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Quality of training in cervical cancer radical surgery: a survey from the European Network of Young Gynaecologic Oncologists (ENYGO)
  1. Nicolò Bizzarri1,
  2. Andrei Pletnev2,
  3. Zoia Razumova3,
  4. Kamil Zalewski4,
  5. Charalampos Theofanakis5,
  6. Ilker Selcuk6,
  7. Tanja Nikolova7,
  8. Maximilian Lanner8,
  9. Natalia R Gómez-Hidalgo9,
  10. Joanna Kacperczyk-Bartnik10,
  11. Denis Querleu1,11,
  12. David Cibula12,
  13. René H M Verheijen13,14 and
  14. Anna Fagotti1,15
  1. 1 UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Agostino Gemelli IRCCS, Rome, Italy
  2. 2 Department of Obstetrics and Gynecology, University of Zielona Góra Faculty of Humanities, Zielona Gora, Poland
  3. 3 Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
  4. 4 Gynecologic Oncology, Holycross Cancer Center, Kielce, Holycross, Poland
  5. 5 Department of Gynaecological Oncology, General Hospital of Athens Alexandra, Athens, Attica, Greece
  6. 6 Gynecologic Oncology, Maternity Hospital, Ankara City Hospital, Ankara, Turkey
  7. 7 Klinikum Mittelbaden, Academic Teaching Hospital of Heidelberg University, Baden-Baden, Germany
  8. 8 Kardinal Schwarzenberg'sches Krankenhaus, Schwarzach im Pongau, Steiermark, Austria
  9. 9 Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Vall d'Hebron Hospital, Barcelona, Spain
  10. 10 II Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
  11. 11 Department of Obstetrics and Gynecology, University Hospital of Strasbourg, Strasbourg, France
  12. 12 Department of Obstetrics and Gynecology, Charles University and General University Hospital in Prague, Prague, Czech Republic
  13. 13 Cancer Center, Department Gynaecological Oncology, UMC Utrecht, Utrecht, The Netherlands
  14. 14 Nérac, Lot-et-Garonne, France
  15. 15 Università Cattolica del Sacro Cuore, Rome, Italy
  1. Correspondence to Dr Nicolò Bizzarri, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Agostino Gemelli IRCCS, Rome, Italy; nicolo.bizzarri{at}yahoo.com

Abstract

Background The European Society of Gynaecological Oncology (ESGO) and partners are committed to improving the training for gynecologic oncology fellows. The aim of this survey was to assess the type and level of training in cervical cancer surgery and to investigate whether the Laparoscopic Approach to Cervical Cancer (LACC) trial results impacted training in radical surgery for gynecologic oncology fellows.

Methods In June 2020, a 47-question electronic survey was shared with European Network of Young Gynaecologic Oncologists (ENYGO) members. Specialist fellows in obstetrics and gynecology, and gynecologic oncology, from high- and low-volume centers, who started training between January 1, 2017 and January 1, 2020 or started before January 1, 2017 but finished their training at least 6 months after the LACC trial publication (October 2018), were included.

Results 81 of 125 (64.8%) respondents were included. The median time from the start of the fellowship to completion of the survey was 28 months (range 6–48). 56 (69.1%) respondents were still fellows-in-training. 6 of 56 (10.7%) and 14 of 25 (56.0%) respondents who were still in training and completed the fellowship, respectively, performed ≥10 radical hysterectomies during their training. Fellows trained in an ESGO accredited center had a higher chance to perform sentinel lymph node biopsy (60.4% vs 30.3%; p=0.027). There was no difference in the mean number of radical hysterectomies performed by fellows during fellowship before and after the LACC trial publication (8±12.0 vs 7±8.4, respectively; p=0.46). A significant reduction in number of minimally invasive radical hysterectomies was noted when comparing the period before and after the LACC trial (38.5% vs 13.8%, respectively; p<0.001).

Conclusion Exposure to radical surgery for cervical cancer among gynecologic oncology fellows is low. Centralization of cervical cancer cases to high-volume centers may provide an increase in fellows’ exposure to radical procedures. The LACC trial publication was associated with a decrease in minimally invasive radical hysterectomies performed by fellows.

  • cervical cancer
  • hysterectomy
  • gynecologic surgical procedures
  • surgical oncology
  • COVID-19

Data availability statement

Data are available upon reasonable request. We will provide our data for the reproducibility of this study in other centers if such is requested.

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Data availability statement

Data are available upon reasonable request. We will provide our data for the reproducibility of this study in other centers if such is requested.

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Footnotes

  • Twitter @ilkerselcukmd, @annafagottimd

  • Contributors NB, AF and DC conceived the project plan. NB, AF, RV wrote the manuscript. NB did the data analysis. All the co-authors collected data, revised and approved the final draft. NB is responsible for the overall content as the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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