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