Dive Brief:

• A population-based study published in JAMA this week has linked the introduction of minimally invasive robotic surgery to a significant reduction in the risk of severe complications in early-stage endometrial cancer.

• Robot-assisted procedures have been an option since Intuitive Surgical’s da Vinci system won approval more than a decade ago but some endometrial cancer patients still undergo open surgery.

• The study suggests healthcare systems that phase out total abdominal hysterectomy in favor of minimally invasive procedures will improve the care of endometrial cancer patients.

Dive Insight:

Minimally invasive treatment of endometrial cancer has previously outperformed open surgery in randomized clinical trials and real-world studies conducted by single sites and multiple institutions. However, none of these studies assessed the effect of transitioning an entire healthcare system to minimally invasive procedures.

Denmark’s decision to refer all patients with early-stage endometrial cancer to specialist centers that performed minimally invasive robotic surgery following the approval of Intuitive Surgical’s da Vinci system provided researchers with a chance to address that gap in the literature.

The study analyzed the outcomes of 5,654 women in the Danish Gynecological Cancer Database who were treated for early-stage endometrial cancer during the period in which Denmark transitioned to minimally invasive procedures. By comparing the outcomes of patients treated under the old and new methods, the researchers showed the benefits of the minimally invasive approach.

The study identified 2,563 women treated after the the introduction of minimally invasive robotic surgery. Around half of these women had robot-assisted procedures, with the rest undergoing either total abdominal hysterectomy or manual minimally invasive laparoscopic surgery.

The severe complication rates in the minimally invasive robotic and laparoscopic surgery arms were 4.6% and 5.1%, respectively. In the total abdominal hysterectomy cohort, the severe complication rate jumped to 11.4%. Analyses performed by the researchers linked open surgery to increased risk of severe complications but found no difference between the two types of minimally invasive care.

Outcomes in the minimally invasive arms were better despite featuring a higher percentage of older women who had high-risk histopathologic characteristics and intra-abdominal adhesions.

The researchers think their data may underestimate the effect of the introduction of robotic surgery. It can take up to 30 operations for surgeons to master the minimally invasive robotic treatment of endometrial cancer. As the dataset covered the period in which the technology was introduced, it is possible that the complication rate was higher than it is today.  

Whatever the actual rate of complications, the study suggests there is value in treating endometrial cancer using minimally invasive procedures whenever possible. A separate study found 86.5% of women treated at National Comprehensive Cancer Network sites in 2013 and 2014 underwent minimally invasive procedures.