Photo Credit: Mohammed Haneefa Nizamudeen

The following is a summary of “Geographic and racial disparities in the quality of surgical care among patients with nonmetastatic uterine cancer,” published in the March 2025 issue of American Journal of Obstetrics & Gynecology by Anastasio et al. 

Minimally invasive surgery and sentinel lymph node biopsy have become more common in early-stage uterine cancer management, but practices vary widely, with disparities in low-volume centers and regions lacking gynecologic oncologists.  

Researchers conducted a retrospective study analyzing the relationships between travel distance, proximity to gynecologic oncologists, and racial disparities in the quality of surgical care among individuals who underwent a hysterectomy for nonmetastatic uterine cancer.  

They identified individuals who underwent a hysterectomy for nonmetastatic uterine cancer in Kentucky, Maryland, Florida, and North Carolina using the 2012–2018 State Inpatient Database and State Ambulatory Surgery Services Database files. County-to-county distances were estimated to travel to the nearest gynecologic oncologist. Multivariable logistic regression models analyzed factors linked to minimally invasive surgery and lymph node dissection, along with the interaction between travel for surgery and patient race.  

The results showed that among 21,837 cases, 45.5% resided in a county without a gynecologic oncologist, and 55.5% travelled to another county for surgery, including 88% of those without local access. Individuals without a gynecologic oncologist who did not travel were more likely to undergo an open surgery and no lymph node dissection, with more significant impact in areas lacking access in surrounding counties. Among those without a local specialist, travellers had a similar likelihood of minimally invasive surgery (71%) but a higher likelihood of lymph node dissection (64.7% vs 57.2%) than nontravelers. A longer travel distance was linked to a higher likelihood of lymph node assessment. Compared to non-Black individuals, Black individuals were less likely to receive minimally invasive surgery (57.0% vs 74.1%). Adjusted regression models accounting for fibroid diagnoses identified Black race as an independent risk factor for open surgery. A significant interaction was observed between Black race and travel, with Black individuals in counties lacking a gynecologic oncologist who did not travel having a lower likelihood of minimally invasive surgery (odds ratio, 0.57 vs non-Black travellers; odds ratio, 0.60 as interaction term; P<.001 for both). Similar racial disparities in surgical quality were noted among Black individuals with local access who travelled out of the county for surgery.  

Investigators concluded that patient travel to specialty centers improved surgical outcomes for nonmetastatic uterine cancer, especially for Black patients lacking local gynecologic oncology access. 

Source: ajog.org/article/S0002-9378(24)00905-0/abstract