Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
Department of Obstetrics and Gynecology, Yanbian University Hospital, Yanji, China.
Cancer Res Treat. 2021 Jan;53(1):243-251. doi: 10.4143/crt.2020.063. Epub 2020 Oct 12.
The objective of this study was to define the learning curve required to attain satisfactory oncologic outcomes of cervical cancer patients who were undergoing open or minimally invasive surgery for radical hysterectomy, and to analyze the correlation between the learning curve and tumor size.
Cervical cancer patients (stage IA-IIA) who underwent open radical hysterectomy (n=280) or minimal invasive radical hysterectomy (n=282) were retrospectively reviewed. The learning curve was evaluated using cumulative sum of 5-year recurrence rates. Survival outcomes were analyzed based on the operation period ("learning period," P1 vs. "skilled period," P2), operation mode, and tumor size.
The 5-year disease-free and overall survival rates between open and minimally invasive groups were 91.8% and 89.0% (p=0.098) and 96.1% and 97.2% (p=0.944), respectively. The number of surgeries for learning period was 30 and 60 in open and minimally invasive group, respectively. P2 had better 5-year disease-free survival than P1 after adjusting for risk factors (hazard ratio, 0.392; 95% confidence interval, 0.210 to 0.734; p=0.003). All patients with tumors < 2 cm had similar 5-year disease-free survival regardless of operation mode or learning curve. Minimally invasive group presented lower survival rates than open group when tumors ≥ 2 cm in P2. Preoperative conization improved disease-free survival in patients with tumors ≥ 2 cm, especially in minimally invasive group.
Minimally invasive radical hysterectomy required more cases than open group to achieve acceptable 5-year disease-free survival. When tumors ≥ 2 cm, the surgeon's proficiency affected survival outcomes in both groups.
本研究旨在确定接受开腹或微创根治性子宫切除术的宫颈癌患者达到满意肿瘤学结果所需的学习曲线，并分析学习曲线与肿瘤大小之间的相关性。
回顾性分析接受开腹根治性子宫切除术（n=280）或微创根治性子宫切除术（n=282）的宫颈癌患者（IA-IIA 期）。使用 5 年复发率的累积和评估学习曲线。基于手术期（“学习期”P1 与“熟练期”P2）、手术方式和肿瘤大小分析生存结果。
开腹组和微创组的 5 年无病生存率和总生存率分别为 91.8%和 89.0%（p=0.098）和 96.1%和 97.2%（p=0.944）。开腹组和微创组的学习期手术数量分别为 30 例和 60 例。调整危险因素后，P2 的 5 年无病生存率优于 P1（风险比，0.392；95%置信区间，0.210 至 0.734；p=0.003）。所有肿瘤<2cm 的患者无论手术方式或学习曲线如何，其 5 年无病生存率均相似。在 P2 中，肿瘤≥2cm 时，微创组的生存率低于开腹组。对于肿瘤≥2cm 的患者，术前锥切术可提高无病生存率，尤其是微创组。
微创根治性子宫切除术需要比开腹组更多的病例才能达到可接受的 5 年无病生存率。当肿瘤≥2cm 时，手术医生的熟练程度会影响两组患者的生存结果。
