Matched-Case Comparisons in a Single Institution to Determine Critical Points for Inexperienced Surgeons’ Successful Performances of Laparoscopic Radical Hysterectomy versus Abdominal Radical Hysterectomy in Stage IA2-IIA Cervical Cancer
Identifieur interne : 001B13 ( Main/Exploration ); précédent : 001B12; suivant : 001B14Matched-Case Comparisons in a Single Institution to Determine Critical Points for Inexperienced Surgeons’ Successful Performances of Laparoscopic Radical Hysterectomy versus Abdominal Radical Hysterectomy in Stage IA2-IIA Cervical Cancer
Auteurs : Dong Hoon Suh [Corée du Sud] ; Hye-Yon Cho [Corée du Sud] ; Kidong Kim [Corée du Sud] ; Jae Hong No [Corée du Sud] ; Yong-Beom Kim [Corée du Sud]Source :
- PLoS ONE [ 1932-6203 ] ; 2015.
Abstract
This is a retrospective study which aims to identify major determinants of successful laparoscopic radical hysterectomy (LRH) versus abdominal radical hysterectomy (ARH) performed by inexperienced surgeons for stage IA2-IIA cervical cancer. A total of 161 consecutive patients with stage IA2–IIA cervical cancer who underwent RH were grouped into 2 groups according to the surgeons’ experience with LRH: experienced surgeon versus inexperienced surgeon. After matching for age and risk factors, surgical and survival outcomes were compared. Experienced surgeon selected patients with earlier-stage and fewer risk factors for LRH than ARH, but inexperience surgeons did not. After matching, the vaginal tumor-free margin of LRH was shorter than that of ARH in experienced surgeon group (1.3 versus 1.7 cm, p=0.007); however, the vaginal tumor-free margin was longer than that of ARH in the inexperienced surgeon group (1.8 versus 1.3 cm, p=0.035). The postoperative hospital stay of LRH was shorter than that of ARH in experienced surgeon group (5.5 versus 7.7 days, p<0.001), but not different from that of ARH in the inexperienced surgeon group. Vaginal tumor-free margin >1.8 cm (OR 7.33, 95% CI 1.22–40.42), stage >IB1 (OR 8.83, 95% CI 1.51–51.73), and estimated blood loss >575 mL (OR 33.95, 95% CI 4.87–236.79) were independent risk factors for longer postoperative hospital stay in the inexperienced surgeon group. There was no difference of 5-year-profression-free survival of LRH patients between experienced surgeon and inexperienced surgeon groups after matching (55.1 versus 33.3%, p=0.391). Selection of earlier-stage disease and moderate vaginal tumor-free margin might be important for an inexperienced surgeon to successfully perform LRH with minimal complications in stage IA2–IIA cervical cancer.
Url:
DOI: 10.1371/journal.pone.0131170
PubMed: 26110866
PubMed Central: 4482442
Affiliations:
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Seongnam</wicri:regionArea><wicri:noRegion>Seongnam</wicri:noRegion></affiliation></author><author><name sortKey="Cho, Hye Yon" sort="Cho, Hye Yon" uniqKey="Cho H" first="Hye-Yon" last="Cho">Hye-Yon Cho</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Department of Obstetrics and Gynecology, Hallym University Dongtan Sacred Heart Hospital, Hwasung, Korea</addr-line></nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea>Department of Obstetrics and Gynecology, Hallym University Dongtan Sacred Heart Hospital, Hwasung</wicri:regionArea><wicri:noRegion>Hwasung</wicri:noRegion></affiliation></author><author><name sortKey="Kim, Kidong" sort="Kim, Kidong" uniqKey="Kim K" first="Kidong" last="Kim">Kidong Kim</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea</addr-line></nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea>Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam</wicri:regionArea><wicri:noRegion>Seongnam</wicri:noRegion></affiliation></author><author><name sortKey="No, Jae Hong" sort="No, Jae Hong" uniqKey="No J" first="Jae Hong" last="No">Jae Hong No</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea</addr-line></nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea>Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam</wicri:regionArea><wicri:noRegion>Seongnam</wicri:noRegion></affiliation></author><author><name sortKey="Kim, Yong Beom" sort="Kim, Yong Beom" uniqKey="Kim Y" first="Yong-Beom" last="Kim">Yong-Beom Kim</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea</addr-line></nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea>Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam</wicri:regionArea><wicri:noRegion>Seongnam</wicri:noRegion></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>This is a retrospective study which aims to identify major determinants of successful laparoscopic radical hysterectomy (LRH) versus abdominal radical hysterectomy (ARH) performed by inexperienced surgeons for stage IA2-IIA cervical cancer. A total of 161 consecutive patients with stage IA2–IIA cervical cancer who underwent RH were grouped into 2 groups according to the surgeons’ experience with LRH: experienced surgeon versus inexperienced surgeon. After matching for age and risk factors, surgical and survival outcomes were compared. Experienced surgeon selected patients with earlier-stage and fewer risk factors for LRH than ARH, but inexperience surgeons did not. After matching, the vaginal tumor-free margin of LRH was shorter than that of ARH in experienced surgeon group (1.3 versus 1.7 cm, p=0.007); however, the vaginal tumor-free margin was longer than that of ARH in the inexperienced surgeon group (1.8 versus 1.3 cm, p=0.035). The postoperative hospital stay of LRH was shorter than that of ARH in experienced surgeon group (5.5 versus 7.7 days, p<0.001), but not different from that of ARH in the inexperienced surgeon group. Vaginal tumor-free margin >1.8 cm (OR 7.33, 95% CI 1.22–40.42), stage >IB1 (OR 8.83, 95% CI 1.51–51.73), and estimated blood loss >575 mL (OR 33.95, 95% CI 4.87–236.79) were independent risk factors for longer postoperative hospital stay in the inexperienced surgeon group. There was no difference of 5-year-profression-free survival of LRH patients between experienced surgeon and inexperienced surgeon groups after matching (55.1 versus 33.3%, p=0.391). Selection of earlier-stage disease and moderate vaginal tumor-free margin might be important for an inexperienced surgeon to successfully perform LRH with minimal complications in stage IA2–IIA cervical cancer.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Park, Jy" uniqKey="Park J">JY Park</name></author><author><name sortKey="Kim, Dy" uniqKey="Kim D">DY Kim</name></author><author><name sortKey="Kim, Jh" uniqKey="Kim J">JH Kim</name></author><author><name sortKey="Kim, Ym" uniqKey="Kim Y">YM Kim</name></author><author><name sortKey="Kim, Yt" uniqKey="Kim Y">YT Kim</name></author><author><name sortKey="Nam, Jh" uniqKey="Nam J">JH Nam</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Elmasri, Wm" uniqKey="Elmasri W">WM Elmasri</name></author><author><name sortKey="Casagrande, G" uniqKey="Casagrande G">G Casagrande</name></author><author><name sortKey="Hoskins, E" uniqKey="Hoskins E">E 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