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.

Abstract Objectives: To examine changes in surgeon volume over time and evaluate the influence of surgeon volume on complications of abdominal radical hysterectomy (ARH) and laparoscopic radical hysterectomy (LRH) for cervical cancer. Design: A retrospective cohort study. Setting: 42 hospitals in China. Population: 14536 patients undergoing ARH and 8148 patients underwent LRH. Methods: The influence of the surgeon volume of ARH and LRH on surgical complications was examined using multivariable logistic regression models. Main outcome measures: Intraoperative complications and postoperative complications. Results: In the ARH cohort, the mean surgeon case volume increased from 3.5 cases in 2004 to 8.7 cases in 2013 and then decreased to 4.9 cases in 2016. The number of surgeons performing LRH increased from 1 surgeon with 1 patient (mean cases=1) in 2004 to 183 surgeons who operated on 2,206 patients in 2016 (mean cases=12.1) (P< 0.01). In the ARH, patients treated by intermediate-volume surgeons had more postoperative complications (OR=1.55, 95% CI=1.11-2.15). In the laparoscopic surgery cohort, surgeon volume had no independent effect on intraoperative or postoperative complications (P=0.46; P=0.13). Conclusions: The performance of ARH by intermediate-volume surgeons is associated with an increased risk of postoperative complications. However, surgeon volume may have little effect on intraoperative or postoperative complications after LRH.

Comprehensive management strategy for cervical cancer screening, cervical lesion diagnosis, and treatment of cervical lesions during the COVID-19 pandemic: Chinese expert consensus