J Gynecol Oncol.  2018 Sep;29(5):e68. 10.3802/jgo.2018.29.e68.

The influence of surgeon volume on outcomes after pelvic exenteration for a gynecologic cancer

• Jalloul RJ
• Nick AM
• Munsell MF
• Westin SN
• Ramirez PT
• Frumovitz
• Soliman PT

• KMID: 2417467
• DOI: http://doi.org/10.3802/jgo.2018.29.e68

Abstract

OBJECTIVE
To determine the effect of surgeon experience on intraoperative, postoperative and long-term outcomes among patients undergoing pelvic exenteration for gynecologic cancer.
METHODS
This was a retrospective analysis of all women who underwent exenteration for a gynecologic malignancy at MD Anderson Cancer Center, between January 1993 and June 2013. A logistic regression was used to model the relationship between surgeon experience (measured as the number of exenteration cases performed by the surgeon prior to a given exenteration) and operative outcomes and postoperative complications. Cox proportional hazards regression was used to model survival outcomes.
RESULTS
A total of 167 exenterations were performed by 19 surgeons for cervix (78, 46.7%), vaginal (43, 25.8%), uterine (24, 14.4%), vulvar (14, 8.4%) and other cancer (8, 4.7%). The most common procedure was total pelvic exenteration (69.4%), incontinent urinary diversion (63.5%) and vertical rectus abdominis musculocutaneous reconstruction (42.5%). Surgical experience was associated with decreased estimated blood loss (p < 0.001), intraoperative transfusion (p = 0.009) and a shorter length of stay (p = 0.03). No difference was noted in the postoperative complication rate (p = 0.12-0.95). More surgeon experience was not associated with overall or disease specific survival: OS (hazard ratio [HR] = 1.02; 95% confidence interval [CI] = 0.97-1.06; p = 0.46) and DSS (HR = 1.01; 95% CI = 0.97-1.04; p = 0.66), respectively.
CONCLUSION
Patients undergoing exenteration by more experienced surgeons had improvement in intraoperative factors such as estimated blood loss, transfusion rates and length of stay. No difference was seen in postoperative complication rates, overall or disease specific survival.

Keyword

Pelvic Exenteration; Surgeon Volume; Pregnancy Outcomes; Gynecologic Neoplasms

MeSH Terms

Cervix Uteri
Female
Genital Neoplasms, Female
Humans
Length of Stay
Logistic Models
Pelvic Exenteration*
Postoperative Complications
Pregnancy
Pregnancy Outcome
Rectus Abdominis
Retrospective Studies
Surgeons
Urinary Diversion