دورية أكاديمية
The influence of surgeon volume on outcomes after pelvic exenteration for a gynecologic cancer.
| العنوان: | The influence of surgeon volume on outcomes after pelvic exenteration for a gynecologic cancer. |
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| المؤلفون: | 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. |
| المصدر: | Journal of gynecologic oncology [J Gynecol Oncol] 2018 Sep; Vol. 29 (5), pp. e68. Date of Electronic Publication: 2018 May 04. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Asian Society of Gynecologic Oncology Country of Publication: Korea (South) NLM ID: 101483150 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2005-0399 (Electronic) Linking ISSN: 20050380 NLM ISO Abbreviation: J Gynecol Oncol Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: June 2011-: Seoul : Asian Society of Gynecologic Oncology : Taehan Puin Chongyang Hakhoe Original Publication: Seoul : Korean Society of Gynecologic Oncology and Colposcopy, June 2008- |
| مواضيع طبية MeSH: | Clinical Competence*, Genital Neoplasms, Female/*surgery , Pelvic Exenteration/*standards , Workload/*statistics & numerical data, Adult ; Aged ; Aged, 80 and over ; Blood Loss, Surgical/prevention & control ; Blood Transfusion/statistics & numerical data ; Female ; Follow-Up Studies ; Humans ; Length of Stay/statistics & numerical data ; Middle Aged ; Pelvic Exenteration/adverse effects ; Pelvic Exenteration/statistics & numerical data ; Postoperative Complications ; Texas ; Treatment Outcome |
| مستخلص: | 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.) |
| References: | J Natl Cancer Inst. 2006 Feb 1;98(3):163-71. (PMID: 16449676) N Engl J Med. 2001 Jul 19;345(3):181-8. (PMID: 11463014) Gynecol Oncol. 2012 Jan;124(1):42-7. (PMID: 22014627) N Engl J Med. 2002 Apr 11;346(15):1128-37. (PMID: 11948273) Gynecol Oncol. 2009 Dec;115(3):334-8. (PMID: 19766295) N Engl J Med. 2002 Apr 11;346(15):1138-44. (PMID: 11948274) Gynecol Oncol. 2011 Jul;122(1):14-8. (PMID: 21444105) Ann Surg Oncol. 2012 Mar;19(3):948-58. (PMID: 21989660) Obstet Gynecol. 2011 May;117(5):1051-9. (PMID: 21508742) Br J Surg. 2005 Apr;92(4):389-402. (PMID: 15786424) Gynecol Oncol. 2012 Apr;125(1):241-4. (PMID: 22240566) Stat Med. 1998 Oct 15;17(19):2157-77. (PMID: 9802176) Cancer. 1948 Jul;1(2):177-83. (PMID: 18875031) Curr Opin Oncol. 2014 Sep;26(5):514-20. (PMID: 25050632) Surgery. 2008 Mar;143(3):343-51. (PMID: 18291255) Cancer. 2015 Aug 15;121(16):2782-90. (PMID: 25892632) Ann Surg. 2004 Aug;240(2):205-13. (PMID: 15273542) N Engl J Med. 2003 Nov 27;349(22):2117-27. (PMID: 14645640) JAMA. 2000 Dec 20;284(23):3028-35. (PMID: 11122590) J Surg Oncol. 2003 Jun;83(2):68-78; discussion 78-9. (PMID: 12772198) Am J Obstet Gynecol. 2011 Sep;205(3):225.e1-7. (PMID: 21684517) J Clin Oncol. 2012 Nov 10;30(32):3976-82. (PMID: 23032619) Gynecol Oncol. 2014 Sep;134(3):546-51. (PMID: 25014540) |
| معلومات مُعتمدة: | K12 CA088084 United States CA NCI NIH HHS; P30 CA016672 United States CA NCI NIH HHS |
| فهرسة مساهمة: | Keywords: Gynecologic Neoplasms; Pelvic Exenteration; Pregnancy Outcomes; Surgeon Volume |
| تواريخ الأحداث: | Date Created: 20180720 Date Completed: 20190528 Latest Revision: 20190528 |
| رمز التحديث: | 20221213 |
| مُعرف محوري في PubMed: | PMC6078889 |
| DOI: | 10.3802/jgo.2018.29.e68 |
| PMID: | 30022632 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 2005-0399 |
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| DOI: | 10.3802/jgo.2018.29.e68 |