Impact of the learning curve on the survival of abdominal or minimally invasive radical hysterectomy for early-stage cervical cancer

Lan Ying Li, Lan Ying Wen, Sun Hee Park, Eun Ji Nam, Jung Yun Lee, Sunghoon Kim, Young Tae Kim, Sang Wun Kim

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)


Purpose 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. Materials and Methods 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. Results 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. Conclusion 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.

Original languageEnglish
Pages (from-to)243-251
Number of pages9
JournalCancer Research and Treatment
Issue number1
Publication statusPublished - 2021 Jan

Bibliographical note

Funding Information:
This study was supported by a faculty research grant of Yonsei University College of Medicine (6-2009-0192 and 6-2014-0003) and the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science, and Technology (NRF-2011-0013127 and NRF-2014R1A1A2053635). The authors report no conflict of interest.

Publisher Copyright:
© 2021 by the Korean Cancer Association

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research


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