Koji Matsuo1, Shinya Matsuzaki2, Rachel S Mandelbaum2, Erica J Chang2, Maximilian Klar3, Kazuhide Matsushima4, Brendan H Grubbs5, Lynda D Roman6, Jason D Wright7. 1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA. Electronic address: koji.matsuo@med.usc.edu. 2. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA. 3. Department of Obstetrics and Gynecology, University of Freiburg, Freiburg, Germany. 4. Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA. 5. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA. 6. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA. 7. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Abstract
OBJECTIVE: Minimally invasive radical hysterectomy (MIS-RH) for early-stage cervical cancer is a relatively new surgical procedure with increased utilization in the mid-/late-2000s. This study examined the association between hospital surgical volume for MIS-RH and perioperative outcomes for early-stage cervical cancer in the period of early adoption. METHODS: This population-based retrospective study queried the National Inpatient Sample from 2007 to 2011. Cervical cancer cases treated with MIS-RH were examined (n = 2202 from 163 hospitals). Annualized hospital surgical volume was defined as the average number of procedures performed per year in which at least one case was performed. Characteristics and outcomes related to MIS-RH use were assessed. The comparator cohort included RH by laparotomy (Open-RH; n = 11,187 from 405 hospitals). RESULTS: Among MIS-RH-offering centers, 42.3% had average 1 case/year and surgical volume of >4 cases/year represented the top decile. When stratified by MIS-RH types, on average 31.3 centers performed robotic-assisted approach per year versus 11.5 centers for the traditional approach. Small bed capacity centers were most likely to perform robotic-assisted RH (adjusted-odds ratio 4.07, P < 0.001). In the traditional MIS-RH group, higher hospital surgical volume was associated with lower surgical morbidity (P = 0.025) whereas in the robotic-assisted approach higher hospital surgical volume was associated with higher surgical morbidity (P < 0.001). In the Open-RH cohort, higher hospital surgical volume was significantly associated with decreased surgical morbidity and mortality (both, P < 0.001). CONCLUSION: In the mid-/late-2000s, MIS-RH surgical volume was modest in the United States. Small bed capacity centers adopted robotic-assisted MIS-RH more frequently, and there was a statistically significant association of increased perioperative complications among higher volume centers. In contrast, higher surgical volume was associated with improved perioperative outcomes with the traditional MIS-RH and open-RH approaches.
OBJECTIVE: Minimally invasive radical hysterectomy (MIS-RH) for early-stage cervical cancer is a relatively new surgical procedure with increased utilization in the mid-/late-2000s. This study examined the association between hospital surgical volume for MIS-RH and perioperative outcomes for early-stage cervical cancer in the period of early adoption. METHODS: This population-based retrospective study queried the National Inpatient Sample from 2007 to 2011. Cervical cancer cases treated with MIS-RH were examined (n = 2202 from 163 hospitals). Annualized hospital surgical volume was defined as the average number of procedures performed per year in which at least one case was performed. Characteristics and outcomes related to MIS-RH use were assessed. The comparator cohort included RH by laparotomy (Open-RH; n = 11,187 from 405 hospitals). RESULTS: Among MIS-RH-offering centers, 42.3% had average 1 case/year and surgical volume of >4 cases/year represented the top decile. When stratified by MIS-RH types, on average 31.3 centers performed robotic-assisted approach per year versus 11.5 centers for the traditional approach. Small bed capacity centers were most likely to perform robotic-assisted RH (adjusted-odds ratio 4.07, P < 0.001). In the traditional MIS-RH group, higher hospital surgical volume was associated with lower surgical morbidity (P = 0.025) whereas in the robotic-assisted approach higher hospital surgical volume was associated with higher surgical morbidity (P < 0.001). In the Open-RH cohort, higher hospital surgical volume was significantly associated with decreased surgical morbidity and mortality (both, P < 0.001). CONCLUSION: In the mid-/late-2000s, MIS-RH surgical volume was modest in the United States. Small bed capacity centers adopted robotic-assisted MIS-RH more frequently, and there was a statistically significant association of increased perioperative complications among higher volume centers. In contrast, higher surgical volume was associated with improved perioperative outcomes with the traditional MIS-RH and open-RH approaches.
Authors: Koji Matsuo; Shinya Matsuzaki; Rachel S Mandelbaum; Kazuhide Matsushima; Maximilian Klar; Brendan H Grubbs; Lynda D Roman; Jason D Wright Journal: Gynecol Oncol Date: 2020-01-22 Impact factor: 5.482
Authors: Koji Matsuo; Shinya Matsuzaki; Rachel S Mandelbaum; Kazuhide Matsushima; Maximilian Klar; Brendan H Grubbs; Lynda D Roman; Jason D Wright Journal: J Surg Oncol Date: 2019-11-19 Impact factor: 3.454
Authors: Alexander Melamed; Daniel J Margul; Ling Chen; Nancy L Keating; Marcela G Del Carmen; Junhua Yang; Brandon-Luke L Seagle; Amy Alexander; Emma L Barber; Laurel W Rice; Jason D Wright; Masha Kocherginsky; Shohreh Shahabi; J Alejandro Rauh-Hain Journal: N Engl J Med Date: 2018-10-31 Impact factor: 91.245
Authors: Sergi Fernandez-Gonzalez; Jordi Ponce; María Ángeles Martínez-Maestre; Marc Barahona; Natalia R Gómez-Hidalgo; Berta Díaz-Feijoo; Andrea Casajuana; Myriam Gracia; Jon Frias-Gomez; Yolanda Benavente; Laura Costas; Lola Martí; Lidia Melero; Jose Manuel Silvan; Eva Beiro; Ignacio Lobo; Jesús De la Rosa; Pluvio J Coronado; Antonio Gil-Moreno Journal: Cancers (Basel) Date: 2022-01-29 Impact factor: 6.639