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2022-RA-1301-ESGO The impact of hospital surgical volume on survival in early-stage cervical cancer treated with radical hysterectomy: a sub-analysis of the SCCAN study
  1. Nicolò Bizzarri1,
  2. Lukáš Dostálek2,
  3. Luc RCW Lonkhuijzen3,
  4. Diana Giannarelli4,
  5. Aldo Lopez5,
  6. Henrik Falconer6,
  7. Denis Querleu1,
  8. Ali Ayhan7,
  9. Sarah H Kim8,
  10. David Isla Ortiz9,
  11. Jaroslav Klat10,
  12. Andreas Obermair11,
  13. Fabio Landoni12,
  14. Juliana Rodriguez13,
  15. Ranjit Manchanda14,
  16. Jan Kosťun15,
  17. Pedro T Ramirez16,
  18. Mehmet M Meydanli17,
  19. Diego Odetto18,
  20. Rene Laky19,
  21. Ignacio Zapardiel20,
  22. Vit Weinberger21,
  23. Ricardo Dos Reis22,
  24. Luigi Pedone Anchora1,
  25. Karina Amaro5,
  26. Sahar Salehi6,
  27. Huseyin Akilli7,
  28. Nadeem R Abu-Rustum8,
  29. Rosa A Salcedo-Hernández9,
  30. Veronika Javůrková10,
  31. Constantijne H Mom3,
  32. Giovanni Scambia1 and
  33. David Cibula2
  1. 1UOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
  2. 2Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital (Central and Eastern European Gynecologic Oncology Group, CEEGOG), Prague, Czech Republic
  3. 3Center for Gynaecologic Oncology Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
  4. 4Biostatistics Unit, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
  5. 5Department of Gynecological Surgery, National Institute of Neoplastic Diseases, Lima, Peru
  6. 6Department of Pelvic Cancer, Karolinska University Hospital and Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
  7. 7Baskent University School of Medicine, Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Ankara, Turkey
  8. 8Memorial Sloan Kettering Cancer Center, New York, NY
  9. 9Gynecology Oncology Center, National Institute of Cancerology Mexico, Mexico City, Mexico
  10. 10Department of Obstetrics and Gynecology, Faculty of Medicine, University Hospital and University of Ostrava, Ostrava, Czech Republic
  11. 11Queensland Centre for Gynaecological Cancer, The University of Queensland, Brisbane, Australia
  12. 12University of Milano-Bicocca, Department of Obstetrics and Gynecology, Gynaecologic Oncology Surgical Unit, ASST-Monza, San Gerardo Hospital, Monza, Italy
  13. 13Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotà, Colombia
  14. 14Wolfson Institute of Preventive Medicine, Barts Cancer Centre, Queen Mary University of London, and Barts Health NHS Trust, London, UK
  15. 15Department of Gynaecology and Obstetrics, University Hospital Pilsen, Charles University, Prague, Czech Republic
  16. 16Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
  17. 17Department of Gynecologic Oncology, Zekai Tahir Burak Women’s Health and Research Hospital, University of Health Sciences, Ankara, Turkey
  18. 18Department of Gynecologic Oncology, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano, Buenos Aires, Argentina
  19. 19Gynecology, Medical University of Graz, Graz, Austria
  20. 20Gynecologic Oncology Unit, La Paz University Hospital – IdiPAZ, Madrid, Spain
  21. 21University Hospital Brno, Medical Faculty of Masaryk University, Brno, Czech Republic
  22. 22Department of Gynecologic Oncology, Hospital de Amor, Barretos, Sao Paulo, Brazil


Introduction/Background The objective was to evaluate the impact of number of radical hysterectomies (RHs) performed per year in each center on disease-free survival (DFS) and overall survival (OS), from patients previously included in the SCCAN study.

Methodology International, multicenter, retrospective study. Patients with FIGO-2009-stage IB1-IIA1 cervical cancer who underwent RH, did not undergo neo-adjuvant chemotherapy and with pathologic negative lymph nodes, were included. Patients were treated in national referral centers for gynecologic oncology according to updated national/international guidelines. Optimal cut-offs for surgical volume were identified using an unadjusted Cox proportional hazard model with DFS as outcome and defined as the value which minimizes the p-value of the split in groups in terms of DFS. A Propensity Score Matching (PSM) was used to adjust the differences between the groups baseline characteristics.

Results 2,157 patients were initially included. The two most significant cut-offs for surgical volume were identified in 7 and 17 surgical procedures, dividing the entire cohort in low, middle, and high-volume centers. After PSM, 1,238 patients, distributed as 619 (50.0%) in high-volume, 523 (42.2%) in middle-volume and 96 (7.8%) in low-volume group, were analyzed. Patients operated in higher volume institutions had a progressively better 5-year DFS than those operated in lower volume centers (92.3% vs 88.9% vs 83.8%,p=0.029). No 5-year OS difference was noted (95.9% vs 97.2% vs 95.2%,p=0.70). Cox multivariate regression analysis for risk of showed that FIGO-stage >IB1, LVSI+, grade >1, tumor diameter >20 mm, minimally invasive approach, non-squamous cell histology, and lower volume centers represented independent risk factors for recurrence.

Abstract 2022-RA-1301-ESGO Figure 1

Conclusion Surgical volume represented an independent prognostic factor affecting DFS. Increasing number of RHs performed in each center every year was associated with improved DFS. Performance of at least 18 RHs per year may be considered the target volume of cases for referral centers associated with better DFS.

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