Disparities seen in access to minimally invasive surgeries for uterine cancer

Despite years of evidence showing the advantages of minimally invasive hysterectomies, access to the surgeries remains limited for uterine cancer patients nationwide—particularly for poor and minority women.

A recent study by Johns Hopkins researchers revealed wide racial and economic disparities in access to minimally invasive surgeries for hysterectomies in treating uterine cancer. Additionally, the study found that hospitals categorized as "low-volume" performed the surgeries very rarely. The findings are published in the January 2016 issue of Obstetrics and Gynecology.

More than 54,000 women are diagnosed with uterine cancer each year in the U.S., the researchers say, and surgery alone cures 60 to 70 percent of women with early-stage disease.

Over the last decade, a number of medical experts have considered minimally invasive procedures to be the standard of care for nonmetastatic uterine cancer. Research has demonstrated that minimally invasive hysterectomies (either laparoscopic or robotic-assisted surgeries) result in fewer complications, higher quality of life, and equal rates of survival when compared to open procedures that call for making large surgical incisions into the abdomen. Researchers found that open hysterectomies requiring large incisions were more than twice as likely as minimally invasive surgeries to result in complications such as infections, pneumonia, blood clots, major blood loss, and longer hospital stays.

The Hopkins team analyzed data from more than 1,000 hospitals in 45 states, on 32,560 patients who underwent either minimally invasive hysterectomies or open hysterectomies for uterine cancer between 2007 and 2011. Researchers saw that 33.6 percent of patients who underwent surgery for nonmetastatic uterine cancer had minimally invasive surgeries, with the percentage rising from 22 percent in 2007 to 50.8 percent in 2011.

"We were encouraged to see that utilization of minimally invasive surgery for endometrial cancer rose significantly since 2007, but we still have a long way to go to provide most patients access to these procedures," says Amanda Fader, director of the Johns Hopkins Kelly Gynecologic Oncology Service and member of The Sidney Kimmel Comprehensive Cancer Center.

Fader's team found that black and Hispanic women were less likely to receive minimally invasive surgeries, along with patients who were on Medicaid or uninsured. In addition, the study revealed that minimally invasive procedures occurred only 23.6 percent of the time in hospitals considered low-volume, which in this sampling performed fewer than 10 hysterectomies for uterine cancer annually. In contrast, patients treated at medium- and high-volume hospitals were up to four times as likely to undergo minimally invasive procedures.

"At Johns Hopkins, we perform minimally invasive surgeries in approximately 91 percent of early-stage endometrial cancers," Fader says. "A small percentage of women with a very large uterus or severe cardiopulmonary disease may not be able to undergo minimally invasive procedures, but this is rare."

Fader notes that the proliferation of robotic surgical equipment in hospitals has helped to increase minimally invasive surgeries, but she places less importance on whether a surgeon uses a robot or traditional laparoscopy.

"The goal is to increase the overall rate of minimally invasive surgery for these patients, irrespective of the specific type of procedure offered," she says.