The following article features coverage from the Society of Gynecologic Oncology 2020 meeting. Click here to read more of Cancer Therapy Advisor‘s conference coverage.

Results of a retrospective study investigating the surgical complication rates associated with adoption of minimally invasive radical hysterectomy (MIS-RH) for early-stage cervical cancer at hospitals where this procedure was performed at low, medium, and high volumes suggest that this technique may be a complex surgical approach. These findings were accepted for presentation at the Society of Gynecologic Oncology (SGO) Annual Meeting on Women’s Cancer and released on March 28, 2020.1

More than 10 years ago, surgeons in the US began to adopt MIS-RH as an alternative to open-radical hysterectomy for early-stage cervical cancer. The aim of this study was to evaluate the hospital complication rate associated with MIS-RH according to the volume of procedures performed.

Data for 14,861 women undergoing radical hysterectomy from 2007 to 2011, the period covering initial adoption of MIS-RH in the US, were accessed from the National Inpatient Sample (NIS), a publicly available database of adult inpatients at a sample of community hospitals across the US that is sponsored by the Agency for Healthcare Research and Quality (AHRQ).2 Cutoffs characterizing low-, mid-, and high-volume hospitals were performance of less than 2, 2 to 3, or 4 or more MIS-RH procedures per year, respectively.

During the period of time covered in the study, the rate of radical hysterectomies performed using the minimally-invasive approach increased from 11.4% to 22.5% (P <.001).


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Of the 2202 MIS-RH procedures performed across 163 hospitals, 48.5%, 38.7%, and 12.9% were classified in low-, mid-, and high-volume groups.

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A key finding from this study was that perioperative complications rates were not significantly different across surgical volume groups, with rates of any complication of 14.6%, 14.8%, and 18.1% in low-, mid-, and high-volume groups, respectively (P =.126). Similar rates of multiple complications were also observed in each of the 3 groups: 3.8% (low-volume), 3.8% (mid-volume), and 5.3% (high-volume; P =.250).

For comparison, an assessment of the perioperative complication rates for the 11,187 women who underwent open-radical hysterectomy procedures during the study period were 12.2%, 11.8%, and 8.7% in low-, mid-, and high-volume groups, respectively, (P <.001) using the same criteria for hospital volume as detailed for MIS-RH.

In their concluding remarks, the study authors commented that “between 2007 and 2011, higher hospital surgical volume was associated with a lower perioperative complication rate in open-RH, but this volume-outcome association was not observed for MIS-RH, suggesting the complexity of this surgical procedure and possible learning-curve effect.”

Read more of Cancer Therapy Advisor‘s coverage of SGO 2020 by visiting the conference page.

References

  1. Matsuzaki S, Mandelbaum RS, Matsushima K, et al. Minimally invasive radical hysterectomy for early-stage cervical cancer: Association between hospital surgical volume and perioperative outcomes. Submitted to: Society of Gynecologic Oncology (SGO) 2020 Annual Meeting on Women’s Cancer. Abstract 351.
  2. HCUP Databases; National Inpatient Sample Overview. Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality. Published December 2019. Accessed April 1, 2020.