The Concomitant Urogynecology and Gynecologic Oncology (CURO) Surgery Study

Objectives: Pelvic floor disorders are seen in 36-50% of gynecologic cancer patients. While studies have evaluated complications at < 30 days currently no research has described >30 day post-operative outcomes for patients undergoing concomitant urogynecology and gynecologic oncology (CURO) procedures. Our primary objective is to describe 30 and 90 day complications after CURO surgeries. Secondary aims include reporting the most common complications, readmission rate, and determining the rate of gynecologic malignancy for CURO surgeries.

Methods: A retrospective observational study was performed from January 1, 2010 to April 1, 2024 at a single tertiary care center. Data was abstracted from electronic medical records by Current Procedural Terminology codes for gynecologic oncology and urogynecology procedures. Surgeon subspecialty was used to confirm concomitant urogynecologic procedures at the time of surgery for known or suspected gynecologic malignancy. The primary outcomes were complication rates at 30-days and 90-days post-operatively. Secondary outcomes were to determine the rates of confirmed malignancy by pathology report, type of urogynecology procedure, and readmission rate for patients undergoing CURO procedures. Perioperative and postoperative complications included transfusion, urinary tract infection, postoperative urinary retention, venous thromboembolism, respiratory complications, readmissions and mesh exposure. Complication rate differences were compared between patients with benign or malignant pathology, and analyzed using χ2 test and odds ratios. Statistical analyses were calculated using SPSS-29.

Results: We identified 66 CURO cases during the study period. Mean age was 66.4 years and mean BMI was 32.5 kg/m2 (Table 1). The < 30 day composite complication rate was 36% while the 30 to 90 day complication rate was 9% (Table 2). Final pathology confirmed 59% malignancies while 41% were benign. The most common complications were urinary retention 24% (16/66) and urinary tract infection 15% (10/66). Readmission rate at < 30 days was 3% (2/66) and ≤90 days post-operative was 6% (4/66). Among all screened cases performed by gynecologic oncologists, only < 0.01% (66/7,609) were CURO surgeries. The most common CURO surgeries involved mid-urethral slings (55%) followed by minimally invasive sacrocolpopexy (33%) with only one via laparotomy. The majority of gynecology oncology procedures included laparoscopic hysterectomy with salpingo-oophorectomy (94%). There was no difference in < 30 day complications when comparing pathology-confirmed malignant and benign cases, OR=0.73, 95% CI 0.26-2.01, p=0.61. Table 2 shows all complications ≥30 day were in the malignant group.

Conclusions: The CURO surgery 30 day complication rate was 36% and ≥30 day complication rate was 9%. There was no difference in < 30day complication rate between benign and malignant groups. This suggests malignancy does not confer increased risk at < 30days, but this trend may not be true at ≥30 days. These findings warrant further evaluation.