The Effect of Laparoscopic Radical Hysterectomy Surgical Volume on
Oncology Outcomes in Early-Stage Cervical Cancer
Abstract
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.