10 The learning curve of robot-assisted laparoscopy has impact on the oncological outcomes of early stage cervical cancer patients

University Medical Centre Utrecht, Netherlands Introduction Previous learning curve studies are focused on short term surgical outcomes of robot-assisted surgery. We are the first to study the influence of learning curve on recurrence rate and quantify its impact on survival in patients with early stage cervical cancer using a validated analysis. Methods We included all patients with early stage cervical cancer treated consecutively by one tertiary surgical team with robot-assisted laparoscopy (2007 – 2017). To establish the number of procedures needed to ascertain oncological proficiency, we performed a risk-adjusted cumulative sum (RA-CUSUM) analysis. The impact of the learning curve on oncological outcomes was quantified with Kaplan-Meier survival analysis. Results In total, 165 patients received radical robot-assisted laparoscopy and had a median follow-up of 57 months (range 3–132 months). Multivariate RA-CUSUM analysis demonstrated a learning phase of 61 procedures. The recurrence rate decreased significantly with increasing experience in robot-assisted laparoscopy. No significant differences in baseline characteristics were observed between patients treated during the learning phase (n=61) and experienced phase (n=104). The 5-year disease-free, disease-specific and overall survival significantly increased in patients treated after the learning phase; 80.2% to 91.1% (P=0.040), 84.7% to 97.7% (P=0.002) and 84.7% to 94.8% (P=0.018), respectively. Conclusions/Implications In this single institution study we found a learning phase for robot-assisted laparoscopy in cervical cancer of 61 procedures with significant impact on the survival rates. With our analysis we aim to encourage others performing robot-assisted radical surgery for cervical cancer to assess their own learning curves.