Abstract
e17578 Background: Endometrial cancer is the most common cancer of the female reproductive organs in the United States, and surgery involving the removal of the uterus, cervix, and ovaries (total hysterectomy) is the most common treatment. However, some women may have their uterus removed with sparing of the ovaries, resulting in the prevention of menopause but an increased incidence of cancer recurrence. Given the pivotal role of surgical outcomes, it is important to examine the variations in treatment approaches – specifically, the choice between total hysterectomy with and without removal of the tubes and/or ovaries – across different demographic groups. Methods: Patients with endometrial cancer were selected from the National Cancer Database (NCDB) and 19,147 patients were identified between 2004 and 2020. We compared the demographic variables of patients who had a total hysterectomy with and without removal of tubes and ovaries. Descriptive statistics, multivariate, and chi-square analyses on SPSS version 28 was used for all analyses; P < 0.05 was considered significant. Results: Black patients with endometrial cancer were 26% less likely to have a total hysterectomy with the removal of tubes and/or ovaries compared to white patients. Conversely, no significant difference was observed in the choice of surgical approach between Hispanic and non-Hispanic patients. A median household income of $74,063 were 97% less likely to have a total hysterectomy with removal of tubes and/ovaries compared to patients with a median household income of less than $46,277. Patients with insurance, including private, Medicaid, Medicare, or other government insurance did not have a significantly different surgical approach than those without insurance. Furthermore, patients living in more educated areas (where <5% of adults lacked a high school degree) were 29% more likely to receive a total hysterectomy with removal of tubes and/or ovaries compared to less educated areas (where >15.3% of adults lacked a high school degree). Conclusions: This study highlights significant determinants that influence the decision to remove the tubes and/or ovaries during a total hysterectomy for endometrial cancer, with emphasis on race, education, and income. Significant implications with removal of ovaries and/or tubes include changes in a woman’s hormonal balance, infertility, and increased risk of further diseases. Understanding and recognizing these determinants within the context of endometrial cancer treatment can contribute to improved patient outcomes, a reduced risk of ovarian cancer and associated complications, and an improvement in overall quality of life. By acknowledging the versatile nature of this decision, healthcare providers can better individualize treatment plans, ultimately striving for favorable long-term health and well-being outcomes for their patients.