Introduction
Radical hysterectomy (RH) is one of the traditional treatments for
early-stage cervical cancer. The laparoscopic technique was first used
for RH in 1992, and minimally invasive surgery has become a common
surgical approach that has advantages of less intraoperative blood loss
and complications and shorter hospital stay when compared with
traditional open surgery1-5. However, the Laparoscopic
Approach to Cervical Cancer (LACC) trial, a high-quality international
multicenter randomized controlled trial, reported that LRH was closely
related to worse oncology outcomes, though without explaining the
reasons. In general, surgeons’ surgical volume may be one of the reasons
influencing oncology outcomes. For example, for other malignant tumors,
it is considered that a greater surgery volume is an important factor
related to better oncological outcomes6. Meta-analysis
to investigate the relationship between the number of gynecology
surgeries and surgical outcomes has been conducted, and it is believed
that intraoperative and postoperative complications are significantly
reduced with high-volume surgeons7.
Nonetheless, previous studies have focused on the relationship between
surgical skills and perioperative period outcomes and surgical volume,
whereas long-term oncological outcomes have seldom been
discussed8-11. Moreover, previous studies mostly
involve single centers and surgeons, with few cases included. Therefore,
this multicenter, retrospective cohort database study based on the large
clinical diagnosis and treatment database of cervical cancer in China
was carried out. The aims were to explore the association between the
LRH volume of surgeons and long-term oncological outcomes of early
cervical cancer to discuss whether the volume of LRH by gynecologists
will affect survival outcomes of early cervical cancer patients.