Comparative effectiveness of minimally invasive and abdominal radical hysterectomy for cervical cancer

Objective: We analyzed the uptake, morbidity, and cost of laparoscopic and robotic radical hysterectomies for cervical cancer.

Methods: We identified women recorded in the Perspective database with cervical cancer who underwent radical hysterectomy (abdominal, laparoscopic, robotic) from 2006 to 2010. The associations between patient, surgeon, and hospital characteristic and use of minimally invasive hysterectomy as well as complications and cost were estimated using multivariable logistic regression models.

Results: We identified 1894 patients including 1610 (85.0%) who underwent abdominal, 217 (11.5%) who underwent laparoscopic, and 67 (3.5%) who underwent robotic radical hysterectomy were analyzed. In 2006, 98% of the procedures were abdominal and 2% laparoscopic; by 2010 abdominal radical hysterectomy decreased to 67%, while laparoscopic increased to 23% and robotic radical hysterectomy was performed in 10% of women (p<0.0001). Patients treated at large hospitals were more likely to undergo a minimally invasive procedure (OR=4.80; 95% CI, 1.28-18.01) while those with more medical comorbidities (OR=0.60; 95% CI, 0.41-0.87) were less likely to undergo a minimally invasive surgery. Perioperative complications were noted in 15.8% of patients who underwent abdominal surgery, 9.2% who underwent laparoscopy, and 13.4% who had a robotic procedure (p=0.04). Both laparoscopic and robotic radical hysterectomies were associated with lower transfusion requirements and shorter hospital stays than abdominal hysterectomy (p<0.05). Median costs were $9618 for abdominal, $11,774 for laparoscopic, and $10,176 for robotic radical hysterectomy (p<0.0001).

Conclusion: Uptake of minimally invasive radical hysterectomy for cervical cancer has been slow. Both laparoscopic and robotic radical hysterectomies are associated with favorable morbidity profiles.