Introduction
In the last two decades, the use of minimally-invasive surgery for endometrial cancer has become widespread since the Laparoscopic Approach to Cancer of the Endometrium (LACE) trial and Gynecologic Oncology Group (GOG) LAP2 study established non-inferiority of laparoscopic versus laparotomic surgery for disease-free and overall survival in endometrial cancer.1-3 Robot-assisted laparoscopic (RAL) surgery was introduced in gynaecological surgery in 20054 and may provide more precision, better views, reduced patient morbidity and improved surgeon ergonomics compared to conventional laparoscopy.5-8 These advantages are especially beneficial in obese patients undergoing open or laparoscopic hysterectomy as they are more prone to post-operative morbidity compared to non-obese patients.9 Obesity is the main risk factor for endometrial cancer and since its incidence is rising10, the preferred approach in minimally-invasive surgery has shifted from straight-stick to robotic.
Over the last years an increased number of gynaecological oncology surgical fellowship programs have adopted RAL surgery as part of their training. The introduction of a new surgical technique is accompanied with a learning curve, which has been assessed in conventional laparoscopic and robotic surgery11-14 and underpins the need for training curricula and guidelines.
Urologists were the first to assess the effect of training in robotic surgery on peri-operative outcomes and developed proficiency-based progression (PBP) training curricula for robotic surgery.15 The Society of European Robotic Gynaecological Surgery (SERGS) and British & Irish Association of Robotic Gynaecological Surgeons (BIARGS) followed by providing curricula and guidelines for training in robot-assisted gynaecological surgery.16,17 However, the effect of training on peri-operative and survival outcomes in endometrial cancer patients undergoing RAL surgery has not been assessed.
The Royal Marsden Hospital is a tertiary cancer centre in the United Kingdom (UK) treating high-risk endometrial cancer patients as a part of the Southwest Thames Gynaecological Cancer Centre. It was the first centre in the UK to adopt RAL surgery for gynaecological cancer in 2007 and has been training subspecialty trainees in gynaecological oncology in RAL surgery since 2015 in a PBP training manner.
The objective of this study was to compare peri-operative and survival outcomes for PBP-training versus non-training cases in endometrial cancer patients undergoing RAL surgery.
MethodsThis project has received ethical approval from the ethics committee in our centre (see Details of Ethics Approval Section). There was no public involvement.