Trends in immediate postoperative complications of trachelectomy for early-stage cervical cancer by surgical approach

Abstract

Objectives: Given recent data demonstrating improved cervical cancer outcomes for open radical hysterectomy, further understanding of surgical and cancer outcomes for fertility-sparing trachelectomy is needed. We examined trends in the use of minimally-invasive (MIS) versus open approach to trachelectomy for early-stage cervical cancer and compared post-operative complications during the index hospitalization. Methods: We performed a retrospective cohort study of women age 45 years and younger with cervical cancer undergoing fertility-sparing trachelectomy in the 2010-2015 National Inpatient Sample. Hospital-level data was used to obtain nationwide estimates of patient characteristics, surgical complications, and length of stay. We compared MIS versus open approach to trachelectomy and compared complications for each using logistic regression models. Results: Nationwide, 523 women underwent fertility-sparing trachelectomy for cervical cancer. The mean age of women undergoing trachelectomy was 33, and 38% (95% CI 29-47) of trachelectomies were done using MIS. Mean length of stay was 2.0 days (95% CI 1.6-2.4) for MIS and 3.5 days (95% CI 3.0-4.0) for open trachelectomies. The overall complication rate was 23% (95% CI 15-31), and there was no statistically significant difference in the odds of a post-op complication for MIS versus open trachelectomy for cervical cancer (14 vs. 29%, OR 0.39, 95% CI 0.14-1.10). Bleeding complications were the most common (10%, 95% CI 4-16). Conclusions: While there was a trend towards slightly lower immediate post-operative complication for MIS trachelectomy, there was no statistically significant difference in immediate post-operative morbidity between open and MIS approaches. Until further data is available to compare cancer outcomes between these approaches, preference may be for open trachelectomy given similar post-operative morbidity.