Pelvic floor disorders (PFDs) occur in 36-50% of gynecologic cancer patients. Approximately 1 out of 10 women report symptomatic prolapse and 48.5% have bothersome urinary incontinence. The rate of combined urogynecology/ gynecologic oncology surgery (CURO) is 2-3%. Planned surgical treatment for PFDs at the time of gynecologic oncology surgery (GOS) provides an opportunity to improve quality of life. While studies have reported adverse outcomes of CURO at < 30-day , there is limited data on >30 day outcomes. The primary objective of this study is to compare adverse outcomes between CURO and GOS at 30-90 days.

A retrospective cohort study was performed from January, 2010, to April 2024 at a single institution. Patients who underwent CURO surgery were identified by a hospital database and data abstraction was performed from electronic medical records. CURO patients were matched with patients who underwent GOS only based on surgery type, age to the nearest decade, and based on final pathology. Intraoperative and postoperative complications up to 90 days were recorded and compared. Table 2 lists post-operative outcomes included in the definition of composite 30-90 day complication. Clavien-Dindo grading was used to compare complication severity between groups. Statistics were reported for all groups as N (percent) for categorical variables and mean ± standard deviation (SD) for continuous variables. Comparisons between cohorts were performed using Chi square and Fisher exact tests for categorical data. All tests were two sided with p-value considered significant at 0.05. All statistical analyses were performed using SAS (Cary, NC).

One hundred and twenty-two matched cases were included in the final analysis. Baseline characteristics were similar between the groups (Table 1). Mean estimated blood loss was higher in the CURO group (mean ± SD; 181.2 mL ±17 v. 123.1 mL ±14 P< 0.001). There were no significant differences in 30 – 90 day complications between the CURO group 11% (7/61) compared to the GOS group 11% (7/61) (Table 2). Overall, Clavien-Dindo grade 2 was the most common complication severity type, but this was not significantly different between the CURO and GOS groups (14 v. 12 respectively), p-value 0.19. The most common CURO surgeries were mid-urethral slings 32/61 (52%), followed by sacrocolpopexies 20/61 (33%). There was one mesh exposure noted during the study period following a sacrocolpopexy.

Adding a urogynecology procedure to a gynecologic oncology procedure is associated with minimal increased risk of adverse events. This data is helpful to guide counseling when considering treating pelvic floor disorders at the time of gynecology oncology procedures.

Table 1: Characteristics of concomitant urogynecology and gynecologic oncology patients. Patients grouped by Combined surgery (CURO) and Gynecology Oncology only surgery (GOS). Reported as N (%) unless otherwise specified. SD = standard deviation, BMI = Body Mass Index, EBL = Estimated blood loss, VTE = Venous thromboembolism