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.