2126 Perioperative Outcomes of Combined Gynecologic Oncology and Urogynecologic Surgeries

Abstract

Study Objective To compare perioperative outcomes of patients undergoing standard oncology staging versus combined oncology staging and urogynecologic procedures for pelvic floor dysfunction repair. Design A retrospective cohort study of two gynecologic oncology patients groups who underwent robotic assisted surgical staging versus surgical staging with concomitant pelvic floor repair. Setting Many women diagnosed with a gynecologic malignancy may have comorbid urogynecologic conditions including pelvic organ prolapse and/or urinary incontinence. Despite a significant prevalence of symptomatic pelvic floor disorders among oncologic patients, few of these patients undergo concomitant pelvic floor procedures. Literature examining the perioperative impact of combining surgeries is currently lacking. Patients or Participants 29 women were identified and controls (n = 14) were matched to combined cases (n = 15). Interventions Surgical staging defined as robotic-assisted total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy. Pelvic floor procedures include: laparoscopic uterosacral ligament suspension, Moschowitz culdoplasty, transobturator sling, and vaginal repair. Measurements and Main Results Both groups had similar mean robotic console time, (178 minutes vs 160 minutes, p = 0.15), however combined procedure cases had increased total operative time compared to controls, (301 minutes vs 210 minutes p < 0.0001). Concurrent cases had increased blood loss estimated by absolute change in hemoglobin (-2.34g/dL vs -1.71g/dL, p = 0.043). Additional urogynecologic procedure increased risk of discharge with an indwelling urinary catheter (76.9% vs 0%, p < 0.0001). Total pain requirements were similar between the two groups (35 MME versus 23 MME, p = 0.46). Postoperative complications were similar between the two groups defined by hospital revisits comparing cases to controls (14.3% vs 13.3%, p = 1). Conclusion Combined case surgery for oncologic staging and urogynecologic pelvic floor repair is a well tolerated combination procedure. Increased total operative time for combined cases is expected, with statistically significant risk for postoperative acute urinary retention typical for urogynecologic procedures. To compare perioperative outcomes of patients undergoing standard oncology staging versus combined oncology staging and urogynecologic procedures for pelvic floor dysfunction repair. A retrospective cohort study of two gynecologic oncology patients groups who underwent robotic assisted surgical staging versus surgical staging with concomitant pelvic floor repair. Many women diagnosed with a gynecologic malignancy may have comorbid urogynecologic conditions including pelvic organ prolapse and/or urinary incontinence. Despite a significant prevalence of symptomatic pelvic floor disorders among oncologic patients, few of these patients undergo concomitant pelvic floor procedures. Literature examining the perioperative impact of combining surgeries is currently lacking. 29 women were identified and controls (n = 14) were matched to combined cases (n = 15). Surgical staging defined as robotic-assisted total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy. Pelvic floor procedures include: laparoscopic uterosacral ligament suspension, Moschowitz culdoplasty, transobturator sling, and vaginal repair. Both groups had similar mean robotic console time, (178 minutes vs 160 minutes, p = 0.15), however combined procedure cases had increased total operative time compared to controls, (301 minutes vs 210 minutes p < 0.0001). Concurrent cases had increased blood loss estimated by absolute change in hemoglobin (-2.34g/dL vs -1.71g/dL, p = 0.043). Additional urogynecologic procedure increased risk of discharge with an indwelling urinary catheter (76.9% vs 0%, p < 0.0001). Total pain requirements were similar between the two groups (35 MME versus 23 MME, p = 0.46). Postoperative complications were similar between the two groups defined by hospital revisits comparing cases to controls (14.3% vs 13.3%, p = 1). Combined case surgery for oncologic staging and urogynecologic pelvic floor repair is a well tolerated combination procedure. Increased total operative time for combined cases is expected, with statistically significant risk for postoperative acute urinary retention typical for urogynecologic procedures.