Initial clinical experience with total Müllerian compartment resection for locally advanced cervical cancer: a single-center preliminary retrospective cohort study and learning-curve analysis.

Objective: In this study, we compared the clinical value of embryonic compartment hysterectomy-i.e., total Müllerian compartment resection (TMCR)-with traditional radical hysterectomy for treating locally advanced cervical cancer, and assessed the learning curve associated with this novel technique. Methods: We conducted a retrospective cohort analysis at the Second Affiliated Hospital of Dalian Medical University that comprised 60 women who underwent initial surgical treatment for cervical cancer (FIGO stages IB3 and IIA2) between May 2018 and May 2024. Participants were assigned to an embryonic-compartment hysterectomy group (n=37) and a traditional hysterectomy group (n=23). We collected demographic data, oncologic information, treatment-related complications, and follow-up data. Perioperative outcomes and oncologic results were compared between the groups, and the learning curve for TMCR was analyzed by applying cumulative sum (CUSUM) and best-fit curve analyses based on surgical duration. Results: We noted no significant differences in age, body mass index, tumor stage, pathologic type, surgical duration, or postoperative hospital stay between the two groups (P>0.05). However, the TMCR ("study") group exhibited less intraoperative blood loss, with a median of 100 ml (50-200 ml) compared with 300 ml (110-500 ml) in the traditional group (P<0.05). Postoperative complication rates were similar, with 24.3% in the study group and 17.4% in the traditional group (P>0.05). The overall median follow-up duration was 30 months; however, the traditional group was followed for a median of 41 months compared with 23 months for the study group. All recurrences and deaths occurred in the traditional group. In addition, the median tumor size in the study group was 51 mm (IQR, 45-57.5 mm), compared with 46 mm (IQR, 42-50 mm) in the traditional group (P<0.05). The CUSUM curve peaked after the 12th case, indicating a transition from learning to proficient phases, with significantly reduced surgical times in the proficient phase (P<0.05). Conclusions: TMCR is safe and feasible for locally advanced cervical cancer. We posit that gynecologic oncologists will be able to achieve proficiency after performing 12 cases, with potential advantages in resecting larger tumors. However, further longitudinal studies and larger clinical trials are necessary to confirm these results.