Utilization of lymph node evaluation at hysterectomy for cervical carcinoma in situ

Background and objectives: This study examined the utilization and characteristics of lymph node evaluation at hysterectomy for carcinoma in situ of the uterine cervix.

Methods: This retrospective cohort study queried the Healthcare Cost and Utilization Project's National Inpatient Sample, evaluating 7395 patients with cervical carcinoma in situ who underwent hysterectomy from 2016 to 2019. A multivariable binary logistic regression model was fitted to identify independent characteristics related to lymph node evaluation. A classification-tree was constructed with recursive partitioning analysis to examine utilization patterns of lymph node evaluation.

Results: Lymph node evaluation at hysterectomy was performed in 4.6%. In amultivariable analysis, older age, higher income, use of robotic-assisted hysterectomy, and surgery at large bed capacity or urban teaching centers in the northeast US region were associated with increased likelihood of lymph node evaluation (all, p < 0.05). Of those independent factors, robotic-assisted surgery exhibited the largest effect size (adjusted odds ratio 3.23, 95% confidence interval 2.54-4.10). Utilization pattern analysis identified nine unique characteristics, of which robotic-assisted surgery was the primary indicator for cohort allocation (12.4% vs. 3.2%, p < 0.001). The difference between the lowest-highest patterns was 33.3% (range, 0%-33.3%).

Conclusion: Lymph node evaluation was rarely performed for cervical carcinoma in situ overall and robotic surgery was associated with increased utilization of lymph node evaluation.