Combined Urogynecology and Gynecologic Oncology Surgery Complications

Concomitant urogynecology and gynecologic oncology procedures have demonstrated feasibility with low short-term morbidity; however, complications beyond 30 days remain poorly defined.

The objective of this study was to compare 90-day complications between combined and gynecologic oncology surgery alone.

A retrospective 1:1 matched cohort study was conducted from January 2010 to April 2024 at a tertiary academic center. Combined cases were matched by surgery type, age (nearest decade), and final pathology. The primary outcome was postoperative complications within 90 days. Complications were analyzed by timing (0-90 d; 30-90 d) and graded using the Clavien-Dindo classification. Categorical variables were compared using χ² or Fisher exact tests and continuous variables using Mann-Whitney U tests (P<0.05).

A total of 122 participants were included and matched (61 combined; 61 gynecologic oncology only). Baseline characteristics were similar. Estimated blood loss was higher in combined procedures (181.2±17.0 mL vs 123.1±14.0 mL, P<0.001). Median length of stay was similar between groups (1.0 d; P=0.18). The majority of malignancies in the combined urogynecology and gynecologic oncology surgery group were endometrial cancer. Time from oncology consultation to surgery was longer for combined cases (32 vs 17 d, P<0.001). Ninety-day complication rates were higher in the combined group (84% vs 41%; P<0.001), attributed primarily to urinary tract infections in the first 30 days. However, 30- to 90-day complications were low; comparable (15% vs 13%, P=0.80), with no difference in severity.

Combined surgery increased transient urinary complications without prolonging hospitalization, supporting the safety of a multidisciplinary approach in patients with early-stage endometrial cancer.