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Original Research

Open Access

Disparities in the surgical treatment of loco-regional endometrial cancer

  • Erica Huelsmann1,*,
  • Michael T. Halpern2
  • Sarah Ackroyd3
  • Amaranta Craig4
  • Karen Houck1
  • Eric Boyd5
  • Enrique Hernandez1

1Temple University Hospital, Philadelphia, PA 19140, USA

2National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA

3University of Chicago, Chicago, IL 60637, USA

4Presbyterian Medical Group, Albuquerque, NM 87106 USA

5Information Management Services, Laurel, MD 20707, USA

DOI: 10.22514/ejgo.2023.101 Vol.44,Issue 6,December 2023 pp.74-80

Submitted: 19 April 2023 Accepted: 29 August 2023

Published: 15 December 2023

*Corresponding Author(s): Erica Huelsmann E-mail:


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.


Endometrial cancer; Disparities; Surgery

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Erica Huelsmann,Michael T. Halpern,Sarah Ackroyd,Amaranta Craig,Karen Houck,Eric Boyd,Enrique Hernandez. Disparities in the surgical treatment of loco-regional endometrial cancer. European Journal of Gynaecological Oncology. 2023. 44(6);74-80.


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