LAUSR

OBJECTIVE To examine the influence of the first level I evidence (Laparoscopic Approach to Cervical Cancer [LACC] trial) on minimally invasive hysterectomy use and perioperative complications for cervical cancer surgery. METHODS This was population-based retrospective observational study, querying National Inpatient Sample. Women with cervical cancer who underwent hysterectomy and lymphadenectomy from 10/2015-12/2018 were examined. A quasi-experimental analysis with interrupted-time series was performed to assess the influence of the LACC trial report on minimally invasive hysterectomy use and perioperative complication rates. RESULTS 5120 women in the pre-LACC period and 1645 women in the post-LACC period were compared. Following the LACC trial report on 3/2018, the minimally invasive hysterectomy use dropped by 19.7 percent points in one month (55.2% in 3/2018 to 35.5% in 4/2018), followed by a continued decline of 8.0% (95% confidence interval 0.1-15.3) monthly. By 12/2018, minimally invasive hysterectomy was used in 17.9% of cases, which was 38.8 percent points lower than the expected rate per the pre-LACC period projection. In multivariable analysis, women in the post-LACC period were 63% less likely to undergo minimally invasive hysterectomy (adjusted-odds ratio 0.37, 95% confidence interval 0.33-0.42) but 23% more likely to have a perioperative complication (38.6% versus 29.1%, adjusted-odds ratio 1.23, 95% confidence interval 1.08-1.40) compared to those in the pre-LACC period. Women in the post-LACC group were more likely to have a longer hospital stay compared to those in the pre-LACC group (median, 3 versus 2 days, P < 0.001). CONCLUSION Following the LACC trial results, U.S. surgeons rapidly shifted from minimally invasive to open hysterectomy for cervical cancer. Decreasing utilization of minimally invasive surgery was associated with an increase in perioperative complications and longer hospital admissions.