To study the trends in route for radical hysterectomy during 2021-2020, and to evaluate post-operative complications before and after the Laparoscopic Approach to Carcinoma of the Cervix (LACC) trial.
Design:
Prospective cohort study.
Setting:
American College of Surgeons National Surgical Quality Improvement Program database from 2012-2020.
Patients or Participants:
Patients who underwent radical hysterectomy for cervical cancer.
Interventions:
Minimally invasive (MIS) and laparotomy radical hysterectomy.
Measurements and Main Results:
We divided the cohort into two groups– MIS vs. laparotomy. The primary outcomes were the trends in MIS radical hysterectomy over the years and complications rate stratified by periods, before and after the publication of the LACC trial in 2018. Thirty-day postoperative complications were defined using the Clavien-Dindo classification system.
A total of 2,984 patients were included, 1,453 (48.7%) underwent MIS and 1,531 (51.3%) underwent laparotomy. There was a significant increase in the MIS approach from 2012 to 2016 (45.6% to 75.3%, p<.001), and a significant decrease in MIS during 2018-2020 (50.4% to 13.5%, p<.001).
Before the LACC trial 38.8% patients underwent laparotomy, and after the trial 84.7% patients underwent laparotomy (p<.001). The proportion of minor complications was lower before the LACC trial (16.9% vs. 20.4%, p=.040). Any complications or major complications proportions were comparable between groups.
In a comparison of MIS vs. laparotomy during the entire study period, patients in the MIS group had lower rates of any complications (16.4% vs. 26.1%, p<.001) and minor complications (12.3% vs. 22.5%, p<.001). The rate of major complications was similar in both groups.
In multivariable regression, only Non-White race was independently associated with any complications’ occurrence [aOR 95%CI 1.43 (1.00-2.03)].
Conclusion:
This study suggests that while the proportion of MIS radical hysterectomy decreased abruptly and significantly following the LACC trial, and the proportion of laparotomies increased concomitantly, there was no change in the rate of major postoperative complications.