Practice patterns and complications of hysterectomy for invasive cervical cancer after the Laparoscopic Approach to Cervical Cancer trial

Abstract

After the publication of the LACC trial, the standard surgical approach for early-stage cervical cancer is open radical hysterectomy. Only limited data were available regarding whether the change to open abdominal hysterectomy observed after the LACC trial led to an increase in post-operative complication rates as a consequence of the decrease in use of the minimally invasive approach. The aim of the current study was to analyze whether there was a correlation with publication of the LACC trial and an increase in the 30-day complications associated with surgical treatment of invasive cervical cancer. We used data from the American College of Surgeons National Surgical Quality Improvement Program to compare a pre-LACC period (January 2016 to December 2017) to a post-LACC period (January 2019 to December 2020). The rates of each surgical approach (open abdominal or minimally invasive) hysterectomy for invasive cervical cancer during the two periods were assessed. Subsequently, we compared 30-day major complication, minor complication, unplanned hospital readmission, and intra/post-operative transfusion rate before and after the publication of the LACC trial. In total, 3024 patients undergoing either open abdominal or minimally invasive hysterectomy for invasive cervical cancer were included in the study. Among them, 1515 (50.1%) were treated in the pre-LACC period and 1509 (49.9%) in the post-LACC period. The rate of minimally invasive approaches decreased significantly from 75.6% (1145/1515) to 41.1% (620/1509) from the pre- to post-LACC period, while the rate of open abdominal approach increased from 24.4% (370/1515) to 58.9% (889/1509) from the pre- to the post-LACC period (p<0.001). The overall 30-day major complications remained stable between the pre-LACC period (85/1515, 5.6%) and the post-LACC period (74/1509, 4.9%) [adjusted odds ratio 0.85 (95% CI, 0.61-1.17)]. The overall 30-day minor complications were similar for the pre-LACC period (103/1515, 6.8%) to the post-LACC period (120/1509, 8.0%) [adjusted odds ratio of 1.17 (95% CI, 0.89-1.55)]. The unplanned hospital readmission rate remained stable during the pre-LACC period (7.9% per 30 person-days) and the post-LACC period (6.3% per 30 person-days) [adjusted HR 0.78 (95% CI, 0.58-1.04)]. The intra/post-operative transfusion rate increased significantly from the pre-LACC period (58/1515, 3.8%) to the post-LACC period (101/1509, 6.7%) [adjusted OR 1.79 (95% CI 1.27-2.53)]. We observe a significative shift in the surgical approach for invasive cervical cancer after the publication of the LACC trial, with a reduction of the minimally invasive and an increase of open abdominal approach. The change in surgical approach was not associated with an increase in the rate of 30-day major or minor complications, and unplanned hospital readmission, while it was associated with an increase in transfusion rate.