Comparison of the Long-Term Oncological Outcomes Between the Initial Learning Period of Robotic and the Experienced Period of Laparoscopic Radical Hysterectomy for Early-Stage Cervical Cancer

Chong, Gun Oh; Lee, Yoon Hee; Lee, Hyun Jung; Hong, Dae Gy; Lee, Yoon Soon

doi:10.1097/igc.0000000000001172

Cited by 16 publications

(20 citation statements)

References 17 publications

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“…A positive impact on oncological outcome with increased experience has been shown for robotic radical prostatectomy by Galfano et al and was implied by Chong et al, who investigated RRHs during the learning phase compared to conventional laparoscopic radical hysterectomies performed by experienced surgeons. [19,20]. Two recent single-institution studies investigated the impact of learning curve on oncological outcome following RRHs for early stage cervical cancer and found improved survival rates with increased surgical experience, achieving similar levels of adequate experience to our study [14,15].…”

Section: Discussionsupporting

confidence: 71%

Increased Institutional Surgical Experience in Robot-Assisted Radical Hysterectomy for Early Stage Cervical Cancer Reduces Recurrence Rate: Results from a Nationwide Study

Ekdahl

Wallin

Alfonzo

et al. 2020

JCM

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The aim of this study was to evaluate the impact of institutional surgical experience on recurrence following robotic radical hysterectomy (RRH) for early stage cervical cancer. All women in Sweden who underwent an RRH for stage IA2-IB1 cervical cancer at tertiary referral centers from its implementation in December 2005 until June 2017 were identified using a Swedish nationwide register and local hospital registers. Registry data were controlled by a chart review of all women. Recurrence rates and patterns of recurrence were compared between early and late (≤50 vs. >50 procedures) institutional series. Six hundred and thirty-five women were included. Regression analysis identified a lower risk of recurrence with increased experience but without a clear cut off level. Among the 489 women who did not receive adjuvant radio chemotherapy (RC-T), the rate of recurrence was 3.6% in the experienced cohort (>50 procedures) compared to 9.3% in the introductory cohort (p < 0.05). This was also seen in tumors < 2 cm regardless of RC-T (p < 0.05), whereas no difference in recurrence was seen when analyzing all women receiving RC-T. In conclusion, the rate of recurrence following RRH for early stage cervical cancer decreased with increased institutional surgical experience, in tumors < 2 cm and in women who did not receive adjuvant RC-T.

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Section: Discussionsupporting

confidence: 71%

Increased Institutional Surgical Experience in Robot-Assisted Radical Hysterectomy for Early Stage Cervical Cancer Reduces Recurrence Rate: Results from a Nationwide Study

Ekdahl

Wallin

Alfonzo

et al. 2020

JCM

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“…From their data on the different parts of robot‐assisted surgery in endometrial cancer, Seamon et al 34 concluded that hysterectomies – and in particular the closure of the vaginal cuff – had the longest learning curve. Other recent studies suggested an impact of the learning curve on oncological outcomes after robot‐assisted radical hysterectomy in women with cervical cancer 35,36 . Chong et al 36 reported inferior OS after robot‐assisted radical hysterectomy during the learning period compared with conventional laparoscopic radical hysterectomy performed by experienced surgeons, though not significant ( P = 0.07).…”

Section: Discussionmentioning

confidence: 93%

“…Other recent studies suggested an impact of the learning curve on oncological outcomes after robot-assisted radical hysterectomy in women with cervical cancer. 35,36 Chong et al 36 reported inferior OS after robot-assisted radical hysterectomy during the learning period compared with conventional laparoscopic radical hysterectomy performed by experienced surgeons, though not significant (P = 0.07). Given the small study size (n = 65) and the absence of a CUSUM analysis, the exact length of the learning curve could not be defined in that study.…”

Section: Discussionmentioning

confidence: 95%

The influence of learning curve of robot‐assisted laparoscopy on oncological outcomes in early‐stage cervical cancer: an observational cohort study

Baeten

Hoogendam

Schreuder

et al. 2020

BJOG

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Objective To investigate the learning curve of robot-assisted laparoscopy in early-stage cervical cancer and quantify impact on oncological outcomes. Design Observational cohort study. Setting Tertiary referral centre with one surgical team. Population All women with early-stage cervical cancer treated consecutively with robot-assisted laparoscopy between 2007 and 2017. Methods With multivariate risk-adjusted cumulative sum analysis (RA-CUSUM), we assessed the learning curve of robot-assisted laparoscopy of a single surgical team based on cervical cancer recurrence. Subsequently, a survival analysis was conducted comparing oncological outcomes of women treated during different phases of the learning curve. Main outcome measures Surgical proficiency based on recurrence, survival rates in the different learning phases. Results One hundred and sixty-five women with cervical cancer underwent robot-assisted laparoscopy, with a median follow up of 57 months (range 3-132 months). The RA-CUSUM analysis demonstrated two phases of the learning curve: a learning phase of 61 procedures (group 1) and an experienced phase representing the 104 procedures thereafter (group 2). The 5-year disease-free survival was 80.2% in group 1 and 91.1% in group 2 (P = 0.040). Both the 5-year disease-specific survival and overall survival significantly increased after the learning phase. Conclusion The learning phase of robot-assisted laparoscopy in early-stage cervical cancer in this institutional cohort is at least 61 procedures, with higher survival rates in the women treated thereafter. The learning curve of robot-assisted laparoscopy affects oncological outcomes and warrants more attention in the design of future studies.

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“…To date, there is scarce research on learning curve analysis based on actual survival. Chong et al compared the learning period of robotic (consecutive 65 cases) and skilled period of laparoscopic radical hysterectomy for earlystage cervical cancer [25]. However, the number of learning period cases was not determined according to the learning curve but was randomly included in the consecutive 65 cases.…”

Section: Discussionmentioning

confidence: 99%

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

Wen

Nam

et al. 2021

Cancer Res Treat

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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.

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Comparison of the Long-Term Oncological Outcomes Between the Initial Learning Period of Robotic and the Experienced Period of Laparoscopic Radical Hysterectomy for Early-Stage Cervical Cancer

Abstract: Despite RRH being performed by an experienced laparoscopic oncologist, RRH showed inferior long-term oncological outcomes and postoperative complication rates compared with those of LRH during the learning period.

Cited by 16 publications

References 17 publications

Increased Institutional Surgical Experience in Robot-Assisted Radical Hysterectomy for Early Stage Cervical Cancer Reduces Recurrence Rate: Results from a Nationwide Study

Increased Institutional Surgical Experience in Robot-Assisted Radical Hysterectomy for Early Stage Cervical Cancer Reduces Recurrence Rate: Results from a Nationwide Study

The influence of learning curve of robot‐assisted laparoscopy on oncological outcomes in early‐stage cervical cancer: an observational cohort study

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

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