The following is a summary of “Practice patterns and complications of hysterectomy for invasive cervical cancer after the Laparoscopic Approach to Cervical Cancer trial,” published in the January 2024 issue of Obstetrics and Gynecology by Schivardi, et al.

Following the Laparoscopic Approach to Cervical Cancer trial publication, open radical hysterectomy became the standard surgical approach for early-stage cervical cancer. However, the impact of this shift on postoperative complication rates remained unclear. For a study, researchers sought to investigate whether the adoption of open abdominal hysterectomy, following the Laparoscopic Approach to Cervical Cancer trial, was associated with increased 30-day postoperative complications in the surgical treatment of invasive cervical cancer.

Data from the American College of Surgeons National Surgical Quality Improvement Program were analyzed to compare outcomes between pre- and post-Laparoscopic Approach to Cervical Cancer trial periods (January 2016 to December 2017 vs. January 2019 to December 2020). Surgical approach rates (open abdominal vs. minimally invasive hysterectomy) during the two periods were evaluated. Additionally, rates of 30-day major complications, minor complications, unplanned hospital readmissions, and intra- or postoperative transfusions were compared before and after the publication of the Laparoscopic Approach to Cervical Cancer trial.

A total of 3,024 patients undergoing open abdominal hysterectomy or minimally invasive hysterectomy for invasive cervical cancer were analyzed. Of these, 1,515 (50.1%) were treated in the pre-Laparoscopic Approach to Cervical Cancer period, and 1,509 (49.9%) in the post-Laparoscopic Approach to Cervical Cancer period. The rate of minimally invasive approaches significantly decreased from 75.6% (1,145/1,515) to 41.1% (620/1,509), while the rate of open abdominal approach increased from 24.4% (370/1,515) to 58.9% (889/1,509) (P<.001). The 30-day significant complications remained stable between the pre-and post-Laparoscopic Approach to Cervical Cancer periods (5.6% vs. 4.9%, respectively; adjusted odds ratio [OR], 0.85; 95% CI, 0.61–1.17). Similarly, the overall 30-day minor complications were similar between the two periods (6.8% vs. 8.0%, respectively; adjusted OR, 1.17; 95% CI, 0.89–1.55). The unplanned hospital readmission rate remained stable during both periods (7.9% vs. 6.3% per 30 person-days, respectively; adjusted hazard ratio, 0.78; 95% CI, 0.58–1.04). However, the intra- and postoperative transfusion rates increased significantly from 3.8% to 6.7% (adjusted OR, 1.79; 95% CI, 1.27–2.53).

Following the Laparoscopic Approach to Cervical Cancer trial publication, there was a notable shift in the surgical approach for invasive cervical cancer, with a decrease in minimally invasive approaches and an increase in open abdominal approaches. However, the change was not associated with increased 30-day major or minor complications or unplanned hospital readmission rates. Nonetheless, there was an observed increase in the transfusion rate.

Reference: ajog.org/article/S0002-9378(23)00608-7/abstract