Impact of facility-volume on the oncologic outcomes of premenopausal patients with early-stage cervical cancer undergoing trachelectomy

Abstract

<h3>Objectives:</h3> Investigate the impact of trachelectomy facility-volume on the outcomes of patients with early-stage cervical carcinoma. <h3>Methods:</h3> Patients aged <50 years diagnosed between 2004 and 2016 with cervical carcinoma, who underwent trachelectomy at the reported facility were identified in the National Cancer Database. Facility-volume was calculated, and high-volume centers were defined as those who reported at least 10 procedures. Impact of facility-volume on peri-operative outcomes (hospital stay, unplanned readmission rate) and overall survival (OS) was evaluated for patients with known tumor histology, and stage I disease who underwent lymphadenectomy. <h3>Results:</h3> A total of 774 trachelectomies were performed for patients with cervical cancer at 269 institutions. Ten (3.3%) institutions reported at least 10 cases between 2004 and 2016, while most institutions (190, 70.6%) reported one or two cases. Outcomes were evaluated for 514 patients with known histology, stage I disease who underwent lymphadenectomy; 29.4% were managed at a high-volume facility. Patients who underwent trachelectomy at a high-volume center were more likely to have private insurance (88.1% vs 77.7%, p=0.023) while there were no differences in terms of race, presence of comorbidities and tumor histology (p>0.05) between high and low volume facilities. Patients who underwent surgery at a high-volume center had lower 30-day re-admission rate (1.3% vs 6.4%, p=0.013) but comparable rate of prolonged (>5 days) hospitalization (8.2% vs 6.5%, p=0.48). There was no difference in OS between high and low-volume centers, p=0.47; 5-year OS rates were 93.8% and 95.4% respectively. After controlling for the presence of comorbidities and tumor histology, performance of trachelectomy at a high-volume facility was not associated with better survival (HR: 1.21, 95% CI: 0.48, 3.05). <h3>Conclusions:</h3> Given the low incidence of cervical cancer in this age group, and possible de-centralization, facility-volume for trachelectomy is very low with no clear detrimental effect on survival or perioperative outcomes. Further research is needed to determine if centralization to high volume centers is associated with superior reproductive and survival outcomes.