TY - JOUR
T1 - Learning curve could affect oncologic outcome of minimally invasive radical hysterectomy for cervical cancer
AU - Kim, Seongmin
AU - Min, Kyung Jin
AU - Lee, Sanghoon
AU - Hong, Jin Hwa
AU - Song, Jae Yun
AU - Lee, Jae Kwan
AU - Lee, Nak Woo
N1 - Funding Information:
This study was funded by the Korea University Grant ( Q1816041 ). We would like to thank Editage ( www.editage.co.kr ) for English language editing.
PY - 2021/1
Y1 - 2021/1
N2 - Background/Objective: Recent prospective studies have shown poorer oncologic outcomes following minimally invasive surgery, which has led many surgeons to deeply inspect their practices. We reviewed our experience and evaluated the results of radical hysterectomy in patients with early stage cervical cancer. Methods: This retrospective study included patients with early stage cervical cancer (Ia1 - IIa1) who were treated with radical hysterectomy from May 2006 to Dec 2016. Patients were divided into three groups according to the surgical approach: radical abdominal hysterectomy (RAH), laparoscopic radical hysterectomy (LRH), and robot-assisted radical hysterectomy (RRH). Results: Learning curves of each type of surgery were obtained using the cumulative sum method. Survival rates were compared using Kaplan–Meier curves. To analyze the learning curve of a single surgeon, 89 patients were selected from the whole population. Learning curves of each group showed two distinct phases. The minimum number of cases required to achieve surgical improvement were 16 in RAH, 13 in LRH, and 21 in RRH. Progression-free survival (PFS) and overall survival did not vary between RAH and minimally invasive surgery (MIS) (p = .828 and p = .757, respectively). However, when stratified by the phases of the learning curves, patients included in the early phase of MIS showed a poorer PFS (p = .014). Conclusions: Surgical proficiency could significantly affect the oncologic outcome in MIS. A prospective study regarding sufficient surgical competence is necessary for elaborate analysis of the feasibility of minimally invasive radical hysterectomy.
AB - Background/Objective: Recent prospective studies have shown poorer oncologic outcomes following minimally invasive surgery, which has led many surgeons to deeply inspect their practices. We reviewed our experience and evaluated the results of radical hysterectomy in patients with early stage cervical cancer. Methods: This retrospective study included patients with early stage cervical cancer (Ia1 - IIa1) who were treated with radical hysterectomy from May 2006 to Dec 2016. Patients were divided into three groups according to the surgical approach: radical abdominal hysterectomy (RAH), laparoscopic radical hysterectomy (LRH), and robot-assisted radical hysterectomy (RRH). Results: Learning curves of each type of surgery were obtained using the cumulative sum method. Survival rates were compared using Kaplan–Meier curves. To analyze the learning curve of a single surgeon, 89 patients were selected from the whole population. Learning curves of each group showed two distinct phases. The minimum number of cases required to achieve surgical improvement were 16 in RAH, 13 in LRH, and 21 in RRH. Progression-free survival (PFS) and overall survival did not vary between RAH and minimally invasive surgery (MIS) (p = .828 and p = .757, respectively). However, when stratified by the phases of the learning curves, patients included in the early phase of MIS showed a poorer PFS (p = .014). Conclusions: Surgical proficiency could significantly affect the oncologic outcome in MIS. A prospective study regarding sufficient surgical competence is necessary for elaborate analysis of the feasibility of minimally invasive radical hysterectomy.
KW - Cervical cancer
KW - Minimally invasive surgery
KW - Oncologic outcome
KW - Radical hysterectomy
UR - http://www.scopus.com/inward/record.url?scp=85085301217&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85085301217&partnerID=8YFLogxK
U2 - 10.1016/j.asjsur.2020.05.006
DO - 10.1016/j.asjsur.2020.05.006
M3 - Article
AN - SCOPUS:85085301217
VL - 44
SP - 174
EP - 180
JO - Asian Journal of Surgery
JF - Asian Journal of Surgery
SN - 1015-9584
IS - 1
ER -