Twenty-year surgical trends in a gynecologic oncology fellowship training program: Implications for practice

Objective To assess whether there were any significant changes in surgical training volume over the past 20 years that might have ramifications toward preparedness for practice. Methods We used deidentified annual summaries of fellow case numbers for the academic years 1999 through 2018. Unpaired t-tests with Welch's correction were performed on all surgical categories for 10-year and 5-year periods. Results The total number of hysterectomies performed each year did not change significantly. The percent of hysterectomies performed by minimally invasive surgery increased significantly starting in 2008. There was a significant decline in the number of radical hysterectomies conducted starting after 2004, which then remained stable. There was also a significant decline in the number of bowel resections/anastomoses performed by fellows on the gynecologic oncology services that occurred and stabilized during the same time frame. There were other significant trends associated with the introduction of minimally invasive techniques. Conclusion The results of this study suggest the need to reevaluate fellowship training and/or the scope of surgical practice in gynecologic oncology.