title: Predictors of postoperative morbidity after laparoscopic versus open radical hysterectomy plus external beam radiotherapy: a propensity-matched comparison.
abstract: BACKGROUND
  Identification of peri-operative variables predicting postoperative morbidity may improve postoperative patients' care. We aimed to identify patients' characteristics and operative factors predictive of early (≤ 30-day) and late (≤ 6-month) morbidity in cervical cancer patients undergoing surgery plus external beam radiotherapy (EBRT).
  
  
  METHODS
  We studied 45 propensity-matched patient pairs (90 patients) undergoing laparoscopic radical hysterectomy (LRH) plus EBRT vs. abdominal radical hysterectomy (RAH) plus EBRT. Basic descriptive, multivariable and artificial neuronal network analyses (ANN) were used to design predicting models influencing outcomes.
  
  
  RESULTS
  Baseline characteristics of the study populations were similar. Patients undergoing LRH experienced lower blood loss (200 (range, 10-700) vs. 400 (range, 100-2000) ml; P < 0.001), shorter length of hospital stay (4 (range, 1-10) vs. 8 (range, 5-52) days; P < 0.001) and similar operative time (235 (± 67.3) vs. 258 (± 70.2) min; P = 0.14) than patients undergoing RAH. We observed that, at multivariate analysis, open approach correlated with overall (OR: 1.2; 95%CI: 1.03-1.46), early (OR: 1.14; 95%CI:0.99-1.3) and late (OR: 1.13; 95%CI: 1.001-1.28) postoperative complications.
  
  
  CONCLUSIONS
  Open approach is the main predictor for developing morbidity among cervical cancer patients undergoing radical hysterectomy followed by adjuvant radiotherapy. Laparoscopic surgery enhances peri-operative surgical results and minimizes the occurrence of late complications.
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bogani
authors.forename: Antonella
authors.initials: A
authors.lastname: Cromi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Serati
authors.forename: Edoardo
authors.initials: E
authors.lastname: Di Naro
authors.forename: Stefano
authors.initials: S
authors.lastname: Uccella
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Donadello
authors.forename: Fabio
authors.initials: F
authors.lastname: Ghezzi
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D008197:Lymph Node Excision; D008875:Middle Aged; D009017:Morbidity; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000209:etiology; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology*; D011379:Prognosis; D057216:Propensity Score; D011446:Prospective Studies; D011878:Radiotherapy / Q000009:adverse effects*; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000628:therapy*
keywords: cervical cancer; late complications; morbidity; radical hysterectomy; radiotherapy