Impact of surgical waiting time on the outcomes of patients with early-stage cervical cancer undergoing radical hysterectomy

Abstract

<h3>Objectives:</h3> Evaluate the impact of surgery wait-time on survival of patients with early stage cervical cancer undergoing radical hysterectomy. <h3>Methods:</h3> Patients with clinical stage I squamous, adenocarcinoma, adenosquamous carcinoma of the cervix, no history of another tumor or other cervical surgical procedure, who underwent primary radical hysterectomy with lymphadenectomy up to 12 weeks from initial diagnosis, with at least 1 month of follow-up were drawn from the National Cancer Database (2004-2015). Surgery wait-time was categorized into <4 weeks (group 1), 4-8 weeks (group 2) and 8-12 weeks (group 3). Impact of surgery wait-time on overall survival (OS) was assessed with the log-rank test. A Cox model was constructed to control for confounders. <h3>Results:</h3> A total of 4782 patients with clinical stage I cervical cancer who underwent primary radical hysterectomy were identified. Median time to surgery was 34 days (IQR:27); 1823 (38.1%) had surgery < 4 weeks from diagnosis, while 2207 (46.2%) and 752 (15.7%) had surgery 4-8 and 8-12 wks from diagnosis. Patients in group 3 (35.6%), group 2 (31.6%) were more likely to have government insurance compared to those in group 1 (24.6%), p<0.001. A higher rate of co-morbidities was observed among patients in group 3 (14.2%) compared to those in group 2 (11.6%) and group 1 (10.5%), p=0.029. Patients in group 3 were more likely to be Black (13.6%) compared to those in group 2 (9.9%) and group 1 (7.7%), p<0.001. Higher rate of positive lymph nodes was observed among patients in group 1 (18.4%) compared to those in group 2 (15.6%) and group 3 (14.7%). Median tumor size was 3 cm for patients in group 1, compared to 2.5 cm and 2.3 cm for those in group 2 and 3, p<0.001. Rate of unplanned re-admission was comparable between the groups (p=0.35). There was no difference in OS between the groups, p=0.12; 5-year OS rates for patients in group 1, 2, and 3 were 85.7%, 86.6% and 89.6% respectively. After controlling for tumor size, histology and extension, status of lymph nodes, receipt of radiotherapy, patient age, insurance, race and comorbidities, surgery waiting-time had no impact on survival. <h3>Conclusions:</h3> In a large cohort of patients with clinical stage I cervical cancer undergoing radical hysterectomy no detrimental effect of surgery wait-time on overall survival was found.