Lai Jerry Cheng-Yen, Chen Hung-Hui, Chu Kuei-Hui, Weng Chia-Sui, Chou Yiing-Jenq, Huang Nicole, Chien Yu-Ju, Wang Kung-Liahng
Institute of Public Health and Department of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
Department of Nursing, Ching Kuo Institute of Management and Health, Keelung, Taiwan, ROC.
Taiwan J Obstet Gynecol. 2017 Aug;56(4):449-455. doi: 10.1016/j.tjog.2016.09.009.
To describe the nationwide trends in the utilization of trachelectomy among Taiwanese women with surgically resectable cervical cancer over the past decade, and to compare associated demographic characteristics, in-hospital complications and related outcomes using a population-based dataset from 1998 to 2013.
We conducted a population-based, cohort study using inpatient admission claims data of Taiwan's National Health Insurance program. Women who underwent trachelectomy for cervical cancers were compared by age at surgery (younger than 40 years, 40-59 years, and 60 years or older).
Our study cohort consisted of 156 women. The overall utilization increased considerably during the study period, particularly in younger women aged 30-39 years. Compared with older women who had trachelectomy, women younger than 40 years were diagnosed more frequently in the later years of study (2007-2013, 69.9% vs 37.3%), were treated more frequently at medical centers (89.0% vs 60.2%) by physicians aged 55 years or older (50.7% vs 22.9%) with high case volume (50.7% vs 26.5%), were less likely to undergo concomitant surgeries for bilateral oophorectomy (1.4% vs 21.7%) and lysis of peritoneal adhesion (2.7% vs 24.1%), and were more likely to undergo lymph node excision (74.0% vs 47.0%) (P < 0.05 for all). During a median of follow-up of 5.4 (2.4-9.5) years, 5.1% received future hysterectomy after trachelectomy (n = 8) with a median time-to-future hysterectomy of 0.6 (0.2-5.0) years. The estimated risks of disease recurrence for cervical cancer and readmission within 30-days (n = 35) were 3.8% and 22.4%, respectively. Women's age at trachelectomy had no apparent association with the length of hospital stay (P = 0.11), in-hospital mortality, readmission within 30-days (P = 0.33), future hysterectomy (P = 0.14), and in-hospital complications (P = 0.47).
Substantial increase in the trend of delayed childbearing may have influenced the decision-making of Taiwanese women with cervical cancer in favor of trachelectomy over hysterectomy over the past 16-years from 1998 to 2013. When considering the uterine preservation for future fertility, women should be counseled about the risk of disease recurrence for cervical cancer before making surgical decision for trachelectomy over hysterectomy.
描述过去十年台湾可手术切除宫颈癌女性中宫颈切除术的全国使用趋势，并使用1998年至2013年的基于人群的数据集比较相关人口统计学特征、住院并发症及相关结局。
我们使用台湾国民健康保险计划的住院索赔数据进行了一项基于人群的队列研究。对因宫颈癌接受宫颈切除术的女性按手术年龄（小于40岁、40 - 59岁和60岁及以上）进行比较。
我们的研究队列包括156名女性。在研究期间，总体使用率大幅上升，尤其是在30 - 39岁的年轻女性中。与接受宫颈切除术的老年女性相比，40岁以下的女性在研究后期（2007 - 2013年）诊断更为频繁（69.9%对37.3%），在医学中心接受治疗的频率更高（89.0%对60.2%），由55岁及以上的医生治疗（50.7%对22.9%），病例量高（50.7%对26.5%），进行双侧卵巢切除术（1.4%对21.7%）和腹膜粘连松解术（2.7%对24.1%）的可能性较小，而进行淋巴结切除的可能性较大（74.0%对47.0%）（所有P < 0.05）。在中位随访5.4（2.4 - 9.5）年期间，5.1%（n = 8）的女性在宫颈切除术后接受了子宫切除术，未来子宫切除术的中位时间为0.6（0.2 - 5.0）年。宫颈癌疾病复发和30天内再入院（n = 35）的估计风险分别为3.8%和22.4%。女性宫颈切除术时的年龄与住院时间（P = 0.11）入院死亡率、30天内再入院（P = 0.33）、未来子宫切除术（P = 0.14）及住院并发症（P = 0.47）无明显关联。
从1998年到2013年的过去16年中，延迟生育趋势的大幅上升可能影响了台湾宫颈癌女性在手术决策上倾向于宫颈切除术而非子宫切除术。在考虑保留子宫以利于未来生育时，在做出宫颈切除术而非子宫切除术的手术决策前，应向女性咨询宫颈癌疾病复发的风险。
