The influence of surgeon volume on outcomes after pelvic exenteration for a gynecologic cancer.

Autor:	Jalloul RJ; Department of Obstetrics and Gynecology, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA., Nick AM; Saint Thomas Medical Partners-Gynecologic Oncology and University of Tennessee Health Sciences Center, Nashville, TN, USA., Munsell MF; Department of Biostatistics, University of Texas, MD Anderson Cancer Center, Houston, TX, USA., Westin SN; Department of Gynecologic Oncology and Reproductive Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX, USA., Ramirez PT; Department of Gynecologic Oncology and Reproductive Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX, USA., Frumovitz M; Department of Gynecologic Oncology and Reproductive Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX, USA., Soliman PT; Department of Gynecologic Oncology and Reproductive Medicine, University of Texas, MD Anderson Cancer Center, Houston, TX, USA. psoliman@mdanderson.org.
Jazyk:	angličtina
Zdroj:	Journal of gynecologic oncology [J Gynecol Oncol] 2018 Sep; Vol. 29 (5), pp. e68. Date of Electronic Publication: 2018 May 04.
DOI:	10.3802/jgo.2018.29.e68
Abstrakt:	Objective: To determine the effect of surgeon experience on intraoperative, postoperative and long-term outcomes among patients undergoing pelvic exenteration for gynecologic cancer. Methods: This was a retrospective analysis of all women who underwent exenteration for a gynecologic malignancy at MD Anderson Cancer Center, between January 1993 and June 2013. A logistic regression was used to model the relationship between surgeon experience (measured as the number of exenteration cases performed by the surgeon prior to a given exenteration) and operative outcomes and postoperative complications. Cox proportional hazards regression was used to model survival outcomes. Results: A total of 167 exenterations were performed by 19 surgeons for cervix (78, 46.7%), vaginal (43, 25.8%), uterine (24, 14.4%), vulvar (14, 8.4%) and other cancer (8, 4.7%). The most common procedure was total pelvic exenteration (69.4%), incontinent urinary diversion (63.5%) and vertical rectus abdominis musculocutaneous reconstruction (42.5%). Surgical experience was associated with decreased estimated blood loss (p<0.001), intraoperative transfusion (p=0.009) and a shorter length of stay (p=0.03). No difference was noted in the postoperative complication rate (p=0.12-0.95). More surgeon experience was not associated with overall or disease specific survival: OS (hazard ratio [HR]=1.02; 95% confidence interval [CI]=0.97-1.06; p=0.46) and DSS (HR=1.01; 95% CI=0.97-1.04; p=0.66), respectively. Conclusion: Patients undergoing exenteration by more experienced surgeons had improvement in intraoperative factors such as estimated blood loss, transfusion rates and length of stay. No difference was seen in postoperative complication rates, overall or disease specific survival. Competing Interests: No potential conflict of interest relevant to this article was reported. (Copyright © 2018. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology.)
Databáze:	MEDLINE
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