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

Ying, Yang; Huang, Yue; Li, Zhengyu

doi:10.3389/fonc.2021.787198

Cited by 4 publications

(5 citation statements)

References 28 publications

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“…Thus, our findings indicate a positive effect of surgical proficiency in MIS for early-stage cervical cancer. These results are in concordance with those of previously reported studies 15 - 18 , 22 .…”

Section: Discussionsupporting

confidence: 94%

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Is there a relationship between surgical proficiency and oncologic outcome of minimally invasive radical hysterectomy for early-stage cervical cancer?

Ahn¹,

Yun²,

Yun³

et al. 2023

Int. J. Med. Sci.

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Objective: Investigate the relationship between surgical proficiency and oncological outcomes of minimally invasive surgery (MIS) in the treatment of early-stage cervical cancer. Methods: This retrospective study included patients with cervical cancer stage IB1, IB2 who were treated with minimally invasive radical hysterectomy from January 2010 to Dec 2020. Patients were divided into two groups based on the year of surgery: phase 1 (from January 2010 to December 2015) and phase 2 (from January 2016 to December 2020). Oncologic outcomes were compared between the groups. Results: In total, 142 patients were included in the final analysis. 73 and 69 patients underwent surgery in phase 1 (51.4%) and phase 2 (48.6%), respectively. Twelve recurrences (12/142, 8.5%) were observed in the entire cohort: ten (13.7%) in phase 1 and two (2.9%) in phase 2. The recurrence rate was significantly higher in phase 1 (p = 0.021). And the phase 1 group showed significantly shorter disease-free survival than the phase 2 group (p = 0.049). In the multivariate analysis, surgical proficiency, represented by the phase of operation, was the only significant predictor of disease-free survival (HR = 0.244, p = 0.042). Conclusions: Surgical proficiency in MIS is a significant factor associated with the outcomes in early-stage cervical cancer. More favorable outcomes can be obtained after operating on a certain number of MIS cases.

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Section: Discussionsupporting

confidence: 94%

“…Several studies have reported the correlation between surgical proficiency and clinical outcomes 15 - 18 . However, evidence regarding the association of surgical proficiency with survival outcomes in MIS remains insufficient.…”

Section: Introductionmentioning

confidence: 99%

Is there a relationship between surgical proficiency and oncologic outcome of minimally invasive radical hysterectomy for early-stage cervical cancer?

Ahn¹,

Yun²,

Yun³

et al. 2023

Int. J. Med. Sci.

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“…The authors found that when stratified by surgical phases, the OS and DFS of the MIS group in the phase 1 group were significantly lower compared to the other phases and compared to the open surgery group after adjusting for age, BMI, FIGO stage, histologic subtype, and grade. Interestingly, when looking specifically at patients in the phase 1 group, the OS and DFS were in line with those of the LACC trial [61].…”

Section: The Effect Of Surgical Expertise/learning Curvesupporting

confidence: 69%

Minimally Invasive Surgery for Cervical Cancer in Light of the LACC Trial: What Have We Learned?

Touhami

Plante

2022

Current Oncology

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Cervical cancer is the most common gynecologic malignancy and the fourth most common cancer in women worldwide. Over the last two decades, minimally invasive surgery (MIS) emerged as the mainstay in the surgical management of cervical cancer, bringing advantages such as lower operative morbidity and shorter hospital stay compared to open surgery while maintaining comparable oncologic outcomes in numerous retrospective studies. However, in 2018, a prospective phase III randomized controlled trial, “Laparoscopic Approach to Carcinoma of the Cervix (LACC)”, unexpectedly reported that MIS was associated with a statistically significant poorer overall survival and disease-free survival compared to open surgery in patients with early-stage cervical cancer. Various hypotheses have been raised by the authors to try to explain these results, but the LACC trial was not powered to answer those questions. In this study, through an exhaustive literature review, we wish to explore some of the potential causes that may explain the poorer oncologic outcomes associated with MIS, including the type of MIS surgery, the size of the lesion, the impact of CO2 pneumoperitoneum, prior conization, the use of uterine manipulator, the use of protective measures, and the effect of surgical expertise/learning curve.

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“…This factor was not considered in the LACC trial. Moreover, the proficiency of surgeons has also been shown to influence the survival outcomes of MIS (30). The surgeon criterion for LRH in the LACC trial was only 10 cases, which is definitely insufficient.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the survival outcomes of laparoscopic, abdominal and gasless laparoscopic radical hysterectomy for early-stage cervical cancer: trial protocol of a multicenter randomized controlled trial (LAGCC trial)

Tang,

Zhou,

Zhang

et al. 2023

Front. Oncol.

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BackgroundRadical hysterectomy (RH) is considered a cornerstone in the treatment of early-stage cervical cancer. However, the debate surrounding the optimal surgical approach, whether minimally invasive or open surgery, remains controversial. The objective of this trial is to evaluate the survival outcomes of cervical cancer patients who undergo different surgical approaches.MethodsThis study is designed as a prospective, multicenter, open, parallel, and randomized controlled trial. A total of 500 patients diagnosed with stage IA1 with LVSI, IA2, IB1, or IB2 (2018 FIGO) will be recruited. Recruitment of participants started in November 2020. The participants will be randomly assigned to one of three groups: conventional laparoscopic RH, gasless laparoscopic RH, or abdominal RH. The primary endpoint of this trial is the 2-year disease-free survival (DFS) rate. The secondary endpoints will include the 2-year overall survival (OS) rate, 5-year DFS/OS, recurrence rates, operation time, intraoperative blood loss, surgery-related complications, and impact on quality of life (QoL).DiscussionWe expect this trial to provide compelling and high-quality evidence to guide the selection of the most appropriate surgical approach for early-stage cervical cancer.Clinical trial registrationChinese Clinical Trial Register, identifier ChiCTR2000035515.

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

Cited by 4 publications

References 28 publications

Is there a relationship between surgical proficiency and oncologic outcome of minimally invasive radical hysterectomy for early-stage cervical cancer?

Is there a relationship between surgical proficiency and oncologic outcome of minimally invasive radical hysterectomy for early-stage cervical cancer?

Minimally Invasive Surgery for Cervical Cancer in Light of the LACC Trial: What Have We Learned?

Comparison of the survival outcomes of laparoscopic, abdominal and gasless laparoscopic radical hysterectomy for early-stage cervical cancer: trial protocol of a multicenter randomized controlled trial (LAGCC trial)

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