Dong-Hoon Suh

Impact of guideline adherence on patient outcomes in early-stage epithelial ovarian cancer.

AIM The aim of this study was to evaluate the effects of adherence to National Comprehensive Cancer Network (NCCN) guidelines on survival outcomes in patients with early-stage epithelial ovarian cancer. METHODS Our institutional cancer registry data on 266 patients with Stage I epithelial ovarian cancer was reviewed retrospectively and compliance with treatment guidelines for surgery and adjuvant treatment was determined. Patients were categorized according to adherence or non-adherence. The primary endpoints were recurrence-free survival and disease-specific survival. Hazard ratios (HRs) for survival were estimated with a Cox proportional hazards model. RESULTS Of the 266 patients, 71 (26.7%) underwent adequate surgical staging in accordance with the guidelines. The guidelines for adjuvant chemotherapy were followed adequately in all 71 patients that were adherent to surgical staging and in 163 of the 195 patients with non-adherence to surgical staging (83.6%). Multivariate analysis, adjusted for prognostic factors, identified higher recurrence-free survival (HR, 0.36; 95% CI, 0.15-0.88) and disease-specific survival (HR, 0.42; 95% CI, 0.16-1.12) among patients whose treatment adhered to both surgical and chemotherapy guidelines, although disease-specific survival was not statistically significant. When excluding clear cell histology from the cohort, the guideline-adherent group had significantly better disease-specific survival than the non-adherent group (HR, 0.13; 95% CI, 0.02-0.94). CONCLUSION The results of this study suggest that adherence to NCCN guidelines may improve survival outcomes in patients with early-stage epithelial ovarian cancer, particularly in cases other than clear cell histology.

Case Selection Is a Fundamental Prerequisite to the Successful Surmounting of Learning Curve of Laparoscopic Radical Hysterectomy in Early-Stage Cervical Cancer: A Matched-Case Comparison in a Single Institution.

Study Objective: To identify the lengthiest step TLH in a teaching hospital and determine which clinical factors affect the duration of this step. Design: Retrospective case series. Setting: The University of Louisville Hospital. Patients: Women undergoing an elective TLH for benign disease from January 2010 to April 2014. Intervention: TLHwas divided into five steps: (1) insertion of laparoscopic ports and adhesiolysis to restoration of normal anatomy; (2) identification of the ureter, resection of adnexal structures to transection of the round ligament; (3) transection of the round ligament to transection of the uterine artery; (4) lateralization of the uterine vessel pedicle to completion of colpotomy; and (5) completion of vaginal cuff closure. The random intercept and slope model was used to identify the lengthiest step of TLH, and the backward elimination procedure was used to evaluate which clinical factors affect this step. Measurements and Main Results: A total of 490 benign TLHs were performed; 399 recordings were identified. Of these, 264 were incomplete and excluded. The remaining 135 complete recordings were reviewed. Mean total length of TLH was 81 minutes (SD=30). The lengthiest step was colpotomy with mean duration of 24 minutes (SD=13). Uterine weight significantly increased the length of time required for colpotomy (p=.001). The primary energy source (ultrasonic scalpel vs. monopolar hook) used to perform colpotomy did not influence the length of time (p=.539, p=.583). Uterine weight (p\.001) and adhesiolysis (p=.003) significantly increased total time of TLH. Conclusion: At a teaching institution where surgeries are performed by residents and fellows, colpotomy is the lengthiest step of TLH and is influenced by uterine weight. This finding may reflect the training levels of the surgeons and the learning curve associated with these steps. Further research should focus upon simulation models and/or tools for colpotomy to increase efficiency in the operating room.