Cesarean radical hysterectomy for cervical cancer in the United States: a national study of surgical outcomes

Abstract

Cesarean radical hysterectomy (cesarean-RH) is performed at the time of cesarean delivery for pregnant women with early-stage cervical cancer. 1 Cesarean-RH is a rare procedure and has been understudied; population statistics are lacking in the literature. This study examined the characteristics and perioperative outcomes of women with cervical cancer who underwent cesarean-RH. STUDY DESIGN: This is a population-based retrospective study that queried the Healthcare Cost and Utilization Project's National Inpatient Sample from 2007e2015. 2 The study start period of 2007 was chosen because of the distinction detailed surgical approaches for RH (abdominal vs other approaches). The study end period of 2015 was chosen because of the change in the International Classification of Disease coding schema. Cervical cancer cases that had both cesarean delivery and abdominal RH (cesarean-RH group) were compared with cases that had RH alone via laparotomy (open-RH; Supplemental Table). Characteristics associated with cesarean-RH and those associated with perioperative complications during the index admission for RH were assessed by fitting binary logistic regression models (conditional backward) in multivariable analyses. All analyses were based on the weighted model. 2

Morbidity of radical hysterectomy combined with caesarean section in pregnant patients with cervical cancer

“…Six women who had a CS combined with a radical hysterectomy had statistically significantly higher estimated blood loss compared to eight women who had a postpartum radical hysterectomy (2033 vs 425 mL; P = 0.0064), although there was no difference in blood transfusions or surgical complications. On the contrary, a recently published populationbased study by Matsuo et al found an increase in total perioperative morbidity in 257 patients with a combined procedure compared to 15,420 patients who underwent an open radical hysterectomy [7]. The increased total perioperative morbidity for the combined group in this study was mainly caused by an increase in perioperative blood loss with an incidence of 27.1% vs 13.8% in the control group.…”

“…Comparing morbidity in one surgical group versus another demands matching for variables impacting on morbidity, such as radicality of the procedure, tumour size and stage of disease. Unfortunately, this was not done in both previous mentioned studies [7,16].…”

“…In a recently published population based, retrospective study, the perioperative morbidity in pregnant cervical cancer patients treated by CS combined with radical hysterectomy was found to be higher compared to a non-pregnant control group treated by radical hysterectomy alone [7]. The authors of this study therefore, advised to consider performing the radical hysterectomy four to six weeks after the CS.…”

Neoadjuvant Chemotherapy in Pregnant Patients with Cervical Cancer: A Monocentric Retrospective Study

“…In addition, the procedure is associated with a higher rate of blood loss, intra-operative hemorrhage, and blood transfusions [ 38 ]. Despite this finding, the rate of other operative and post-operative complications appears to be comparable to that of a non-pregnant radical hysterectomy or with the fetus in situ [ 39 ], as does the surgical mortality rate [ 40 ]. In our experience, 11 of 13 patients (84.6%) performed CRH.…”

Risk of Upper-body Adverse Events in Robot-assisted Total Laparoscopic Hysterectomy for Benign Gynecologic Disease

“…Covariates section and grouping as well as measured outcomes were consistent with our prior studies [28][29][30], and a complete list of the ICD-9 codes was described previously [28][29][30]. Data variables abstracted from the NIS program included: patient demographics, hospital characteristics, gynecologic disease type, surgical procedure type, and perioperative outcomes.…”