Effect of Quality Control Program in Surgical Management of Early Cervical Cancer.
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ABSTRACT: Background
Regular assessments of clinical performance in gynecologic cancer surgery is important for the safety of patients. We evaluated the effects of quality control (QC) program on the treatment pattern and clinical outcomes of early cervical cancer.Methods
Medical records of cervical cancer patients who received operation in our institution from January 2007 to December 2018 were retrospectively reviewed. Cases were divided into 2 groups, before and after the initiation of QC program, group 1 (2007-2013) and group 2 (2014-2018), based on the operation date. Two groups were compared in clinicopathologic variables, surgical methods, operative details, adjuvant treatments, recurrence and survival.Results
A total of 305 cervical cancer patients were included in the analysis, 210 in group 1 and 95 in group 2. In group 2, minimally invasive surgery (MIS) was more frequently performed (60.0% vs. 76.8%, P = 0.004), especially in earlier stages (stage IA, 72.6% vs. 100.0%; stage IB, 52.2% vs. 69.5%). However, the median tumor size treated by MIS was decreased in stage IB (20 mm vs. 17 mm, P = 0.015). Frequency of adjuvant treatment was also reduced in stage IB (56.5% vs. 37.3%, P = 0.016). Recurrence within 3 years, 3-year disease free survival and overall survival did not show significant difference; however, 3-year recurrence after MIS was significantly reduced in stage IB.Conclusion
QC program enforced stricter patient selection criteria for MIS and positively affected clinical outcomes in cervical cancer patients who underwent surgery. Systemic monitoring should be considered for patient safety.
SUBMITTER: Shim JE
PROVIDER: S-EPMC8608925 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:INTRODUCTION:Sexual activity is important for marital quality, especially in cervical cancer survivors. Vagina extension following laparoscopic radical hysterectomy with bilateral ovarian preservation (VEOP), vagina extension following laparoscopic radical hysterectomy with bilateral oophorectomy (VEBO), radical hysterectomy with bilateral ovarian preservation (RHOP), and radical hysterectomy with bilateral oophorectomy (RHBO) are the common surgeries for young cervical cancer patients. AIM:To investigate the effect of the 4 surgical methods on female/male sexual activity and marital quality in early-stage cervical cancer survivors. METHODS:Multiple linear regression analysis was conducted in 205 patients with stage Ia1-IIa2 cervical cancer to evaluate the factors that affected male/female sexual function and marital quality. MAIN OUTCOME MEASURE:Female Sexual Function Index (FSFI), modified Kupperman Index (KI), modified Sexual Life Quality Questionnaire (mSLQQ-QoL), and ENRICH marital inventory were used to reflect changes in female/male sexual function and marital quality in the 4 groups. RESULTS:Female/male sexual function and marital quality were both highest in the VEOP group and lowest in the RHBO group. The regression results showed that ovarian preservation and vaginal extension were associated with female/male sexual function and marital quality. Furthermore, when vaginal extension and ovarian preservation were replaced by vaginal length, sexual psychological change, and hormone level index (KI), respectively; male sexual function was associated with vaginal length and sexual psychological change, whereas female sexual function and marital quality were only associated with hormone level and sexual psychological change. Clinical statistics found that four-fifths of the recurrent patients had vaginal extension (P = .042), and 3-quarters of these patients had large tumors. CONCLUSION:Ovarian preservation and vaginal extension are both important for male/female sexual activity and marital quality. Vaginal extension may play a positive role in female sexual life via psychology and in male sexual life via vaginal length. Vaginal extension may not be suitable for patients with large masses. Zhang Y, Sun S, Ding J, et al. The Effect of Different Surgical Methods on Female and Male Sexual Activity and Marital Quality in Patients With Early-Stage Cervical Cancer. Sex Med 2020;8:307-314.
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Project description:ObjectiveTo examine the association between surgical volume and survival of women with early-stage cervical cancer who underwent radical hysterectomy.MethodsThis is a nationwide multicenter retrospective study examining consecutive women with clinical stage IB1-IIB cervical cancer who underwent radical hysterectomy and pelvic lymphadenectomy from 2004 to 2008 (N=5,964). The surgical volume per site over the 5-year period was defined as low-volume (fewer than 32 surgeries, 46 [39.7%] institutions, n=649 [10.9%]), mid-volume (32-104 surgeries, 60 [51.7%] institutions, n=3,662 [61.4%]), and high-volume (105 surgeries or more, 10 [8.6%] institutions, n=1,653 [27.7%]). Surgical volume-specific survival was examined with multivariable analysis and propensity score matching.ResultsThe median number of surgeries per site was 44 (interquartile range, 17-65). The 5-year disease-free survival rates among stage IB1-IIB disease were 77.2%, 79.9%, and 84.5% for low-, mid-, and high-volume groups, respectively. On multivariable analysis, women in high-volume centers had a decreased risk of recurrence (adjusted hazard ratio [HR] 0.69, 95% CI 0.58-0.82, P<.001) and all-cause mortality (adjusted HR 0.73, 95% CI 0.59-0.90, P=.003) compared with those in mid-volume centers. Specifically, women in high-volume centers had a decreased risk of local recurrence (adjusted HR 0.62, 95% CI 0.49-0.78, P<.001) but not distant recurrence (adjusted HR 0.85, 95% CI 0.67-1.06, P=.142) compared with those in mid-volume centers. Among 1,700 women with clinical stage IB1 disease treated with surgery alone, surgery at high-volume centers was associated with a decreased risk of recurrence (adjusted HR 0.45, 95% CI 0.25-0.79, P=.006) and all-cause mortality (adjusted HR 0.29, 95% CI 0.11-0.76, P=.013) compared with surgery at mid-volume centers on multivariable analysis. After propensity score matching, surgery at high-volume centers remained an independent prognostic factor for decreased recurrence (adjusted HR 0.69, 95% CI 0.57-0.84, P<.001) and all-cause mortality (adjusted HR 0.75, 95% CI 0.59-0.95, P=.016) compared with surgery at mid- and low-volume centers on multivariable analysis.ConclusionHospital volume for radical hysterectomy may be a prognostic factor for early-stage cervical cancer. Surgery at high-volume centers is associated with decreased local recurrence risk and improved survival.
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