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

I G T Baeten, J P Hoogendam, H W R Schreuder, I M Jürgenliemk-Schulz, R H M Verheijen, R P Zweemer, C G Gerestein
BJOG: An International Journal of Obstetrics and Gynaecology 2020 July 6

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 early stage cervical cancer patients 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 patients treated during different phases of the learning curve.

MAIN OUTCOME MEASURES: Surgical proficiency based on recurrence, survival rates in the different learning phases.

RESULTS: 165 cervical cancers patients were operated by 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 patients 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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