3.8 Article

Impact of surgeon learning curve in minimally invasive radical hysterectomy on early stage cervical cancer patient survival

Journal

FACTS VIEWS AND VISION IN OBGYN
Volume 13, Issue 3, Pages 233-244

Publisher

UNIVERSA PRESS
DOI: 10.52054/FVVO.13.3.035

Keywords

cervical cancer; minimally invasive; radical hysterectomy; experience; learning curve; laparoscopy

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Surgeon experience significantly influences the oncological outcomes of early-stage cervical cancer patients undergoing MI-RH. The study demonstrates a clear association between increased surgeon experience and a reduced risk of disease recurrence, ultimately leading to higher disease-free survival rates for patients.
Background: Recently, it has been sustained that only surgeons skilled in minimally invasive radical hysterectomy (MI-RH) could provide valuable oncological outcomes in early-stage cervical cancer. Still, literature lacks data correlating surgeon experience with patient survival rate. We aimed to investigate the impact of surgeon training on this rate. Methods: This is a retrospective study of 243 early-stage cervical cancer treated with MI-RH. Multiple regression analyses were undertaken to investigate the impact of the surgeons learning curve, according to the number of MI-RH, on patients prognosis. Results: A steady trend of reduction in disease recurrence risk is associated with increased surgeon experience. The peak of the learning curve was shown at the 19th MI-RH (hazard ratio of disease-free survival: 0.321; 95%CI: 0.140-0.737; p= 0.007). The 3 years disease-free survival that a surgeon could provide to patients is significantly lower at the beginning of his/her learning path comparing to what he/she could guarantee once adequate experience had been achieved (75.4% and 91.6% respectively, p=0.005). Surgeon experience appears to be an independent prognostic factor. Conclusion: The experience that a surgeon can achieve practicing in MI-RH significantly influences oncological outcomes of early-stage cervical cancer patients. Future studies comparing minimally invasive and open surgery should take this into account. It would be advisable that the scientific community precisely establishes the minimum training required in the field of MI-RH for early-stage cervical cancer.

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