Trends over time in the use of laparoscopic hysterectomy for the treatment of endometrial cancer

Objective — To determine the rates of laparoscopy compared to laparotomy over time for the treatment of endometrial cancer in the province of Ontario, Canada, and to determine factors associated with having laparoscopic surgery.

Methods — This was a population-based retrospective cohort study using healthcare administrative databases. Incident cases of endometrial cancer from April 2002-March 2011 were identified in the provincial cancer registry. Record linkages were made with other healthcare databases to determine type of hysterectomy, (laparoscopic or abdominal +/- staging), year of diagnosis, comorbidities, location of residence, surgeon and hospital type.

Results — 12104 patients with endometrial cancer treated with hysterectomy were identified, of which 2116 had laparoscopic surgery (17.5%). Rates of laparoscopy increased over time from 6.5% in 2002 to 30.2% in 2011 (p<0.0001). The median length of hospital stay after abdominal hysterectomy was significantly longer (3 days vs 1 day, p<0.0001). Adjusting for age, comorbidity score, income quintile and type of hospital (community versus academic), the probability of admission or emergency room visit within 30 days of surgery was significantly higher in patients with abdominal surgery (OR 1.61 (95% CI 1.36-1.92)(p<0.0001). The odds of having laparoscopic surgery was higher with a gynecologic oncologist (OR 2.85, 95% CI 1.61-5.85) or a general gynecologist at an academic hospital (OR 2.07, 95% CI 1.09-3.95) compared to a general gynecologist at a community hospital.

Conclusions — This population-based cohort study confirms the increased use over time of laparoscopic surgery to treat endometrial cancers in Ontario, and demonstrates the benefits of decreased hospital stay and decreased patient morbidity.