Outcome of radical hysterectomies performed by general gynecologists in Jamaica

Abstract

General gynecologists with significant experience in general gynecologic surgery who underwent adequate, but abbreviated, training became competent in performing a radical hysterectomy, with outcomes comparable to those seen in high-resource countries.

Improving access to safe, quality surgical care for gynecologic cancers through capacity‐building interventions in low‐ and middle‐income countries: A scoping review

“…These findings are consistent with the broader literature 38–40 . Nevertheless, these results were challenged by another study which showed that GGs with substantial experience in general gynecologic surgery may become competent in performing a modified radical hysterectomy with abridged training, demonstrating outcomes comparable to those measured in high income countries (HICs) 33 . Considering these summed findings, there is a great need to explore the implications of implementing programs providing subspecialized gynecologic oncologic training to GGs and/or GSs.…”

“…Five studies (26%) compared differences in patient outcomes for treatment of early‐stage cancer provided by a subspecialized versus a non‐subspecialized surgical provider 31–35 . Notably, only two of these studies included patients with cervical cancer, 31,33 one of which also included patients with endometrial cancer 33 .…”

“…Notably, only two of these studies included patients with cervical cancer, 31,33 one of which also included patients with endometrial cancer 33 . Four of the studies reported better outcomes from subspecialized versus non‐subspecialized surgical providers, 31,32,34,35 while one study reported comparable staging accuracy (79.3% compared to 61% in the cited literature), duration of operation (225 compared to 225 min), intraoperative blood loss (878 mL compared to 996, 856, and 910 mL), complications (3.4% vs 1.5%–2.5% and 10% ureteric injury; 1.7% compared to 2.5% postoperative fistula formation), and 5‐year survival (77.6% compared to 83%, 72%, and 84%) for GGs with significant experience in performing a modified (type II) radical hysterectomy as compared to the literature 33 . One study on cervical cancer reported greater adherence to surgical guidelines among GynOncs (84.3%) compared to non‐GynOncs (74.5%) ( P 0.003), shorter median operative time (180 vs 270 min) ( P < 0.0001), lower median estimated blood loss (350 vs 425 mL) ( P < 0.0001), less frequent blood transfusion (26.9% vs 33.6%) ( P 0.046), and lower incidence of cystotomy (0.5% vs 2.4%) ( P 0.038); ureteric injury (1.4% vs 3.8%) ( P 0.027); and fistula formation (0.4% vs 3.1%) ( P 0.002) 31 .…”

“…33 Four of the studies reported better outcomes from subspecialized versus non-subspecialized surgical providers, 31,32,34,35 compared to 83%, 72%, and 84%) for GGs with significant experience in performing a modified (type II) radical hysterectomy as compared to the literature. 33 One study on cervical cancer reported greater adherence to surgical guidelines among GynOncs (84.3%) compared to non-GynOncs (74.5%) (P 0.003), shorter median operative time (180 vs 270 min) (P < 0.0001), lower median estimated blood loss (350 vs 425 mL) (P < 0.0001), less frequent blood transfusion (26.9% vs 33.6%) (P 0.046), and lower incidence of cystotomy (0.5% vs 2.4%) (P 0.038); ureteric injury (1.4% vs 3.8%) (P 0.027); and fistula formation (0.4% vs 3.1%) (P 0.002). 31 The group operated on by GynOncs also demonstrated longer recurrence-free (P 0.001, HR 0.64) and cancer-specific survival (P 0.005, HR 0.64) on univariate analysis which was preserved on multivariate analysis (recurrence-free survival: P 0.0001, HR0.57; cancer-specific survival P 0.001, HR 0.58).…”

“…[38][39][40] Nevertheless, these results were challenged by another study which showed that GGs with substantial experience in general gynecologic surgery may become competent in performing a modified radical hysterectomy with abridged training, demonstrating outcomes comparable to those measured in high income countries (HICs). 33 Considering these summed findings, there is a great need to explore the implications of implementing programs providing subspecialized gynecologic oncologic training to GGs and/or GSs. It is crucial to develop standardized, evidence-based metrics to measure patient outcomes and facilitate amelioration of any discrepancies in care contributing to those outcomes.…”