Disparities in the surgical treatment of loco-regional endometrial cancer

This study aims to assess disparities in the surgical treatment of women with loco regional endometrial carcinoma (EC) utilizing a large national cancer database. The Surveillance, Epidemiology and End Results Program (SEER)-Medicare linked resource was used to analyze data from women with loco-regional EC treated in the United States from 2009-2017 who underwent a hysterectomy and were enrolled in Medicare. This is a retrospective cohort study. Total of 26,398 women met inclusion criteria. Most patients (17,921; 67.9%) underwent minimally invasive surgery (MIS). The percentage of patients undergoing MIS for EC significantly increased with time from 53% in 2009-2011 to 79% in 2015-2017 (p < 0.0001). Most non-Hispanic Black patients underwent laparotomy (1066 of 2091; 51%); most non-Hispanic White and Hispanic patients underwent MIS (non-Hispanic White: 15,127 of 21,555; 70%, Hispanic: 992 of 1632; 61%, p < 0.0001). A lower proportion of women with dual Medicare/Medicaid underwent MIS (59% vs. 70%, p < 0.0001). Centers with "Teaching Hospital" designation had significantly higher rates of MIS (p < 0.0001); "Sole Community" designation centers had significantly lower rates of MIS (p < 0.0001). Readmissions for surgical complications within 30 days of surgery were more frequent in the laparotomy cohort (p < 0.0001). On multivariate analysis, an increased hazard for death was observed among women who underwent laparotomy (Hazard Ratio (HR) 1.423; 95% Confidence Interval (CI) 1.345-1.507; p < 0.0001). These differences remained when analyzing women with localized and those with regional disease separately. We demonstrate both patient and organization-level differences between those who received laparotomy versus MIS for surgical management of EC.