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Multicenter Study
. 2023 Apr 1;141(4):642-652.
doi: 10.1097/AOG.0000000000005059. Epub 2023 Mar 9.

Endometrial Cancer Surgery With or Without Concomitant Stress Urinary Incontinence Surgery

Katina Robison  1 , Kyle Wohlrab, Chanelle J Howe, Holly E Richter, Vivian Sung, Kerri S Bevis, Christine Luis, Carolyn McCourt, Jerry Lowder, John Occhino, Gretchen Glaser, Elizabeth Lokich, Gena Dunivan, Amy Brown, Elena Tunitsky-Bitton, Stephanie Wethington, Chi Chiung Grace Chen, David Rahn, Matthew Carlson, Robin Cram, Christina Raker, Melissa A Clark
Affiliations
Multicenter Study

Endometrial Cancer Surgery With or Without Concomitant Stress Urinary Incontinence Surgery

Katina Robison et al. Obstet Gynecol. .

Abstract

Objective: To compare quality of life (QOL) among patients with endometrial intraepithelial neoplasia or early-stage endometrial cancer and stress urinary incontinence (SUI) who chose to have concomitant surgery with cancer surgery alone.

Methods: A multicenter, prospective cohort study was conducted across eight U.S. sites. Potentially eligible patients were screened for SUI symptoms. Those who screened positive were offered referral to urogynecology and incontinence treatment, including concomitant surgery. Participants were categorized into two groups: 1) concomitant cancer and SUI surgery or 2) cancer surgery alone. The primary outcome was cancer-related QOL as measured by the FACT-En (Functional Assessment of Cancer Therapy-Endometrial) (range 0-100; higher score indicates better QOL). The FACT-En and questionnaires assessing urinary symptom-specific severity and effects were assessed before surgery and 6 weeks, 6 months, and 12 months after surgery. Adjusted median regression accounting for clustering was used to examine the relationship between SUI treatment group and FACT-En scores.

Results: Of 1,322 (53.1%) patients, 702 screened positive for SUI with 532 analyzed; 110 (21%) chose concomitant cancer and SUI surgery, and 422 (79%) chose cancer surgery alone. FACT-En scores increased for both the concomitant SUI surgery and cancer surgery-only groups from the preoperative to the postoperative period. After adjustment for timepoint and preoperative covariates, the median change in FACT-En score (postoperative-preoperative) was 1.2 points higher (95% CI -1.3 to 3.6) for the concomitant SUI surgery group compared with the cancer surgery-only group across the postoperative period. Median time until surgery (22 days vs 16 days; P <.001), estimated blood loss (150 mL vs 72.5 mL; P <.001), and operative time (185.5 minutes vs 152 minutes; P <.001) were all greater for the concomitant cancer and SUI surgery group compared with the cancer-only group, respectively.

Conclusion: Concomitant surgery did not result in improved QOL compared with cancer surgery alone for endometrial intraepithelial neoplasia and patients with early-stage endometrial cancer with SUI. However, FACT-En scores were improved in both groups.

Trial registration: ClinicalTrials.gov NCT02667431.

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Conflict of interest statement

Financial Disclosure Kyle Wohlrab reports receiving payment from Boston Scientific. His spouse (Katina Robison, MD) is the lead author of this article and received a PCORI grant to fund the project. Holly E. Richter disclosed the following: ongoing research funding: NIH/NIA; NIH/University of Pennsylvania; NIH/University of Minnesota; NICHD/University of Texas at Austin, NIH/UT Southwestern; Renovia; EBT Medical; Reia. Past: NICHD; NIDDK/Univ North Carolina; Allergan; Renovia; Pelvalon. Other disclosures: DSMB member: BlueWind Medical; UpToDate: royalties, Board of Directors: AUGS and WorldWide Fistula Fund; editorial duties: IUJO and Obstetrics & Gynecology . Carolyn McCourt reports receiving a payment from UpToDate. Jerry Lowder’s institution received grant support from NIH-NIDDK. He received payment from Hanson Curran LLP for medicolegal review and expert testimony. Gena Dunivan's institution received payment from Renovia. David Rahn’s institution received payment from the National Institute on Aging (NIA), National Institute of Child Health and Human Development (NICHD), and Pfizer, Inc. The other authors did not report any potential conflicts of interest.

References

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