The impact of the surgical routes and learning curve of radical hysterectomy on the survival outcomes in stage IB cervical cancer: A retrospective cohort study

Objective: Little is known about the definite reasons of the disadvantage of minimally invasive surgery in the treatment of early stage cervical cancer. This study is to compare survival outcomes of patients with stage IB cervical cancer who received radical hysterectomy (RH) by one surgeon in different periods. Methods: A retrospective analysis was performed on stage IB cervical cancer patients who received RH from February 2001 to November 2015 at a tertiary hospital. All the major procedures were performed by one surgeon. The clinicopathological characteristics and survival outcomes were compared with laparoscopic RH (LRH) and abdominal RH (ARH) groups in the periods of 2001-2005, 2006-2010, and 2011-2015. Results: Totally 406 patients were included in the study, 135 (33.3%) and 271 (66.7%) in ARH and LRH groups respectively. The 5-year disease-free survival (DFS) of all patients increased from 2001 to 2005 to 2006-2010 but decreased in 2011-2015. No significant differences exist in the 5-year DFS and overall survival (OS) rates in the first 50 patients of LRH and ARH groups. The subgroup analysis in stage IB1 patients (68.2% of all participants) reached the same conclusions. Conclusion: For RH patients, in which all major procedures were performed by one surgeon, the DFS did not exhibit substantial improvement in the period of 2001-2015 since the extensive adoption of LRH. The learning curve probably explains the disadvantage of LRH.