Both gynecologic cancer and urogynecologic problems affect a similar population and increase in incidence with age. Addressing these conditions with concurrent surgeries is not yet very common, presumably due to concerns regarding coordinating surgeons, delaying time to surgery, risks associated with cancer treatment, etc. They have however, been completed successfully in this hospital system. The aim of this study was to describe patients who underwent concurrent Gynecologic Oncology and Urogynecology surgeries at a single institution. We hypothesize that concurrent surgery is feasible without adverse oncologic nor urogynecologic outcomes.

A retrospective review of all patients who underwent planned concurrent surgical procedures with Gynecologic Oncology and Urogynecology from 1/1/2007 to 2/5/2018 was performed. Chart review yielded demographics and parameters related to the patients’ oncologic and urogynecologic diagnoses, including age, cancer type, cancer stage, adjuvant cancer therapy, prolapse stage, type of incontinence, co-morbidities, mesh complications, and recurrence of cancer or prolapse. Data were analyzed with descriptive statistics. Progression-free survival (PFS) was defined as months from surgery to first evidence of disease progression via radiographic imaging, elevation in CA125 above the normal range, clinical examination, or patient death. Overall survival (OS) was defined as months from diagnosis to patient death or last contact.

Twenty-nine patients were identified as having undergone planned combination surgeries in the specified time period. Final tumor pathology included endometrial (44.8%), ovarian/primary peritoneal (27.6%), cervical (3.4%), and non-gynecologic metastasis (3.4%) while 17.2% were benign. Cancer staging surgery was open in 51.9% of cases and laparoscopic in 48.1%. Urogynecologic surgery included prolapse surgery in 44.8% of cases, incontinence surgery in 44.8%, and both in 10.3%. Mesh was used in 44.8% of cases. Urogynecologic surgeries performed included vaginal hysterectomy (13.8% of cases), anterior/posterior repair (44.8%), autologous fascial sling (6.9%), McCall’s culdoplasty (10.3%), synthetic mesh retropubic sling (TVT) (41.4%), abdominal sacrocolpopexy (3.4%), sacrospinous ligament suspension (13.8%), rectovaginal fistula repair (6.9%), and uterosacral ligament suspension (6.9%), with most patients undergoing more than one urogynecologic procedure (Figure 1).The mean BMI was 34.6 kg/m2, and mean age at cancer diagnosis was 64.2 years.  Adjuvant cancer therapy included radiation alone (8.7%) , chemotherapy alone (21.7%) and both (4.3%). Cancer recurred in 24.1% of patients. In those patients who recurred, median PFS was 10.5 months (95% CI: 5.6-19.6). The median overall survival in patients with gynecologic primary cancers was 56.5 months (95% CI: 24.5-97.3). There were no prolapse recurrences. Stress urinary incontinence (SUI) recurred or persisted in 25% (3/12) who had TVT placed, and the average BMI for these women was 31.9 kg/m2. Mesh extrusion occurred in 1/13 patients (8%), and she did not have radiation therapy. Superficial surgical site infection (SSI) occurred in 10.3% of patients, and there was no trend in surgery type between them. Deep SSI did not occur in any cases.

This series of combined surgeries is widely representative of the variety of oncology and urogynecology procedures that can be performed concomitantly. Complication rates were overall low and within expected ranges for these surgeries performed separately. The rate of persistent or recurrent SUI after TVT was higher than expected, but that is unlikely to be related to concurrent cancer surgery. Alternatively, the increased rate in this group may be associated with obesity, which has been identified as an independent predictor of SUI recurrence. Although many surgeons are hesitant to place mesh in patients who may require radiation therapy, neither of the patients in this study who received both mesh and radiation had a mesh-related complication. In this limited sample size, concurrent urogynecology and oncology surgery did not appear to have any adverse effect on long term outcomes for either condition.

Performing concurrent urogynecology and oncology surgery is feasible and safe in a wide variety of conditions. Offering these surgeries in combination to our patients has the potential to decrease both the health care cost and patient burden in an especially vulnerable population.

Serati, Maurizio, Fabio Ghezzi, Elena Cattoni, Andrea Braga, Gabriele Siesto, Marco Torella, Antonella Cromi, Domenico Vitobello and Stefano Salvatore. "Tension-Free Vaginal Tape for the Treatment of Urodynamic Stress Incontinence: Efficacy and Adverse Effects at 10-Year Follow-Up." European Urology 61, no. 5 (2012): 939-946.