Learning curve analysis of laparoscopic radical hysterectomy and lymph node dissection in early cervical cancer

Objective: We aimed to evaluate the learning curve for laparoscopic radical hysterectomy and lymph node dissection (LRHND) in uterine cervical cancer and to compare the surgicopathologic outcomes of cases treated in the first half of the curve with those treated in the second half of the curve. Study design: The medical records of LRHND patients between August 2004 and April 2011 were reviewed retrospectively. The patients were divided into two groups of the first 35 cases (phase I) and the second 35 cases (phase II). All operations were performed by the same surgeon. Demographic data and surgicopathologic parameters were analyzed. The learning curve was evaluated using the cumulative summation (CUSUM) technique. Results: No difference was found in demographics and histologic type between the two groups. The mean operating time (307.7 +/- 85.8 min) of phase I was significantly longer than phase II (266.3 +/- 58.8 min) (P = 0.021). The number of complications in phase I patients (N = 9) was significantly higher than that (N = 1) of phase II patients (P = 0.013). There were no significant differences between the two groups with respect to lymph node yield and likelihood of identifying positive lymph nodes, resection margins, parametrium, stromal invasion, and lymphovascular space invasion. Disease-free survival did not differ between the two groups (P = 0.142). The learning period for LRHND to reach a turning point was calculated to be 40 cases. Conclusions: An extended learning period can be required for LRHND, during which survival and pathologic outcome of LRHND may not be adversely affected. (C) 2012 Elsevier Ireland Ltd. All rights reserved.