Dataset Information

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

ABSTRACT:

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 women with early-stage cervical cancer 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 women treated during different phases of the learning curve.

Main outcome measures

Surgical proficiency based on recurrence, survival rates in the different learning phases.

Results

One hundred and sixty-five women with cervical cancer underwent 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 women treated thereafter. The learning curve of robot-assisted laparoscopy affects oncological outcomes and warrants more attention in the design of future studies.

Tweetable abstract

The learning curve of robot-assisted laparoscopy in early-stage cervical cancer affects oncological outcomes and warrants more attention.

SUBMITTER: Baeten I

PROVIDER: S-EPMC7818258 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Publications

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

Baeten Igt I Hoogendam J P JP Schreuder Hwr H Jürgenliemk-Schulz I M IM Verheijen Rhm R Zweemer R P RP Gerestein C G CG

BJOG : an international journal of obstetrics and gynaecology 20200728 3

<h4>Objective</h4>To investigate the learning curve of robot-assisted laparoscopy in early-stage cervical cancer and quantify impact on oncological outcomes.<h4>Design</h4>Observational cohort study.<h4>Setting</h4>Tertiary referral centre with one surgical team.<h4>Population</h4>All women with early-stage cervical cancer treated consecutively with robot-assisted laparoscopy between 2007 and 2017.<h4>Methods</h4>With multivariate risk-adjusted cumulative sum analysis (RA-CUSUM), we assessed the ...[more]

PMID: 32627934

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Project description:Importance:Robot-assisted pancreaticoduodenectomy (RPD) has been reported to be safe and feasible. As a new technique, RPD has a learning curve similar to that of other types of minimally invasive pancreatic surgery such as laparoscopic pancreaticoduodenectomy. To our knowledge, no reports exist on the outcomes of open pancreaticoduodenectomy (OPD) and RPD after the learning curve. Objective:To analyze and evaluate the actual advantages of RPD. Design, Setting, and Participants:Between May 2010 and December 2018, 450 patients underwent RPD in the Shanghai Ruijin Hospital affiliated with Shanghai Jiaotong University in Shanghai, China, a high-volume pancreatic disease center. According to our previous study, an important flexion point in the learning curve is 250 cases. Data on the last 200 RPD cases were collected from January 2017 to December 2018. During that period, 634 patients underwent OPD. These patients were divided into 2 groups, and propensity score matching was used to minimize bias. The demographic data and operative outcomes were collected and analyzed. Analysis began May 2019. Exposures:Robot-assisted pancreaticoduodenectomy and OPD. Main Outcomes and Measures:The short-term operative outcomes of RPD and OPD. Results:After 1:1 matching, 187 cases of RPD and OPD were recorded. In the RPD group, 78 patients (41.7%) were women, and the mean (SD) age was 60.9?(11.4) years. In the OPD group, 80 patients (42.8%) were women, and the mean (SD) age was 60.1?(10.8) years. Robot-assisted pancreaticoduodenectomy had advantages in operative time (mean [SD], 279.7?[76.3] minutes vs 298.2?[78.3] minutes; P?=?.02), estimated blood loss (mean [SD], 297.3?[246.8] mL vs 415.2?[497.9] mL; P?=?.002), and postoperative length of hospital stay (mean [SD], 22.4?[16.7] days vs 26.1?[16.3] days; P?=?.03). However, there was no significant difference in the R0 resection rate and incidence rate of postoperative complications, such as postoperative pancreatic fistula, bile leak, and delayed gastric emptying. The incidence rates of postoperative bleeding and reoperation in the RPD group were similar to those in the OPD group, with no statistically significant difference. Conclusions and Relevance:After passing the learning curve, RPD had advantages in operative time and blood loss compared with OPD. There were no differences in postoperative complications such as postoperative pancreatic fistula, bile leak, and delayed gastric emptying. However, patients recovered more quickly after RPD than after OPD. A prospective randomized clinical trial is needed in the future to verify these results.

Project description:Laparoscopy-assisted distal gastrectomy (LADG) is widely used for gastric cancer (GC) patients nowadays. This study aimed to investigate the time trend of outcomes so as to describe the learning curve for GC patients with LADG at a single medical institution in western China over a 6-year period.A total of 246 consecutive GC patients with LADG were divided into 5 groups (group A: 46 patients from 2006 to 2007; group B: 47 patients in 2008; group C: 49 patients in 2009; group D: 73 patients in 2010; and group E: 31 patients in 2011). All surgeries were conducted by the same surgeon. Comparative analyses were successively performed by Mann-Whitney U test or Student t test among the 5 different groups for the clinical data, including clinicopathologic characteristics, surgical parameters, postoperative course, and survival outcomes, through which the learning curve was described.There were no differences in the baseline information among the 5 groups (P?>?0.05), and the proportion of advanced GC patients with LADG slightly increased from 58.7% to 77.4% during the 6 years. Besides, the proportion of D2/D2+ lymphadenectomy and the number of retrieved lymph nodes gradually grew from 60.9% to 80.6% and from 20.0 to 28.8, respectively. In addition, the operation time decreased from 299.2 to 267.8 minutes, while the estimated blood loss dropped from 175.2 to 146.8?mL. Furthermore, some surgical parameters (surgical duration and blood loss) and postoperative course (such as postoperative complications, the time to ambulation, to first flatus, and to first liquid intake as well as the length of hospital stay) were all observed to be significantly different between group A and other groups (P?<?0.05), illustrating a similar downward trend and remaining stable to form a plateau after 46 cases in group A. However, no difference on overall survival was found among these 5 groups, and multivariate analysis indicated that factors, such as age, tumor differentiation, tumor size, and T stage as well as N stage, were independent prognostic factors for patients with LADG.Improvement on surgical parameters and postoperative course can be seen over the past years, and the cutoff value of the learning curve of LADG for surgeons with rich experience in open operation might be 46 cases.

Dataset Information

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

Objective

Design

Setting

Population

Methods

Main outcome measures

Results

Conclusion

Tweetable abstract

Publications

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

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