Regional trends of minimally invasive radical hysterectomy for cervical cancer and exploration of perioperative outcomes |
| |
| Institution: | 1. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA;2. Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA;3. Division of Preventive Medicine, Brigham and Women''s Hospital and Harvard Medical School, Boston, MA, USA;4. Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA;5. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA;6. Clinical and Translational Epidemiology Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA;7. Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA;8. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA;9. Department of Global Health, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA;10. Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA;1. Musculoskeletal Science and Translational Research Center, Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand;2. Cancer Registry Unit, Lampang Cancer Hospital, Lampang, Thailand;3. Center of Multidisciplinary Technology for Advanced Medicine (CMUTEAM), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand;4. Chiang Mai Cancer Registry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand;5. Department of Orthopaedic, Faculty of Medicine, Khon Kaen University, Khon Kean, Thailand;6. Cancer Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kean, Thailand;7. Health System Development, National Cancer Institute, Bangkok, Thailand;8. Cancer Registry Unit, National Cancer Institute, Bangkok, Thailand;9. Department of Orthopaedic, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand;10. Cancer Information Center, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand;1. Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA;2. Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA;3. Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA;4. Department of Sociology, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA;5. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA;1. Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen 2100, Denmark;2. Statistics and Data Analysis, Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen 2100, Denmark;3. Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark;4. Cancer Surveillance and Pharmacoepidemiology, Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen 2100, Denmark;5. Department of Gynecology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark;1. Department of Epidemiology, Fielding School of Public Health, University of California, 10833 Le Conte Ave, Los Angeles, CA 90095, USA;2. Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark;3. Department of Clinical Epidemiology, Aarhus University, Olof Palmes Alle 43-45, 8200 Aarhus N Aarhus, Denmark;4. College of Health and Public Service, University of North Texas, 1155 Union Circle, Denton, TX, 76203, USA |
| |
| Abstract: | IntroductionRadical hysterectomy (RH) with bilateral pelvic lymph node dissection is the standard treatment for early stage cervical cancer which can be performed either by an abdominal or a minimally invasive (MIS) approach. In 2018, Ramirez et al. presented their randomized-controlled trial data which demonstrated that patients who were treated with minimally invasive surgical (MIS) radical hysterectomy (RH) had higher rates of locoregional disease recurrence and lower rates of overall survival when compared to patients treated with an abdominal approach. The objective of this study is to examine the trends in management of patients diagnosed with cervical cancer in New York State (NYS) and to analyze their perioperative outcomes.MethodsUsing the Statewide Planning and Research Cooperative System (SPARCS) Database, patients undergoing RH for early stage cervical cancer in NYS between the years of 2007–2015 were identified and categorized based on surgical approach. Demographic information was collected and multivariable regression was conducted to assess the impact of hysterectomy approach on perioperative outcomes.ResultsIn NYS, 5575 patients were treated with RH for early stage cervical cancer with 3257 (58.4%) treated by abdominal RH and 2318 (41.6%) treated with MIS RH. Between the years of 2007 and 2015, patients diagnosed with cervical cancer treated with MIS RH increased from 25.7% to 48.3% respectively. Surgeons performing MIS RH were more likely to be younger (average age 47.1 vs 49.2, p < 0.001) and have less time elapsed from their fellowship graduation (20.37 vs 22.64 years, p < 0.001). Patients who saw high volume doctors (OR 1.95, CI 1.65–2.31) and were seen in high volume facilities (OR 1.40, CI 1.18–1.65) were more likely to undergo MIS RH compared to abdominal RH. Patients who underwent MIS RH were more likely to be discharged home as opposed to acute rehab or nursing facility, when compared to patients treated with abdominal RH (98.5 vs 94.2% p < 0.001). When analyzing perioperativce outcomes, patient undergoing MIS RH had a 85% decrease in length of hospital stay compared to abdominal RH, a 40% reduction in 30-day readmission rates, and a 10% reduction in hospital costs respectively.DiscussionIn our study period, between the years of 2007 and 2015, the number of cervical cancer cases treated with MIS RH increased from 25.7% to 48.3%. MIS techniques led to a reduction in length of hospital stay, patient readmission rates, and hospital costs. Based on recent data from Ramirez et al., preliminary data demonstrated decrease in MIS RH for treatment of cervical cancer after presentation of the LACC trial and our data confirmed these reported trends in NYS. With this change in surgical practice, there will be associated changes in perioperative outcomes. Moreover, for patients diagnosed with cervical cancer with microscopic disease or previous treatment with an excisions procedure, MIS approach should be considered for improvement in perioperative outcomes as long as oncologic outcomes are not compromised. |
| |
| Keywords: | Cervical cancer Radical hysterectomy Trends Minimally invasive |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
