There was no difference in oncologic outcomes comparing minimally invasive and open surgery among patients with high-risk endometrial cancer.