Decline in radical hysterectomies for early cervical cancer may affect gynecologic oncology training

Objective: To evaluate the 12-year trend in the number of radical hysterectomies performed for cervical cancer in the US, and the potential impact of this trend on gynecologic oncology fellow surgical training. Methods: We queried the SEER database 13 registries to determine the number of radical hysterectomies performed each year in women with stage IA2 to IIA cervical cancer from 1998 to 2010, and extrapolated this number to the US in its entirety. Based on the number of gynecologic oncology fellows in clinical training each year, we calculated the number of radical hysterectomies available per fellow, if all operations were performed with a fellow. Least squares linear regression was applied to the data to describe trends. Results: In 1998, 3,550 radical hysterectomies were performed and there were 72 clinical fellows, resulting in an estimated 49 radical hysterectomies available per fellow. Through 2010, the number of radical hysterectomies decreased by 98 per year (R2=0.80) and the average number of fellows increased by three per year. Thus, between 1998 and 2010 the number of radical hysterectomies available per fellow decreased by 2.2 cases per year, with only 20 radical hysterectomies estimated to be available per fellow in 2010 (R2=0.94). Conclusion: The declining frequency of radical hysterectomy and the rising number of gynecologic oncology fellows calls for new strategies to improve fellow exposure to radical hysterectomy and consideration of alternative surgical training modalities, such as surgical simulators.