Objective: To analyze the effect of surgical experience with laparoscopic radical hysterectomy (LRH) on oncological outcome in cervical cancer patients. Methods: We retrospectively compared the oncological outcomes of 1469 patients with stage IB1 cervical cancer receiving LRH from 2004 to 2016. The surgical volume for each surgeon was defined as low (fewer than 50 surgeries), mid (51-100 surgeries), and high (100 surgeries or more). Kaplan-Meier curves and the Cox proportional hazards model were used to estimate the effect of surgical experience on the oncological outcomes of patients. Results:A total of 1405 cases were included in this study. The average operative times of the low-volume (n = 427), mid-volume (n = 396) and high-volume (n=582) groups were 270, 260 and 227 minutes, respectively (P < 0·001), and mean blood loss was 218 ml, 197 ml and 179 ml, respectively (P = 0·004). The 5-year OS of the low-volume, mid-volume and high-volume groups was 96·1%, 93·1% and 92·5%, with 5-year DFS rates of 92·0%, 87·5% and 87·6%, respectively. There was no significant difference among the three groups. However, surgery volume was not an independent risk factor for shorter OS or DFS after controlling for case mix, nor was surgeons’ experience after 1:1 PSM (Propensity score matching) between each two of the three groups. Conclusion: The results showed that surgeons’ surgical volume did not affect the oncological outcome of LRH but that operative time and blood loss were significantly improved with a higher surgical volume.

Objective: Compare the outcomes associated with laparoscopic radical hysterectomy (LRH) and abdominal radical hysterectomy (ARH) for cervical cancer. Design: Retrospective, multicenter observational analysis Setting: Select patients of LRH and ARH from cervical cancer database and compare their outcomes. Population: Patients with stage IA1 (Lymphovascular space invasion [LVSI]-positive) and stage IIA2 cervical cancer (N=6804) were enrolled, of whom 3003 underwent laparoscopy (LRH group), and 3801 underwent laparotomy (ARH group). Methods: Kaplan-Meier survival analysis,propensity score matching (PSM) and Cox regression. Main Outcome Measures: Five-year overall survival (OS) and 5-year disease-free survival (DFS) Results: Before PSM, there was no difference in outcomes between the groups (5-year OS: LRH 89.2% vs. ARH 90.6%, P=0.903.; 5-year DFS: LRH 84.5% vs. ARH 87.1%, P=0.155). Surgical approach did not affect 5-year OS; however, it did affect 5-year DFS (hazard ratio [HR]=0.827, 95% confidence interval [CI]: 0.711-0.962, P=0.014). After PSM, there was no difference in 5-year OS between the LRH (N=1828) and ARH (N=1828) groups (91.0% vs. 93.1%, P=0.220); but there was a significant difference in 5-year DFS between the LRG and ARH groups (86.2% vs. 90.6%, P=0.002). Cox regression revealed that the surgical approach did not affect 5-year OS; however, it did affect 5-year DFS (HR=0.701, 95% CI: 0.563-0.874, P=0.002). Conclusions: For IA1 (LVSI-positive) and IIA1 cervical cancers, the recurrence rate following laparoscopic surgery was higher than that following open surgery, regardless of the surgeon’s experience.