Seven-year survival analysis in women with unsuspected uterine malignancy after laparotomic versus laparoscopic hysterectomy: A national claim data retrospective cohort study

Abstract

Objective: The primary aim was to compare the overall survival of women with unsuspected uterine malignancy (UUM) diagnosed after laparotomic versus laparoscopic hysterectomy for benign gynecologic diseases. The secondary aim was to evaluate the incidence of UUM. Methods: A national health insurance database was analyzed from 2006 to 2010. Results: From the database (24 million women annually), 157 232 women who received hysterectomy for benign diseases were extracted. These women were divided into a laparotomic group (n = 103 631) and a laparoscopic group (n = 53 601). The overall incidences of UUM, unsuspected endometrial cancer, and unsuspected uterine malignancy other than endometrial cancer (UUMOEC) were 0.66%, 0.46%, and 0.19%, respectively. Kaplan–Meier survival analysis and Cox regression analysis showed that the laparoscopic group was associated with more favorable overall survival than the laparotomic group, especially in UUMOEC (P < 0.001). Conclusion: In women with UUM diagnosed after hysterectomy for benign diseases, overall survival up to 7 years favors laparoscopy over laparotomy, especially in UUMOEC and the incidence of UUM is relatively low. However, considering the devastating effect of intraperitoneal dissemination of UUM, surgeons should fully explain this issue to patients preoperatively and try to avoid intraperitoneal spread of tumor cells intraoperatively. © 2021 International Federation of Gynecology and Obstetrics