Surgical skill and oncological outcome of laparoscopic radical hysterectomy: JGOG1081s-A1, an ancillary analysis of the Japanese Gynecologic Oncology Group Study JGOG1081
Surgical skill and oncological outcome of laparoscopic radical hysterectomy: JGOG1081s-A1, an ancillary analysis of the Japanese Gynecologic Oncology Group Study JGOG1081
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DOI：
10.1016/j.ygyno.2022.02.005
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发表时间：
2022-05-02
影响因子：
4.7
通讯作者：
Enomoto, Takayuki
中科院分区：
文献类型：
--
作者：
Kobayashi, Eiji;Nakatani, Eiji;Enomoto, Takayuki
目标。我们调查了腹腔镜下宫颈癌根治性子宫切除术（LRH）患者的手术技巧和手术方式是否与肿瘤预后相关。我们之前评估了251例FIGO期（2009年）IA2、ib1和IIA1宫颈癌患者的LRH数据，这些数据来自JGOG 1081研究。1)重新检查JGOG 1081s队列研究，细化手术细节，延长随访时间作为图表复习。2)专家在不了解复发情况的情况下，使用改进的OSATS （Objective Structured Assessment of Technical skills）工具，对复发病例和匹配的非复发对照病例的未编辑视频进行各种手术技能和手术方式的新比较。在中位随访46个月后，251名患者中有31名肿瘤复发。5年无复发生存率为86.9%(81.8 ~ 90.6)，5年总生存率为93.7%（87.5 ~ 96.8）。图表回顾的多因素分析发现，每个机构LRH少于20例的经历是复发的独立预后因素（风险比（HR） 2.49, 95%CI 1.12-5.53, p = 0.025）。对于手术视频回顾，我们比较了23个复发病例的视频和23个背景匹配的非复发对照。视频回顾中修改后的OSATS分数越低，复发的风险越高。我们的新研究发现，LRH手术经验和技能倾向于有更好的肿瘤预后。(c) 2022爱思唯尔公司版权所有。
Objectives. We investigated whether surgical skill and procedure were related to oncological outcomes in cervical cancer patients who underwent Laparoscopic Radical Hysterectomy (LRH).Methods. We previously assessed data of LRH from 251 patients with FIGO stage (2009) IA2, IB1and IIA1 cervical cancer collected for JGOG 1081s study. 1) The JGOG 1081s cohort study was re-examined to refine the surgical details and extend the follow-up period as chart review. 2) Unedited videos for recurrent cases and matched non-recurrent control cases were newly compared by experts for various surgical skills and surgical procedures using the modified Objective Structured Assessment of Technical Skills (OSATS) tool, without awareness of the recurrence status as video review.Results. After a median follow-up of 46 months, tumors had recurred in 31 of the 251 patients. The five-year Recurrence-Free Survival rate was 86.9% (81.8-90.6) and five-year Overall Survival rate was 93.7% (87.5-96.8). Multivariate analysis from chart reviews found that an experience with LRH of less than 20 cases per institution was an independent prognostic factor for recurrence (Hazard Ratio (HR) 2.49, 95%CI 1.12-5.53, p = 0.025). For the surgical video review, we compared 23 videos of recurrent caseswith 23 background-matched non-recurrent controls. Lower modified OSATS scores fromthe video review were consistently trended to have a higher risk of recurrence.Conclusions. Our new study has found that LRH surgical experience and skill trended to have better oncological outcomes. (c) 2022 Elsevier Inc. All rights reserved.