Implementation of laparoscopic hysterectomy for endometrial cancer over the past decade

Tim Wollinga, Nicole P. M. Ezendam, Florine A. Eggink, Marieke Smink, Dennis van Hamont, Brenda Pijlman, Erik Boss, Elisabeth J. Robbe, Huy Ngo, Dorry Boll, Constantijne H. Mom, Maaike A. van der Aa, Roy F. L. P. Kruitwagen, Hans W. Nijman, Johanna M. A. Pijnenborg

Laparoscopic hysterectomy (LH) for the treatment of early-stage endometrial carcinoma/cancer (EC) has demonstrated to be safe in several randomized controlled trials. Yet, data on implementation of LH in clinical practice are limited. In the present study, implementation of LH for EC was evaluated in a large oncology network in the Netherlands. Retrospectively, a total of 556 EC patients with FIGO stage I-II were registered in the selected years. The proportion of LH gradually increased from 11% in 2006 to 85% in 2015. LH was more often performed in patients with low-grade EC and was not related to the studied patient characteristics. The introduction of TLH was frequently preceded by LAVH. Patients treated in teaching hospitals were more likely to undergo a LH compared to patients in non-teaching hospitals. The conversion rate was 7.7%, and the overall complication rates between LH and AH were comparable, but less postoperative complications in LH. Implementation of laparoscopic hysterectomy for early-stage EC increased from 11 to 85% in 10 years. Implementation of TLH was often preceded by LAVH and was faster in teaching hospitals.