Impact of the Learning Curve on the Survival of Abdominal or Minimally Invasive Radical Hysterectomy for Early-Stage Cervical Cancer

Abstract

The objective of this study was to define the learning curve required to attain satisfactory oncologic outcomes of cervical cancer patients who were undergoing open or minimally invasive surgery for radical hysterectomy, and to analyze the correlation between the learning curve and tumor size. Materials and Methods Cervical cancer patients (stage IA-IIA) who underwent open radical hysterectomy (n=280) or minimal invasive radical hysterectomy (n=282) were retrospectively reviewed. The learning curve was evaluated using cumulative sum of 5-year recurrence rates. Survival outcomes were analyzed based on the operation period ("learning period," P1, vs. "skilled period," P2), operation mode, and tumor size. Results The 5-year disease-free and overall survival rates between open and minimally invasive groups were 91.8% and 89.0% (p=0.098) and 96.1% and 97.2% (p=0.944), respectively. The number of surgeries for learning period was 30 and 60 in open and minimally invasive group, respectively. P2 had better 5-year disease-free survival than P1 after adjusting for risk factors (hazard ratio, 0.392; 95% confidence interval, 0.210 to 0.734, p=0.003). All patients with tumors < 2 cm had similar 5-year disease-free survival regardless of operation mode or learning curve. Minimally invasive group presented lower survival rates than open group when tumors ≥2 cm in P2. Preoperative conization improved disease-free survival in patients with tumors ≥2 cm, especially in minimally invasive group. Conclusion Minimally invasive radical hysterectomy required more cases than open group to achieve CANCER RESEARCH AND TREATMENT (CRT) 3 Korean Cancer Association This article is protected by copyright. All rights reserved. acceptable 5-year disease-free survival. When tumors ≥2 cm, the surgeon's proficiency affected survival outcomes in both groups.

The Surgeon’s Proficiency Affected Survival Outcomes of Minimally Invasive Surgery for Early-Stage Cervical Cancer: A Retrospective Study of 851 Patients

“…Several studies have focused on the correlation between surgeon proficiency and clinical outcomes in recent years. Lan Ying Li et al found that compared to open surgery, more cases were required for surgeons performing minimally invasive RH to reach an acceptable five-year DFS (8). Kim et al demonstrated that surgeons' proficiency in the MIS group significantly affected progression-free survival (PFS) (9).…”

“…Lan Ying Li et al. found that compared to open surgery, more cases were required for surgeons performing minimally invasive RH to reach an acceptable five-year DFS ( 8 ). Kim et al.…”

Assessment of ESGO Quality Indicators in Cervical Cancer Surgery: A Real-World Study in a High-Volume Chinese Hospital

“…Increasing studies showed that high surgical volume of cervical cancer was a favorable prognostic factor for operative outcomes and peri-operative complication rates ( 18 – 21 ). Latest studies stressed that a steady trend of reduction in disease recurrence risk is associated with increased surgeon experience ( 22 , 23 ). The 3-year RFS was significantly lower at the beginning of a surgeon’s learning path compared to the time he had been adequate experience.…”

A meta-analysis of survival after minimally invasive radical hysterectomy versus abdominal radical hysterectomy in cervical cancer: center-associated factors matter

“…MIS revealed superiority of survival outcomes in prostate, colon and rectum cancers and equivalent outcomes in endometrial cancer according to the Gynecologic Oncology Group Study LAP2 trial and the laparoscopic approach to cancer of the endometrium LACE trial [18][19][20]. Researchers proposed several hypothetical factors that might lead to poor performance of MIS in cervical cancer such as uterine manipulator, CO 2 pneumoperitoneum, learning curve, hospital volume, technique of surgeons and tumor size in patients [21,22]. Therefore, we aim to evaluate the oncological safety of MIS in cervical cancer patients stratified by characteristics of disease (FIGO stage and tumor size), publication (publication time and journal), study design (singlecenter or multi-center) and treatment center (average sample size per center) and to identify possible factors that led to the controversies of MIS among previous studies.…”