Comparative Effectiveness of Abdominal versus Laparoscopic Radical Hysterectomy for Cervical Cancer in the Postdissemination Era
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Purpose Despite the benefits of minimally invasive surgery for cervical cancer, there are a lack of randomized trials comparing laparoscopic radical hysterectomy and abdominal radical hysterectomy. We compared morbidity, cost of care, and survival between abdominal radical hysterectomy and laparoscopic radical hysterectomy for cervical cancer. Materials and Methods We used the Korean nationwide database to identify women with cervical cancer who underwent radical hysterectomy from January 1, 2011 to December 31, 2014. Patients who underwent abdominal radical hysterectomy were compared to those who underwent laparoscopic radical hysterectomy. Perioperative morbidity, the use of adjuvant therapy, and survival were evaluated after propensity score balancing. Results We identified 6,335 patients, including 3,235 who underwent abdominal radical hysterectomy and 3,100 who underwent laparoscopic radical hysterectomy. The use of laparoscopic radical hysterectomy increased from 46.1% in 2011 to 51.8% in 2014. Patients who were younger, had a more recent year of diagnosis, and were treated in the metropolitan area were more likely to undergo a laparoscopic procedure (p < 0.001). Compared to abdominal radical hysterectomy, laparoscopic radical hysterectomy was associated with lower rates of complication, fewer transfusions, a shorter hospital stay, less adjuvant therapy, and reduced total medical costs (p < 0.001). Laparoscopic surgery was associated with a better overall survival than abdominal operation (hazard ratio, 0.74; 95% confidence interval, 0.64 to 0.85). Conclusion In the postdissemination era, laparoscopic radical hysterectomy was associated with more favorable morbidity profiles, a lower cost of care, and comparable survival than abdominal radical hysterectomy.
Abstract
Purpose Despite the benefits of minimally invasive surgery for cervical cancer, there are a lack of randomized trials comparing laparoscopic radical hysterectomy and abdominal radical hysterectomy. We compared morbidity, cost of care, and survival between abdominal radical hysterectomy and laparoscopic radical hysterectomy for cervical cancer. Materials and Methods We used the Korean nationwide database to identify women with cervical cancer who underwent radical hysterectomy from January 1, 2011 to December 31, 2014. Patients who underwent abdominal radical hysterectomy were compared to those who underwent laparoscopic radical hysterectomy. Perioperative morbidity, the use of adjuvant therapy, and survival were evaluated after propensity score balancing. Results We identified 6,335 patients, including 3,235 who underwent abdominal radical hysterectomy and 3,100 who underwent laparoscopic radical hysterectomy. The use of laparoscopic radical hysterectomy increased from 46.1% in 2011 to 51.8% in 2014. Patients who were younger, had a more recent year of diagnosis, and were treated in the metropolitan area were more likely to undergo a laparoscopic procedure (p < 0.001). Compared to abdominal radical hysterectomy, laparoscopic radical hysterectomy was associated with lower rates of complication, fewer transfusions, a shorter hospital stay, less adjuvant therapy, and reduced total medical costs (p < 0.001). Laparoscopic surgery was associated with a better overall survival than abdominal operation (hazard ratio, 0.74; 95% confidence interval, 0.64 to 0.85). Conclusion In the postdissemination era, laparoscopic radical hysterectomy was associated with more favorable morbidity profiles, a lower cost of care, and comparable survival than abdominal radical hysterectomy.
참고문헌 (32)
- Dursun P, "The history of radical hysterectomy", J Low Genit Tract Dis, 15, pp.235~245 (2011)
- Conrad LB, "Role of minimally invasive surgery in gynecologic oncology : an updated survey of members of the Society of Gynecologic Oncology", Int J Gynecol Cancer, 25, pp.1121~1127 (2015)
- 이정윤, "Controversies in the management of endometrial cancer: a survey of the Korean Gynecologic Oncology Group", Journal of Gynecologic Oncology, 26(4), pp.277~283 (2015), 대한부인종양학회
- 정규원, "Survival of Korean Adult Cancer Patients by Stage at Diagnosis, 2006-2010: National Cancer Registry Study", Cancer Research and Treatment, 45(3), pp.162~171 (2013), 대한암학회
- Siegel R, "Cancer statistics, 2012", CA Cancer J Clin, 62, pp.10~29 (2012)
- Bergmark K, "Vaginal changes and sexuality in women with a history of cervical cancer", N Engl J Med, 340, pp.1383~1389 (1999)
- Scotti RJ, "Urodynamic changes in urethrovesical function after radical hysterectomy", Obstet Gynecol, 68, pp.111~120 (1986)
- Sood AK, "Anorectal dysfunction after surgical treatment for cervical cancer", J Am Coll Surg, 195, pp.513~519 (2002)
- Nam JH, "Laparoscopic versus open radical hysterectomy in early-stage cervical cancer: long-term survival outcomes in a matched cohort study", Ann Oncol, 23, pp.903~911 (2012)
- Park JY, "Laparoscopic versus open radical hysterectomy in patients with stage IB2 and IIA2 cervical cancer", J Surg Oncol, 108, pp.63~69 (2013)
- Abu-Rustum NR, "Total laparoscopic radical hysterectomy with pelvic lymphadenectomy using the argon-beam coagulator: pilot data and comparison to laparotomy", Gynecol Oncol, 91, pp.402~409 (2003)
- Bogani G, "Laparoscopic versus open abdominal management of cervical cancer : long-term results from a propensity-matched analysis", J Minim Invasive Gynecol, 21, pp.857~862 (2014)
- Frumovitz M, "Comparison of total laparoscopic and abdominal radical hysterectomy for patients with early-stage cervical cancer", Obstet Gynecol, 110, pp.96~102 (2007)
- Magrina JF, "Robotic radical hysterectomy : comparison with laparoscopy and laparotomy", Gynecol Oncol, 109, pp.86~91 (2008)
- Wang W, "Long-term oncological outcomes after laparoscopic versus abdominal radical hysterectomy in stage IA2 to IIA2 cervical cancer : a matched cohort study", Int J Gynecol Cancer, 26, pp.1264~1273 (2016)
- Soliman PT, "Radical hysterectomy : a comparison of surgical approaches after adoption of robotic surgery in gynecologic oncology", Gynecol Oncol, 123, pp.333~336 (2011)
- Wright JD, "Comparative effectiveness of minimally invasive and abdominal radical hysterectomy for cervical cancer", Gynecol Oncol, 127, pp.11~17 (2012)
- "Laparoscopic approach to cervical cancer (LACC)" (2018)[URL]
- World Health Organization, "International statistical classification of diseases and related health problems" (1994), World Health Organization
- Korean Health Insurance Review and Assessment Service, "Cost of health insurance medical care benefits" (2016), Korean Health Insurance Review and Assessment Service
- Elixhauser A, "Comorbidity measures for use with administrative data", Med Care, 36, pp.8~27 (1998)
- Sohn S, "A nationwide epidemiological study of newly diagnosed spine metastasis in the adult Korean population", Spine J, 16, pp.937~945 (2016)
- 손세일, "A Nation-Wide Epidemiological Study of Newly Diagnosed Primary Spine Tumor in the Adult Korean Population, 2009-2011", 대한신경외과학회지, 60(2), pp.195~204 (2017), 대한신경외과학회
- Robins JM, "Marginal structural models and causal inference in epidemiology", Epidemiology, 11, pp.550~560 (2000)
- Stukel TA, "Analysis of observational studies in the presence of treatment selection bias : effects of invasive cardiac management on AMI survival using propensity score and instrumental variable methods", JAMA, 297, pp.278~285 (2007)
- Wright JD, "Comparative effectiveness of minimally invasive hysterectomy for endometrial cancer", J Clin Oncol, 34, pp.1087~1096 (2016)
- Barnett JC, "Cost comparison among robotic, laparoscopic, and open hysterectomy for endometrial cancer", Obstet Gynecol, 116, pp.685~693 (2010)
- Rauh-Hain JA, "Comparative effectiveness of minimally invasive staging surgery in women with early stage cervical cancer", Proceedings of the Society of Gynecologic Oncologists (2018)
- Ramirez PT, "Phase III randomized trial of laparoscopic or robotic versus abdominal radical hysterectomy in patients with earlystage cervical cancer: LACC Trial", Proceedings of the 49th Annual Meeting of the Society of Gynecologic Oncologists (2018), Society of Gynecologic Oncology
- 박정열, "How should gynecologic oncologists react to the unexpected results of LACC trial?", Journal of Gynecologic Oncology, 29(4), pp.1~3 (2018), 대한부인종양학회[DOI]
- Rainer Kimmig, "Minimally invasive surgery for cervical cancer: consequences for treatment after LACC Study", Journal of Gynecologic Oncology, 29(4), pp.1~5 (2018), 대한부인종양학회[DOI]
- Hiroyuki Kanao, "Unexpected result of minimally invasive surgery for cervical cancer", Journal of Gynecologic Oncology, 29(4), pp.1~5 (2018), 대한부인종양학회[DOI]