Surgical Outcomes of Total Laparoscopic Hysterectomies Based on Uterine Cancer Staging

Minimally invasive surgery is effective for early-stage uterine cancer due to its confinement to the corpus uteri. Stage 1 endometrial cancer has two subgroups: stage 1A (<50% myometrium invasion) and stage 1B (≥50% myometrium invasion). We compared outcomes of total laparoscopic hysterectomies (TLHs) based on these distinct stages.

We analyzed TLHs using the 2021 American College of Surgeons National Surgery Quality Improvement Program targeted hysterectomy database, including only stage 1A and stage 1B corpus uteri cancer cases.

From the database, 1287 patients with stage 1A and 403 patients with stage 1B classification were identified. Patients with stage 1B were older (68.28 vs 62.78 years), had a lower body mass index (34.42 vs 37.21 kg/m²), and had a higher proportion of hypertension (63.77% vs 57.42%) than stage 1A. The stage 1B cohort had higher hospital readmission rates (4.71% vs 2.49%) and a higher risk of returning to the operating room (2.73% vs 0.70%). Multivariate logistic regression indicated that stage 1B was independently associated with higher rates of hospital readmission (odds ratio 1.995) and a higher risk of returning to the operating room (odds ratio 3.830). All P values were statistically significant (<0.05).

Stage 1B uterine cancer was independently associated with higher rates of return to the operating room and hospital readmission. These data show that diagnosing and surgically treating uterine cancer earlier through a TLH procedure resulted in fewer complications.