loading page

The influence of learning curve of robot-assisted laparoscopy on oncological outcomes in early stage cervical cancer: an observational cohort study
  • +4
  • Ilse Baeten,
  • Jacob Hoogendam,
  • Henk Schreuder,
  • Ina Jürgenliemk-Schulz,
  • Rene Verheijen,
  • Ronald Zweemer,
  • Kees Gerestein
Ilse Baeten
UMC Utrecht
Author Profile
Jacob Hoogendam
UMC Utrecht
Author Profile
Henk Schreuder
UMC Utrecht
Author Profile
Ina Jürgenliemk-Schulz
UMC Utrecht
Author Profile
Rene Verheijen
UMC Utrecht
Author Profile
Ronald Zweemer
UMC Utrecht
Author Profile
Kees Gerestein
UMC Utrecht
Author Profile

Abstract

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. Funding: None. Keywords: Cervical cancer, robot-assisted laparoscopy, learning curve, RA-CUSUM, recurrence, survival.

Peer review status:ACCEPTED

12 Feb 2020Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
13 Feb 2020Submission Checks Completed
13 Feb 2020Assigned to Editor
13 Feb 2020Reviewer(s) Assigned
06 Apr 2020Review(s) Completed, Editorial Evaluation Pending
04 May 2020Editorial Decision: Revise Minor
22 May 20201st Revision Received
27 May 2020Submission Checks Completed
27 May 2020Assigned to Editor
25 Jun 2020Review(s) Completed, Editorial Evaluation Pending
26 Jun 2020Editorial Decision: Accept