Short summary

The aim of this Ph.D.-study is to elucidate the question whether robotic-assisted laparoscopic surgery is cost-effective compared with the traditional laparoscopic and open access methods. The study will focus on obese women with endometrial and cervical cancer, as our hypothesis is: "Robotic-assisted laparoscopic hysterectomy is more cost-effective than open access hysterectomy and total laparoscopic hysterectomy in obese women with endometrial or cervical cancer".

In order to test the main hypothesis, data from different national registers and database regarding somatic in- and outpatient visits in all hospitals in Denmark, activities in primary health care, analgesic medicine dispensed and social data such as education, labor market affiliation, income and unemployment benefit reimbursement will be used and compared in the obese women vs the non-obese. 

Rationale

Surgery in obese women is associated with a high intraoperative and postsurgical risk of complications. Robotic surgery has several advantages which support more complex operations as e.g. pelvic lymph node dissection. It has been suggested that robotic surgery is associated with higher costs compared to open and laparoscopic surgery. However, to evaluate the total costs related to a surgical procedure several factors should be taken into account. The present study will include total work- and health related costs to better evaluate the costs related to different surgical procedures with a particular focus on the obese women with endometrial and cervical cancer.

Description of the cohort

The population will be identified from the nationwide clinical database The Danish Gynecological Cancer Database, which contains information from 97 % of Danish patients diagnosed with gynecological cancer in Denmark. All patients diagnosed with endometrial- and cervix cancer from 2005-2013 will be included and the database contains approximately 5500-6500 endometrial cancer patients and 2000-3000 cervix cancer patients. Descriptive variables such as age, BMI, comorbidity, stage of disease, data of pathology and surgical/gynecological data, intra- and postoperative complications and outpatient visits are more or less recorded electronically in the database.

Data and biological material

The present study concerns a historical cohort. It is an observational register-based study with time related observations. Hence, the first gynecological operation indicates the baseline of the data analysis. Data from the national registries will be linked to each individual person.

Collaborating researchers and departments

Department of Gynecology and Obstetrics, Odense University Hospital

• PhD-student Malene Korsholm, Cand.Scient.san.publ.
• Associate professor and supervisor Pernille Tine Jensen, PhD, Post doc

Institute of Clinical Research, University of Southern Denmark

• Professor and co-supervisor Ole Mogensen

Centre of Health Economics Research (COHERE), Department of Public Health, University of Southern Denmark

• Professor and co-supervisor Jan Sørensen

Research Unit of Gynecology and Obstetrics, Institute of Clinical Research, University of Southern Denmark

• Associate Professor and co-supervisor Chunsen Wu

Odense University Hospital/Institute of Clinical Research, University of Southern Denmark.