Letter to the Editor, BJOG Exchange

Letter to the Editor, BJOG Exchange

Mini- commentary on BJOG-19-1190.R1: Cardio-metabolic risk factors among young infertile women: a systematic review and meta-analysis

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 early stage cervical cancer patients 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 patients treated during different phases of the learning curve. Main Outcome Measures: Surgical proficiency based on recurrence, survival rates in the different learning phases. Results: 165 cervical cancers patients were operated by 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 patients treated thereafter. The learning curve of robot-assisted laparoscopy affects oncological outcomes and warrants more attention in the design of future studies. Funding: None. Keywords: Cervical cancer, robot-assisted laparoscopy, learning curve, RA-CUSUM, recurrence, survival.

Letter to the Editor, BJOG Exchange

References1. Ravi, K.; Gunawardana, S.; Ravi, K.; Abeywickrema, M.; Davies, M.; Tough, E. et al. Why stillbirth deserves a place on the medical school curriculum: Stillbirth-related teaching in UK medical schools. BJOG. 2020;127(3):414.2. Frøen, J. E.; Heazell, A.E P.; Flenady, V.; de Bernis, L.; Kinney, M. V.; Blencowe, H. et al. The Lancet Ending Preventable Stillbirths Study Group. Ending preventable stillbirths: an executive summary for The Lancet’s series. Lancet [Internet]. 2016 18 May 2019. Available from: https://www.thelancet.com/pb/assets/raw/Lancet/stories/series/stillbirths2016-exec-summ.pdf.3. UK Foundation Programme Office. F2 Career Destinations Report. 2018.4. Burden, C.; Bradley, S.; Storey, C.; Ellis, A.; Heazell, A.E.P.; Downe, S. et al. From grief, guilt pain and stigma to hope and pride - a systematic review and meta-analysis of mixed-method research of the psychosocial impact of stillbirth. BMC Pregnancy Childbirth. 2016;16:9.—————————————————————————————————————————Funding Support: No specific funding received.—————————————————————————————————————————Statement of Contribution to Authorship: E.C. and D.S. conceived the idea for the Commentary. E.C. performed the literature review and wrote the initial version of the manuscript. D.S. supervised the writing of the manuscript and provided critical feedback prior to submission of the final version.—————————————————————————————————————————Disclosure of Interests: D.S. is an Executive Scientific Editor for BJOG. Otherwise the authors declare that they have no known competing interests or personal relationships that could have influenced the work reported in this paper.—————————————————————————————————————————

Mini-commentary on BJOG-19-1615.R1: Pregnancy outcomes in women with primary biliary cholangitis and primary sclerosing cholangitis