title: Association between timing of cervical excision procedure to minimally invasive hysterectomy and surgical complications.
abstract: OBJECTIVE
  To determine if the time interval between excision procedure and definitive minimally invasive surgery (MIS) for cervical cancer impacts 30-day postoperative complications.
  
  
  METHODS
  A retrospective cohort of patients diagnosed with cervical cancer from January 2000 to July 2015 was evaluated. Patients who underwent a cervical excision procedure followed by definitive MIS within 90days were included. Early definitive surgery was defined as ≤6 weeks following excision procedure, while delayed was defined as 6weeks to 3months. The primary outcome was 30-day complications. Statistical analysis included descriptive statistics and modified Poission regression.
  
  
  RESULTS
  Overall, 138 patients met inclusion criteria. Of these, 33% (n=46) had early definitive surgery and 67% (n=92) had delayed definitive surgery. Median age was 42years (range 23-72years) and median BMI was 28kg/m2(range 16-50kg/m2). Within demographic and surgical factors collected, only smoking status differed between groups with those in the delayed surgery group more likely to be non-smokers than those in the early surgery group (p=0.04). When adjusting for relevant demographic and surgical factors, patients in the early group were twice as likely to have 30-day complication (aRR 2.6, 95%CI 1.14-5.76, p=0.02). Evaluating only women who underwent a radical procedure, 30-day complications remained higher in the early surgery group (RR 2.56; 95%CI 1.22-5.38, p=0.01).
  
  
  CONCLUSIONS
  Performing definitive MIS for cervical cancer within 6weeks after cervical excision is associated with increased risk for 30-day complications. Providers should consider delaying definitive surgical procedures for at least 6weeks following excision to reduce surgical complications.
authors.affiliation: University of North Carolina at Chapel Hill, United States; Department of Obstetrics and Gynecology, United States; Division of Gynecologic Oncology, United States. Electronic address: sasulliv@unch.unc.edu.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Sullivan
authors.affiliation: University of North Carolina at Chapel Hill, United States; Department of Obstetrics and Gynecology, United States; Division of Gynecologic Oncology, United States.
authors.forename: Leslie H
authors.initials: LH
authors.lastname: Clark
authors.affiliation: University of North Carolina at Chapel Hill, United States; Department of Obstetrics and Gynecology, United States.
authors.forename: Allison S
authors.initials: AS
authors.lastname: Staley
authors.affiliation: University of North Carolina at Chapel Hill, United States; Department of Obstetrics and Gynecology, United States; Division of Gynecologic Oncology, United States.
authors.forename: Arthur-Quan
authors.initials: AQ
authors.lastname: Tran
authors.affiliation: University of North Carolina at Chapel Hill, United States.
authors.forename: Aaron
authors.initials: A
authors.lastname: Winn
authors.affiliation: University of North Carolina at Chapel Hill, United States; Department of Obstetrics and Gynecology, United States; Division of Gynecologic Oncology, United States; University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, United States.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000601:surgery*
keywords: CKC; Cervical cancer; Excision; Hysterectomy; LEEP