COMPARATIVE ANALYSIS OF THE SURGICAL TREATMENT FOR UTERINE CANCER: EXTENDED RADICAL HYSTERECTOMY VERSUS HYSTERECTOMY WITH CONTIGUOUS ORGAN RESECTION

Introduction: The choice of the technique is a decision that can directly determine the outcome and prognosis of several surgical pathologies, such as uterine cancer. In this context, two important techniques are common and often applied in Brazil, coded by the Brazilian health system as extended radical hysterectomy and hysterectomy with contiguous organ resection (COR). Furthermore, it is crucial to understand the impacts of these techniques on public health, to identify potential ways to minimize damage, optimize recovery and ensure better outcomes. Objective: To conduct a comparative public epidemiological investigation between techniques in hysterectomies related to oncologic surgery. Method: Epidemiological study, performed under analysis in DATASUS (SIH/SUS and SISCOLO/SUS), in the period 2009 to 2018. The statistical analysis was ran on the platform OpenEpi 3.01 (MIT/USA) and p<0.01 was considered significant. Results: During 20092018, the extended radical oncologic hysterectomies computed 33,692 operations, being 8.7 times higher than the oncological hysterectomies COR (p<0.01) 3,880 procedures. The ratio of COR hysterectomies grew at a rate of 0.84% (± 0.11) per year, while the extended radical technique did so with a rate of 4.4% (± 0.17) per year (p<0.01). Also, the COR hysterectomies had an annual average of 6.7±0.37 days of hospitalization, while the extended radical technique showed an annual average of 4.2±0.33 days, representing a 2-days early discharge, on average (p<0.01). In mortality rate, the COR technique showed an average growth of 45.6%±0.23 per year, and this was significantly higher (p<0.01) when compared to the average annual growth of 4.3%±0.73 of the extended radical technique. Regarding costs, there was no correlation between techniques and their expenses (p=0.78), whose COR hysterectomy cost, by procedure, an annual average of R$ 5,317.78 (±1,777.6) and the extended radical, R$ 5,089.01 (±1,777.6). Conclusion: Our study suggests that the COR hysterectomy has significantly negative impacts on the patients evolution, with a longer hospitalization time, probably related to higher morbidity associated with resection of multiple organs, besides lower survival rate, possibly associated with more advanced staging. Moreover, it is inferred that the precise diagnosis of each underlying disease would be relevant to better understand the treatment-prognostic, intimate correlates of these surgical interventions in oncology.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019