Impact of laparoscopic surgical proficiency on survival outcomes in laparoscopic radical hysterectomy for cervical cancer: a multi-center cohort study
This study aims to evaluate the impact of gynecologic oncologists' laparoscopic proficiency on survival outcomes in cervical cancer patients. A cohort of 1,965 cervical cancer cases from four clinical centers in China was analyzed, including abdominal radical hysterectomy (ARH), laparoscopic radical hysterectomy (LRH), and robotic radical hysterectomy (RRH). The median operative time (MOT) for LRH was used as a measure of surgical proficiency. Survival outcomes of ARH vs. LRH were compared in early-stage cervical cancer patients without adjuvant therapy to identify a critical MOT threshold. Below this threshold, no significant differences in prognosis were observed between ARH and LRH. Propensity score matching and mixed-effects Cox regression were used to adjust for baseline risk factors and random effects, validating the finding across all LRH cases. The Kaplan-Meier analysis showed that improved prognosis was associated with reduced MOT. When gynecologic oncologists had an MOT within 210 min, LRH vs ARH was no longer a significant risk factor (HR 1.1998; 95% CI: 0.9785-1.4713; p = 0.07998). Propensity score matching and mixed-effects Cox regression were used to further clarify the significant prognostic differences in LRH performed by different level surgeons. MOT reflects surgical efficiency and serves as a key indicator of the operative proficiency of gynecologic oncologists, which is pivotal in determining the survival prognosis of cervical cancer patients undergoing LRH. For surgeons with rigorous laparoscopic training, the survival outcomes of LRH are expected to be comparable to those of ARH.