Same day discharge (SDD) after surgery for gynecologic cancer patients in Germany?

aimAmbulatory surgery is well established outside Europe for women diagnosed with gynecologic cancer. Increasing pressure on hospital staff, the rise of multi-resistant nosocomial infections, and the risk of future pandemics support the concept of same day discharge (SDD). Why is this option not offered to patients in Germany? Can a deficit in surgical or anesthesiological expertise explain this phenomenon? PATIENTS AND

methodsIn a prospective case-series, 83 consecutive cancer patients underwent outpatient surgery at Eviamed Oncology Center between April 2024 and December 2025. We hypothesized that complication rates would be at least equal to those observed in our hospital-based experience. Most patients were diagnosed with cervical cancer (n = 41), followed by vulvar cancer (n = 27), corpus uteri (n = 8), vaginal cancer (n = 5), and borderline of the ovary (n = 1). Major surgery was performed laparoscopically in 35 patients by lymphadenectomy (LNE) alone or vaginal-assisted simple (LAVH) or radical hysterectomy (VALRH) and in 15 patients by inguinal LNE combined with vulvectomy. Pre- and postoperative findings were presented and discussed in an interdisciplinary tumor board. Postoperatively, all patients were contacted by telephone and underwent clinical follow-up with the responsible surgeon. Adequate family support was insured for at least five postoperative days.

resultsIn the laparoscopy group, mean age was 49 years (range 24–87) and mean BMI was 27.3 (range 18.8–43.8). Mean operative time was 147 min (range 70–288), anaesthesia duration 183 min (range 90–338), and postoperative observation time 151 min (range 83–260). Patients diagnosed with vulva cancer were, on average, 18 years older, with similar BMI but up to 40% shorter procedure times. There were no intraoperative complications, no conversion to laparotomy, no blood transfusion, and no hospital admission within 30 days post surgery which was identical to our experience with hospital-based treatment. Postoperative complications included one ureteral leak, three symptomatic lymphoceles, and one urinary tract infection in the laparoscopy group, and one symptomatic lymphocele in the vulva group. A cost-utility analysis based on the current German reimbursement system revealed a substantial financial deficit as calculated for LAVH & LNE.

conclusionThe limited implementation of same-day discharge for gynecologic cancer surgery in Germany is not due to deficiencies in surgical or anesthesiological expertise, but rather to inadequate reimbursement structures within the healthcare system.