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

Igt Baeten; J P Hoogendam; Hwr Schreuder; I M Jürgenliemk-Schulz; Rhm Verheijen; R P Zweemer; C G Gerestein

doi:10.1111/1471-0528.16399

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

Igt Baeten, J P Hoogendam, Hwr Schreuder, I M Jürgenliemk-Schulz, Rhm Verheijen, R P Zweemer, C G Gerestein

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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.

Original language	English
Pages (from-to)	563-571
Number of pages	9
Journal	BJOG - An International Journal of Obstetrics and Gynaecology
Volume	128
Issue number	3
Early online date	6 Jul 2020
DOIs	https://doi.org/10.1111/1471-0528.16399
Publication status	Published - Feb 2021

Keywords

Cervical cancer
learning curve
recurrence
risk-adjusted cumulative sum analysis
robot-assisted laparoscopy
survival

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Baeten, I., Hoogendam, J. P., Schreuder, H., Jürgenliemk-Schulz, I. M., Verheijen, R., Zweemer, R. P., & Gerestein, C. G. (2021). The influence of learning curve of robot-assisted laparoscopy on oncological outcomes in early-stage cervical cancer: an observational cohort study. BJOG - An International Journal of Obstetrics and Gynaecology, 128(3), 563-571. https://doi.org/10.1111/1471-0528.16399

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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.",

keywords = "Cervical cancer, learning curve, recurrence, risk-adjusted cumulative sum analysis, robot-assisted laparoscopy, survival",

author = "Igt Baeten and Hoogendam, {J P} and Hwr Schreuder and J{\"u}rgenliemk-Schulz, {I M} and Rhm Verheijen and Zweemer, {R P} and Gerestein, {C G}",

note = "Funding Information: RPZ is a proctor for robot‐assisted surgery in gynaecological oncology on behalf of Intuitive Surgical. RHMV reports grants and non‐financial support from Medtronic and grants from Intuitive Surgical Inc., all outside the submitted work. All other authors declare they have no conflicts of interests related to the presented research. Completed disclosure of interests forms are available to view online as supporting information. Publisher Copyright: {\textcopyright} 2020 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = feb,

doi = "10.1111/1471-0528.16399",

language = "English",

volume = "128",

pages = "563--571",

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Baeten, I, Hoogendam, JP, Schreuder, H, Jürgenliemk-Schulz, IM, Verheijen, R, Zweemer, RP & Gerestein, CG 2021, 'The influence of learning curve of robot-assisted laparoscopy on oncological outcomes in early-stage cervical cancer: an observational cohort study', BJOG - An International Journal of Obstetrics and Gynaecology, vol. 128, no. 3, pp. 563-571. https://doi.org/10.1111/1471-0528.16399

The influence of learning curve of robot-assisted laparoscopy on oncological outcomes in early-stage cervical cancer: an observational cohort study. / Baeten, Igt; Hoogendam, J P; Schreuder, Hwr et al.
In: BJOG - An International Journal of Obstetrics and Gynaecology, Vol. 128, No. 3, 02.2021, p. 563-571.

Research output: Contribution to journal › Article › Academic › peer-review

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T1 - The influence of learning curve of robot-assisted laparoscopy on oncological outcomes in early-stage cervical cancer

T2 - an observational cohort study

AU - Baeten, Igt

AU - Hoogendam, J P

AU - Schreuder, Hwr

AU - Jürgenliemk-Schulz, I M

AU - Verheijen, Rhm

AU - Zweemer, R P

AU - Gerestein, C G

N1 - Funding Information: RPZ is a proctor for robot‐assisted surgery in gynaecological oncology on behalf of Intuitive Surgical. RHMV reports grants and non‐financial support from Medtronic and grants from Intuitive Surgical Inc., all outside the submitted work. All other authors declare they have no conflicts of interests related to the presented research. Completed disclosure of interests forms are available to view online as supporting information. Publisher Copyright: © 2020 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/2

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N2 - 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.

AB - 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.

KW - Cervical cancer

KW - learning curve

KW - recurrence

KW - risk-adjusted cumulative sum analysis

KW - robot-assisted laparoscopy

KW - survival

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DO - 10.1111/1471-0528.16399

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JO - BJOG - An International Journal of Obstetrics and Gynaecology

JF - BJOG - An International Journal of Obstetrics and Gynaecology

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Baeten I, Hoogendam JP, Schreuder H, Jürgenliemk-Schulz IM, Verheijen R, Zweemer RP et al. The influence of learning curve of robot-assisted laparoscopy on oncological outcomes in early-stage cervical cancer: an observational cohort study. BJOG - An International Journal of Obstetrics and Gynaecology. 2021 Feb;128(3):563-571. Epub 2020 Jul 6. doi: 10.1111/1471-0528.16399

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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