尽管在早期子宫癌的手术治疗中，微创手术和前哨淋巴结活检的比率随着时间的推移而大幅增加，但美国的实践差异很大，并且低容量中心和黑人种族患者之间存在差异。美国有相当多的县没有妇科肿瘤科医生，并且妇科癌症发病率最高的县中几乎一半缺乏当地妇科肿瘤科医生。本研究旨在评估妇科肿瘤科医生的出行距离和接近程度与妇科肿瘤科医生的关系。接受非转移性子宫癌子宫切除术的患者接受手术治疗的质量存在种族差异。肯塔基州、马里兰州、佛罗里达州和北卡罗来纳州接受非转移性子宫癌子宫切除术的患者在 2012 年至 2018 年州住院患者中被确定。数据库和国家门诊手术服务数据库文件。县到县的距离被用作前往最近的妇科肿瘤科医生的距离。使用多变量逻辑回归模型分析与接受微创手术和淋巴结清扫术相关的因素，以及对手术旅行和患者种族之间相互作用的评估。在 21,837 例病例中，45.5% 居住在没有妇科肿瘤科医生的县;总体而言，55.5% 的人前往另一个县进行手术，其中 88% 的人缺乏当地妇科肿瘤科医生。那些无法在所在县找到当地妇科肿瘤科医生且没有前往进行手术的患者更有可能接受开放手术且不接受淋巴结清扫术，而那些在周边县无法接触到妇科肿瘤科医生的患者受到的影响更大。在没有妇科肿瘤科医生的县的患者中，与非旅行者相比，那些前往手术的患者接受微创手术的可能性相似（71%），但接受淋巴结清扫的可能性更大（64.7% vs 57.2%）。在没有妇科肿瘤科医生的县中，旅行距离较长与接受淋巴结评估有关。与非黑人患者相比，黑人患者接受微创手术的可能性较小（57.0% vs 74.1%）。在控制肌瘤诊断的调整回归模型中，黑人种族是接受开放手术的独立危险因素。黑人种族和旅行进行手术之间存在显着的相互作用，居住在没有妇科肿瘤医生且不旅行的县的黑人患者接受微创手术的可能性逐渐降低（与非黑人患者相比，优势比为 0.57）因手术而旅行的人；交互作用项为 0.60；两者的 P<.001）。对于居住在有妇科肿瘤科医生出县接受手术的县的黑人患者来说，手术质量也存在类似的种族差异。患者，特别是黑人患者，如果在当地无法获得妇科肿瘤科医生的专科护理，则可以从前往专科就诊中受益中心，以确保非转移性子宫癌获得高质量的手术。需要开展进一步的工作，确保通过患者旅行或专家外展，公平、普遍地获得高质量护理。版权所有 © 2024 Elsevier Inc. 保留所有权利。

Although the rates of minimally invasive surgery and sentinel lymph node biopsy have increased considerably over time in the surgical management of early-stage uterine cancer, practice varies significantly in the United States, and there are disparities among low-volume centers and patients of Black race. A significant number of counties in the United States are without a gynecologic oncologist, and almost half of the counties with the highest gynecologic cancer rates lack a local gynecologic oncologist.This study aimed to evaluate the relationships of distance traveled and proximity to gynecologic oncologists with the receipt of and racial disparities in the quality of surgical care among patients who underwent a hysterectomy for nonmetastatic uterine cancer.Patients who underwent a hysterectomy for nonmetastatic uterine cancer in Kentucky, Maryland, Florida, and North Carolina were identified in the 2012 to 2018 State Inpatient Database and the State Ambulatory Surgery Services Database files. County-to-county distances were used as the distances traveled to the nearest gynecologic oncologist. Factors associated with the receipt of minimally invasive surgery and lymph node dissection were analyzed using multivariable logistic regression models, as was the assessment of the interaction between travel for surgery and patient race.Among 21,837 cases, 45.5% lived in a county without a gynecologic oncologist; overall, 55.5% traveled to another county for surgery, including 88% of those who lacked a local gynecologic oncologist. Patients who lacked access to a local gynecologic oncologist in their county who did not travel for surgery were more likely to receive open surgery and no lymph node dissection, and those in counties without access in any surrounding county were affected even more. Among patients in counties without a gynecologic oncologist, those who traveled for surgery had a similar likelihood of undergoing minimally invasive surgery (71%) but had a greater likelihood of undergoing lymph node dissection (64.7% vs 57.2%) than nontravelers. Among those in counties without a gynecologic oncologist, a longer distance traveled was associated with receipt of a lymph node assessment. When compared with non-Black patients, Black patients were less likely to undergo minimally invasive surgery (57.0% vs 74.1%). In adjusted regression models that controlled for a diagnosis of fibroids, Black race was an independent risk factor for the receipt of open surgery. There was a significant interaction between Black race and travel for surgery, and Black patients who lived in counties without a gynecologic oncologist who did not travel faced an incrementally lower likelihood of receiving minimally invasive surgery (odds ratio, 0.57 when compared with non-Black patients who traveled for surgery; odds ratio, 0.60 as interaction term; P<.001 for both). Similar disparities in surgical quality by race were noted for Black patients who lived in counties with a gynecologic oncologist who traveled out of county for surgery.Patients, particularly those of Black race, who lacked local access to gynecologic oncologist specialty care benefitted from traveling to specialty centers to ensure access to high-quality surgery for nonmetastatic uterine cancer. Further work is needed to ensure equitable and universal access to high-quality care through patient travel or specialist outreach.Copyright © 2024 Elsevier Inc. All rights reserved.