Effect of surgeon case volume on major surgical complications for abdominal and laparoscopic radical hysterectomy for cervical cancer in China, 2004-2016: A retrospective cohort study

Effect of surgeon case volume on major surgical complications for abdominal and laparoscopic radical hysterectomy for cervical cancer in China, 2004-2016: A retrospective cohort study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of surgeon case volume on major surgical complications for abdominal and laparoscopic radical hysterectomy for cervical cancer in China, 2004-2016: A retrospective cohort study Cong Liang, Weili Li, Xiaoyun Liu, Hongwei Zhao, Lu Yin, Mingwei Li, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2139253/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background To date, there are few studies that have investigated the association between surgeon volume and outcomes of radical hysterectomy. To examine changes in surgeon volume over time and evaluate the influence of surgeon volume on complications of abdominal and laparoscopic radical hysterectomy for cervical cancer. Methods We conducted a population-based retrospective study using the Major Surgical Complications of Cervical Cancer in China (MSCCCC) database to collect the data of patients who underwent radical hysterectomy from 2004–2016 at 42 hospitals. Patients were stratified into tertiles according to annualized surgeon volume. The influence of the surgeon volume of abdominal and laparoscopic radical hysterectomy on surgical complications was examined using multivariable logistic regression models. Results A total of 22,684 patients who underwent radical hysterectomy were identified. In the abdominal surgery cohort, the mean surgeon case volume increased from 3.5 cases in 2004 to 8.7 cases in 2013 and then decreased to 4.9 cases in 2016. The number of surgeons performing laparoscopic radical hysterectomy increased from 1 surgeon with 1 patient (mean cases = 1) in 2004 to 183 surgeons who operated on 2,206 patients in 2016 (mean cases = 12.1) (P < 0.01). In the abdominal surgery cohort, patients treated by intermediate-volume surgeons had more postoperative complications (OR = 1.55, 95% CI = 1.11–2.15). In the laparoscopic surgery cohort, surgeon volume had no independent effect on intraoperative or postoperative complications (P = 0.46; P = 0.13). Conclusions The performance of ARH by intermediate-volume surgeons is associated with an increased risk of postoperative complications. However, surgeon volume may have little effect on intraoperative or postoperative complications after LRH. Oncology Obstetrics & Gynecology cervical cancer radical hysterectomy cervical cancer major complications Figures Figure 1 Introduction Cervical cancer ranks as the fourth most frequently diagnosed cancer in women (570,000 cases) [ 1 ]. Radical hysterectomy with bilateral pelvic lymph node dissection is the recommended surgical treatment for women with early-stage disease [ 2 ]. Major complications during radical hysterectomy (RH) depend on many factors, such as patients characteristics, tumor characteristics, hospital medical resources, surgical approach [ 3 ], surgeon volume, and hospital volume [ 4 ]. Among these, the surgeon’s volume has increasingly received attention [ 5 ]. Accumulative evidence to date has suggested that higher surgeon volume leads to improved perioperative outcomes for oncologic surgery, such as surgery for esophageal cancer [ 6 ], brain tumors [ 7 ], pancreatic cancer [ 8 ], bladder cancer [ 9 ], endometrial cancer [ 10 ], rectal cancer [ 11 ] and lung cancer [ 12 ]. However, some scholars argue that surgeon volume is not associated with complications [ 13 , 14 ]. Recognition of the volume-outcomes paradigm in high-risk cancer procedures has led to changes in practice. Consequently, some health systems are instituting a minimum surgeon volume standard for high-risk surgery, such as esophagectomy and lung resection [ 6 , 15 ]. Wright et al. demonstrated that women treated by high-volume surgeons had fewer postoperative medical complications and lower transfusion requirements after abdominal radical hysterectomy (ARH) [ 16 ]. To date, there are few studies that have investigated the association between surgeon volume and outcomes of laparoscopic radical hysterectomy (LRH) based on large population cohort, although there is a proportionate increase in LRH [ 17 ]. In addition, there is a paucity of data about surgeon volume in Asian populations. The first objective of this population-based analysis is to explore the association between surgeon volume and complications after ARH and LRH. The second objective is to examine changes in the number of surgeons, mean surgeon case volume and the total number of cases of cervical cancer over time. Methods Data source Data from the Major Surgical Complications of Cervical Cancer in China (MSCCCC) project database were utilized. The MSCCCC database is a multicenter retrospective database established to measure surgical quality. Approximately 97.5% of cases from the database could be matched to the cases in Chinese Clinical Cervical Cancer (FOUR-C) project ( http://www.chictr.org.cn/index.aspx , ChiCTR1800017778). The MSCCCC database gathers hospitalization information for 36,543 patients from 42 hospitals in 14 provinces of China from 2004–2016 (updated of June 2020). The 42 hospitals consist of 32 general hospitals, 4 cancer centers and 6 women and children’s hospitals (W&C hospitals) [ 17 , 18 ]. Using the discharge diagnosis of “cervical cancer” as the keyword or the International Classification of Diseases Tenth Revision code C53.9 for computerized search, specially-trained gynecologists abstracted data from medical records and the hospital information system. The documentation used for data extraction on complications included inpatient medical records for surgical treatment, postoperative adjuvant therapy records within 6 months, outpatient records, and readmission to the other department for complication treatment within 2 years [ 17 , 18 ]. The MSCCCC database collects data on patient demographics, clinical characteristics, and hospital factors. After completion of double data entry, data checking were carried out by two independent gynecologists to eliminate input errors and logic errors. Data masking was used to protect patient privacy. Ethical approval was obtained from Institutional Ethics Committee of Southern Medical University Nanfang Hospital (NFEC-2017-135). Cohort identification Women who underwent RH for cervical cancer between 2004 and 2016 were analyzed. The inclusion criteria were as follows: 1) the patient had been diagnosed stage IA1 with LVSI (lymphovascular space invasion) to stage IIB, according to the 2009 International Federation of Gynecology and Obstetrics (FIGO) staging system; 2) the patient underwent type B or C RH (Querleu and Morrow classification) [ 19 ] + pelvic lymphadenectomy (PLN) ± para-aortic lymphadenectomy (PALA); and 3) the patient underwent ARH or LRH. The exclusion criteria were as follows: 1) the patient was diagnosed with cervical cancer during pregnancy, was diagnosed with incidental cervical cancer after extrafascial hysterectomy or had a prior history of other malignancies; 2) the patient had an unknown lymphadenectomy status or did not undergo lymphadenectomy; 3) the patient underwent laparoscopic-assisted radical vaginal hysterectomy or robot-assisted RH; or 4) the patient had missing surgeon data or a missing date of operation. Clinical and demographic characteristics The demographic characteristics included age, year of surgery, urban-rural distribution, mode of delivery, and comorbidities. Clinical characteristics that were analyzed included FIGO stage, gross type of tumor, histological type, preoperative anticancer treatment, hysterectomy type and lymph node dissection. Other operation details include operative time and estimated blood loss. The hospitals where patients were treated were characterized based on hospital function (general hospital, cancer center, or W&C hospital), region of the country (north, south, central, east, southwest, northwest or northeast), and city scale (first-tier, second-tier, and third-tier or below). The levels of urban economic development were as follows: first-tier cities > second-tier cities > third-tier cities. Surgeon volume We calculated the total volume of each surgeon. For each surgeon, annualized surgeon volumes were calculated as the total number of procedures that the surgeon performed divided by the number of years in which an individual surgeon contributed to at least one RH [ 10 , 16 , 20 ]. Patients were stratified into two cohorts based on the hysterectomy approach: ARH group or LRH group. Surgeon volume cutoff points were then selected to divide patients into approximately equal tertiles. Abdominal surgeon cutoff points were: low volume (≤ 8.1 procedures per year), intermediate volume (8.2–16.9 procedures per year), and high volume (>16.9 procedures per year). Laparoscopic surgeon cutoff points were: low volume (≤ 11.0 procedures per year), intermediate volume (11.1–20.0 procedures per year), and high volume (>20.0 procedures per year). Outcomes Complications were divided into intraoperative complications and postoperative complications. The intraoperative complications, which included ureteral injury, bladder injury, bowel injury, vascular injury, obturator nerve injury, and stomach injury, were recorded. Postoperative complications included bowel obstruction, pelvic hematoma, hemorrhage, vesicovaginal fistula, ureterovaginal fistula, ureteral fistula, rectovaginal fistula, venous thromboembolism and chylous leakage. We also recorded deaths from surgical complications. Statistical analysis The relationship between the number of surgeons and year was assessed by a non-parametric Spearman correlation test. Due to discontinuous data, one of the hospitals was not including in the graphs. Frequency distributions between categorical variables were compared using χ2 or the Fisher’s exact test, and continuous variables were compared using a one-way analysis of variance. The median and interquartile range (IQR) of surgeon volume were also reported for each tertile. Binary logistic regression models were used to determine predictors of treatment by the intermediate and high volume (highest 2/3 volume) surgeons. Demographic, clinical, and hospital characteristics constituted independent variables. To examine the association between surgeon volume and outcome, we built binary logistic regression models including surgeon volume while adjusting for the other variables described above. The results are reported as odds ratios (ORs) and 95% confidence intervals (CIs). A value of P < 0.05 was considered statistically significant. All analyses were performed with the SPSS 23.0 statistical software package (SPSS, Inc., Chicago, IL, USA). Results Trends in the number of surgeons and patients We identified a total of 22,684 patients, including 14536 (64.1%) patients who underwent ARH and 8148 (35.9%) patients who underwent LRH (Table 1). The number of surgeons performing ARH each year increased from 89 surgeons who operated on 313 patients in 2004 to 187 surgeons who operated on 1,294 patients in 2012 (P<0.01, r = 0.99). However, the number of abdominal surgeons decreased to 122 surgeons with 594 patients in 2016 (P = 0.20, r=-0.80). The mean surgeon case volume increased from 3.5 cases in 2004 to 8.7 cases in 2013 and then decreased to 4.9 cases in 2016 (Fig. 1 A). The number of surgeons performing LRH increased from 1 surgeon with 1 patient in 2004 to 183 surgeons who operated on 2,206 patients in 2016 (P < 0.01, r = 0.99). The mean number of surgeons performing LRH increased from 1 to 12.1 cases between 2004 and 2016 (Fig. 1 B). Characteristics of the cohort In the ARH cohort, the median volume of surgeons in the low-volume group was two (IQR 1.0-3.5) per year and rose to 30.9 (IQR 21.9–42.1) in the high volume group. Similarly, in the LRH cohort, the median volume of surgeons in the low-volume group was 2.3 (IQR 1.0–5.0) and increased to 27.8 (IQR 21.6–30.1) in the high-volume group (Table 2). In both the ARH and LRH cohorts, the operation time and bleeding loss for patients in the high-volume surgeon group were significantly lower than those for patients in the intermediate-volume and low-volume groups (P < 0.001) (Table 2). In the multivariable model of the ARH cohort, patients diagnosed in later years, patients living in rural areas, patients with a higher tumor stage (except stage IIB), patients with the endophytic or preclinical gross type, patients with preoperative radiotherapy, patients undergoing type C1 or C2 hysterectomy, patients undergoing surgery in a W&C hospital or cancer center, and patients undergoing surgery in a hospital of a first-tier city were more likely to be treated by high-volume or intermediate-volume surgeons (P 60 years, later year of diagnosis, previous cesarean section, FIGO stage IIA2 and IIB, PLN + PALA, and type C1 and C2 hysterectomy were associated with treatment by a high-volume or an intermediate-volume surgeon (P<0.05). In addition, patients undergoing surgery in the cancer center, patients undergoing surgery in the hospital of a second-tier city, and patients undergoing surgery in the hospital of the southwest area were more likely to be treated by intermediate- or high-volume surgeons (P < 0.05). Patients with the endophytic gross type, patients with neoadjuvant chemotherapy, and patients undergoing surgery in W&C hospitals were associated with treatment by a low-volume laparoscopic surgeon (P < 0.05) (Table 3). The impact of surgeon volume on complications In the univariate analysis of the ARH group, the overall complication rates were 3.06% for women treated by low-volume surgeons, 3.42% for those treated by intermediate-volume surgeons, and 2.01% for those treated by high-volume surgeons (P < 0.001) (Table 4). Compared with patients treated by intermediate-volume surgeons, those operated on by high-volume surgeons had fewer postoperative complications (2.87% vs. 1.69%, P < 0.001), fewer ureteral injuries (0.45% vs. 0.16%, P = 0.045), fewer bowel obstructions (1.28% vs. 0.61%, P = 0.003), and fewer ureterovaginal fistulas (0.43% vs. 0.13%, P = 0.006). There was no significant difference in the frequencies of other complications (P < 0.05). In the univariate analysis of the LRH group, patients treated by intermediate-volume surgeons had the highest ureterovaginal fistula rate (low vs. intermediate vs. high volume = 1.02% vs. 1.78% vs. 1.08%, P = 0.02). The frequencies of the other complications among laparoscopic surgery cases were similar across the tertiles (P > 0.05) (Table 4). In the multivariable analysis of the ARH cohort, patients treated by intermediate-volume surgeons were more likely to experience postoperative complications than those treated by high-volume surgeons (OR = 1.55, 95% CI = 1.11–2.15). However, abdominal surgeon volume had no influence on overall complications or intraoperative complications (P > 0.05). In the multivariable analysis of the LRH cohort, surgeon volume had no effect on overall complications, intraoperative complications or postoperative complications (P > 0.05) (Table 5). Discussion Our findings suggest that trends in the number of surgeons and mean surgeon case volume over time were different in ARH and LRH. In the ARH cohort, postoperative complication rates were higher among intermediate-volume surgeons, while patients treated by high-volume surgeons had lower postoperative complications. However, in the LRH cohort, surgeon volume had little effect on intraoperative and postoperative complications. The trends in the number of surgeons and mean surgeon volume over time were differed between the two surgical approaches. From 2004 to 2016, the number of laparoscopic surgeons and mean surgeon case volume rose annually. This increasing acceptance of laparoscopic technique could be due to the short-term benefits of LRH, including a more cosmetically pleasing incision, less bleeding, less postoperative pain, and faster postoperative recovery. However, the opposite trend was observed in ARH cohort. The number of abdominal surgeons and mean surgeon case volume have been decreasing since 2013. In addition, it is noteworthy that categorical definitions of surgeon volume varied substantially among the different studies. In the study of Wright et al.[ 16 ], a high-volume surgeon and a low-volume surgeon were defined as a surgeon who performed more than 3.75 and less than 2.25 ARHs per year, respectively; but we defined the same terms as a surgeon who performed greater than 16.9 and less than or equal to 8.1 ARHs per year, respectively. The surgeon volume gap between the two groups was much larger than that of the study by Wright et al.. In addition, our results revealed a positive correlation between the number of surgeons and the number of patients. The increasing number of surgeons could effectively alleviate national disease stress. In patients with endometrial cancer in the United States, although there was a small increase in the overall number of patients per year, the surgical treatment of patients has been limited to a smaller number of surgeons [ 10 ]. They suggested that the increased complexity of treatment has resulted in fewer general gynecologists treating these women. Referral of women with endometrial cancer to gynecologic oncology subspecialists is recommended [ 21 ]. Our data demonstrated that the association between surgeon volume and complications for cervical cancer was complex. In the ARH cohort, the postoperative complication rate was higher for intermediate-volume surgeons than for high-volume surgeons (OR = 1.55, 95%=1.11–2.15). However, the postoperative complication rate was found to be similar in the low-volume surgeon group and high-volume surgeon group (OR = 1.38, 95%=0.97–1.96). This observation resembles that of Wright et al. 16 . Their results showed that the perioperative complication rate was highest in the intermediate-volume surgeon group compared with the low-volume and high-volume surgeon groups (low vs. intermediate vs. high = 2.9% vs. 6.7% vs. 1.8%, P<0.001). However, no direct comparisons between intermediate-volume surgeons group and other groups were performed in their study. We suppose that surgeon volume had an inverted U-shaped relationship with postoperative complications, rather than a simple linear relationship. Low-volume surgeons with limited experience and limited surgical opportunities performed surgery with utmost caution to prevent complications. The majority of high-volume surgeons benefited from the effect of sufficient learning curve and close cooperation with an experienced surgical team, which translates into a lower complication rate. One possible reason for highest postoperative complications in the intermediate-volume surgeon group could be that they were more lenient in their selection of patients. Patients treated by intermediate-volume surgeons had a higher frequency of FIGO stage IIB, more preoperative radiotherapy, and a higher frequency of PLA +PALA and type C2 hysterectomy. In the Laparoscopic Approach to Cervical Cancer (LACC) trial, ARH was associated with higher rates of disease-free survival and overall survival than minimally invasive radical hysterectomy among women with early-stage cervical cancer [ 22 ]. ARH therefore has re-emerged as a mainstream treatment for cervical cancer. We may need to pay more attention to the impact of the abdominal surgeon volume on complications. In our laparoscopy surgery cohort, surgeon volume had no significant effects on intraoperative complications or postoperative complications. It appears that the effects of surgeon volume on radical hysterectomy complications of different surgical routes are different. Similar results have been reported in endometrial cancer. Among patients who underwent abdominal hysterectomy for endometrial cancer, increased surgical volume was associated with reductions in perioperative surgical complications and medical complications [ 23 ]. However, during laparoscopic hysterectomy, the surgeon volume appear to have little effect on perioperative morbidity for endometrial cancer [ 20 ]. A retrospective analysis of 1016 laparoscopic hysterectomies for benign gynecologic problems found that increasing the surgical volume could not reduce the rate of serious complications [ 24 ]. In addition, surgeon volumes in terms of different surgical procedures differentially affects surgical complication outcomes. This population-based study by Sheetz et al. demonstrated that the comparative safety of laparoscopic and open colectomy was influenced by surgeon volume, but the relationship was stronger for laparoscopy [ 25 ]. Numerous factors affects surgical experience. First, surgical experience was assessed and quantified by different metrics, such as annual surgeon volume (frequency), technique-specific volume, surgeon cumulative volume, and years of experience [ 11 , 26 , 27 ]. Yasunaga et al.[ 28 ] defined surgeon volume as the number of radical hysterectomies that each gynecologist had performed as an operating surgeon over his or her professional career. Their study showed that higher surgeon volume (greater than 200 procedures) was associated with a reduced incidence of postoperative urinary disorders. However, they did not mention the surgical route of radical hysterectomy. Second, surgical educators recognize that skill sets may transfer between operations [ 29 ]. Modrall et al [ 30 ]. defined the aggregate annual volume per surgeon of upper gastrointestinal operations as the “surrogate volume”, including excision of esophageal diverticulum, gastrectomy, gastroduodenectomy, and repair of diaphragmatic hernia. Among surgeons with a low-volume esophagectomy experience, increasing the volume of surrogate operations improved the outcomes observed for esophagectomy. However, there has been little discussion about “surrogate surgery” in gynecological cancer surgery. It was uncertain whether surrogate operative experiences, such as experiences of extrafascial hysterectomy in benign disease and cytoreductive surgery in ovarian cancer, yield improvements in outcomes for radical hysterectomy. Third, the characteristics of the surgeons may have an effect on surgical experience, such as the age of the surgeon. Surgeon age ≤ 51 and ≥ 56 years may increase short- and long-term mortality after esophagectomy for cancer, and the highest surgical competence is achieved between 52 and 56 years of surgeon age [ 31 ]. The reason for the decreasing performance among older surgeons might be related to mental fatigue, poorer compliance with evidence-based medicine, and higher administrative positions leading to reduced surgical frequency 31 . This population-based study is the first to examine changes in the number of surgeons and annual surgeon volume for cervical cancer over time, and to explore the association between surgeon volume and complications after ARH and LRH in China. First, a strength of our study is its large sample size. We reviewed 22,684 cases treated at 42 hospitals over a 13-year period so that data on the rare adverse events could be collected. Second, we also included clinical characteristics, such as FIGO stage, histology, preoperative treatment, hysterectomy type, and lymph node dissection type that may influence treatment outcome 17 . We also recognize several limitations to our findings. First, this study was a retrospective study in which the data were obtained from inpatient medical records or through readmission. Data on complications that may have occurred after discharge and have been treated by other hospitals, could not be obtained. Second, we divided the patients into tertiles based on annualized surgeon volumes, but the results of the present study could not translate into clinically meaning cutoff points. Third, although we considered a wide range of clinical characteristics and tumor characteristics, there might be other unmeasured confounding factors affecting complications, such as assistant surgeons [ 32 ], uterine size, downstream care, surgical instruments and management of complications. In addition, skill transference between LRH and ARH remains unclear. Fourth, our study only included patients from only 42 hospitals and the findings may not be representative of other areas in China. Conclusion In conclusion, patients treated by intermediate-volume surgeons may have more postoperative complications after ARH, while patients treated by high-volume surgeons had fewer postoperative complications. In the LRH cohort, surgeon volume appeared to have no significant predictive value for complications. Declarations Acknowledgements We are grateful to Min Hao (Department of Obstetrics and Gynecology, The Second Hospital of ShanXi Medical University), Wuliang Wang (Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhengzhou University), Ying Yang (Department of Obstetrics and Gynecology, Xinqiao Hospital, Third Military Medical University), Shan Kang (Department of Obstetrics and Gynecology, The Forth Hospital of Hebei Medical University & The Tumor Hospital of Hebei Province), Bin Ling (Department of Obstetrics and Gynecology, China-Japan Friendship Hospital), Xinli Sun and Hongwei Zhao (Department of Gynecology, Shanxi Provincial Cancer Hospital), Yu Guo and Lihong Lin (Department of Gynecology, Anyang Tumor Hospital), Li Wang (Department of Gynecology, The Affiliated Tumor Hospital of Zhengzhou University), Weidong Zhao (Department of Gynecology and Oncology, Anhui Provincial Cancer Hospital), Yan Ni (Department of Obstetrics and Gynecology, The Yuncheng Central Hospital of Shanxi province), Donglin Li and Wentong Liang (Department of Obstetrics and Gynecology, Guizhou Provincial People`s Hospital), Jianxin Guo (Department of Obstetrics and Gynecology, Daping Hospital, The Third Military Medical University), Xuemei Zhan and Mingwei Li (Department of Gynecology, Jiangmen Central Hospital), Weifeng Zhang (Department of Obstetrics and Gynecology, Ningbo Women & Children's Hospital), Peiyan Du (Department of Gynecological Oncology, Cancer Center of Guangzhou Medical University), Ziyu Fang (Department of Obstetrics and Gynecology, Liuzhou Workers' Hospital), Long Chen (Department of Obstetrics and Gynecology, Qingdao Municipal Hospital), Encheng Dai and Ruilei Liu (Department of Obstetrics and Gynecology, Linyi People's Hospital), Mubiao Liu and Yuanli He (Department of Obstetrics and Gynecology, Zhujiang Hospital, Southern Medical University), Jilong Yao and Zhihua Liu (Department of Obstetrics and Gynecology, Shenzhen Maternity & Child Healthcare Hospital), Xueqin Wang (Department of Obstetrics and Gynecology, The Fifth Affiliated Hospital of Southern Medical University), Yan Xu (Department of Obstetrics and Gynecology, Guangzhou Panyu Central Hospital), Ben Ma (Department of Obstetrics and Gynecology, Guangzhou First People's Hospital), Zhonghai Wang (Department of Obstetrics and Gynecology, Shenzhen Nanshan People's Hospital), Lin Zhu (Department of Gynecology, The Second Hospital of Shandong University), Hongxin Pan (Department of Obstetrics and Gynecology, the 3rd Affiliated Hospital of Shenzhen University, Luohu People's Hospital), Qianyong Zhu (Department of Obstetrics and Gynecology, No.153. Center Hospital of Liberation Army, Hospital No.988 of the Chinese People's Liberation Army Joint Support Force), Xiaohong Wang (Department of Obstetrics and Gynecology, Jinan City People's Hospital, Former Laiwu People's Hospital), Dingyuan Zeng and Zhong Lin (Department of Obstetrics and Gynecology, Maternal and Child Health Care Hospital of Liuzhou), Shaoguang Wang (Department of Obstetrics and Gynecology, Yantai Yuhuangding Hospital), Bin Zhu (Department of Obstetrics and Gynecology, Yiwu Maternal and Child Health Hospital), Anwei Lu (Department of Obstetrics and Gynecology, Maternal and Child Health Care Hospital of Guizhou Province), Mei Ji (Department of Obstetrics and Gynecology, the First Affiliated Hospital of Zhengzhou University), Qianqing Wang (Department of Obstetrics and Gynecology, Central Hospital Affiliated to Xinxiang Medical University), Zhumei Cui (Department of Gynecology, The Affiliated Hospital of Qingdao University Medical College), Biliang Chen (Department of Gynecology, Xijing Hospital of Air Force Medical University), Qinghuang Xie (Department of Gynecology, Foshan Women and Children Hospital), Qiubo Lv (Department of Gynecology, Beijing Hospital), Chang Liu (Department of Gynecology, the First Hospital of Lanzhou University), and Yi Zhang (Department of Gynecology, the First Hospital of China Medical University) for providing medical records. Author contributions CL and WL: Major contributor in writing the manuscript and analyzed the participant data; XL, HZ, LY, ML,YG, and JL: Contribute to data collection; XB: Contribute to data analysis; CC: Funding recipient and major contributor in study design. All authors gave final approval of the content of the manuscript. Funding The National Science and Technology Support Program of China (2014BAI05B03); The Natural Science Fund of Guangdong Province (2015A030311024); The Science and Technology Plan of Guangzhou (158100075). They provided financial assistance that played an important role in the collection of data. Availability of data and materials The dataset generated and/or analysed during the current study are not publicly available due to promises of participant anonymity and confidentiality but are available from the corresponding author on reasonable request. Ethics approval Ethical approval was obtained from Institutional Ethics Committee of Southern Medical University Nanfang Hospital (NFEC-2017-135). Consent for publication Not applicable. Competing interests The author(s) declared no potential conficts of interest for the research, authorship, and/or publication of this article. Author details 1 Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China. 2 Department of Gynecology, The Third Affiliated Hospital of Zunyi Medical College, Zunyi, China. 3 Department of Gynecology, Shanxi Provincial Cancer Hospital, Taiyuan, China. 4 Department of Obstetrics and Gynecology, the Jiangmen Central Hospital of SUN YAT-SEN University, Jiangmen, China. 5 Department of Gynecology, Anyang Tumor Hospital, Anyang, China. 6 Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China. 7 Department of Epidemiology, College of Public Health, Guangzhou Medical University, Guangzhou, China. References Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. 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Effect of surgical volume on morbidity and mortality of abdominal hysterectomy for endometrial cancer. Obstetrics and gynecology (New York. 1953). 2011;117(5):1051–1059. Tunitsky E, Citil A, Ayaz R, Esin S, Knee A, Harmanli O. Does surgical volume influence short-term outcomes of laparoscopic hysterectomy? Am J Obstet Gynecol. 2010;203(1):21–24. Sheetz KH, Norton EC, Birkmeyer JD, Dimick JB. Provider Experience and the Comparative Safety of Laparoscopic and Open Colectomy. Health Serv Res. 2017;52(1):56–73. Maruthappu M, Gilbert BJ, El-Harasis MA, et al. The Influence of Volume and Experience on Individual Surgical Performance. Ann Surg. 2015;261(4):642–647. Cusimano MC, Baxter NN, Gien LT, et al. Impact of surgical approach on oncologic outcomes in women undergoing radical hysterectomy for cervical cancer. Am J Obstet Gynecol. 2019;221(6):611–619. Yasunaga H, Nishii O, Hirai Y, Ochiai K, Matsuyama Y, Ohe K. Impact of surgeon and hospital volumes on short-term postoperative complications after radical hysterectomy for cervical cancer. J Obstet Gynaecol Re. 2009;35(4):699–705. Modrall JG, Chung J, Kirkwood ML, et al. Low rates of complications for carotid artery stenting are associated with a high clinician volume of carotid artery stenting and aortic endografting but not with a high volume of percutaneous coronary interventions. J Vasc Surg. 2014;60(1):70–76. Modrall JG, Minter RM, Minhajuddin A, et al. The Surgeon Volume-outcome Relationship. Ann Surg. 2018;267(5):863–867. Markar SR, Mackenzie H, Lagergren P, Lagergren J. Surgeon Age in Relation to Prognosis After Esophageal Cancer Resection. Ann Surg. 2018;268(1):100–105. Deery SE, O'Donnell TFX, Zettervall SL, et al. Use of an Assistant Surgeon Does not Mitigate the Effect of Lead Surgeon Volume on Outcomes Following Open Repair of Intact Abdominal Aortic Aneurysms. Eur J Vasc Endovasc. 2018;55(5):714–719. Tables Table 1. Schema of patient selection. Variable No. of patients 1.All patients diagnosed with cervical cancers, 2004-2016 36,543 2. Type B or C radical hysterectomy 31,581 3. Pelvic lymphadenectomy ± para-aortic lymphadenectomy 30,641 4. 2009 FIGO stage IA1 with LVSI to IIB 24,447 5. No pregnancy, incidental cervical cancer or previous malignant disease 24,350 6. Abdominal surgery or total laparoscopic surgery 23,409 7. Missing information of surgeon or date of surgery 22,684 Table 2. Demographic and clinical characteristics of the abdominal and laparoscopic cohorts stratified by surgeon volume. Characteristic Abdominal surgeon volume P value Laparoscopic surgeon volume P value Low Intermediate High Low Intermediate High Patients 4837 33.3 4913 33.8 4786 32.9 2642 32.4 2637 32.4 2869 35.2 Surgeons 362 44 22 212 33 18 Annualized hospital volume 2.0 (1.0-3.5) 10.8 (9.1-12.5) 30.9 (21.9-42.1) 2.3 (1.0-5.0) 13.5(12.3-16.9) 27.8(21.6-30.1) Age at surgery, years ≥ 60 444 9.2 515 10.5 798 16.7 <0.001 257 9.7 299 11.3 346 12.1 0.02 < 60 4393 90.8 4398 89.5 3988 83.3 2385 90.3 2338 88.7 2523 87.9 Year of diagnosis 2004-2009 1736 35.9 1748 35.6 245 5.1 <0.001 149 5.6 46 1.7 59 2.1 <0.001 2010-2016 3101 64.1 3165 64.4 4541 94.9 2493 94.4 2591 98.3 2810 97.9 Urban-rural distribution Rural 2316 47.9 2988 60.8 3098 64.7 <0.001 1572 59.5 1450 55.0 1638 57.1 <0.001 Urban 1423 29.4 1539 31.3 1004 21.0 739 28.0 959 36.4 1055 36.8 Unknown 1098 22.7 386 7.9 684 14.3 331 12.5 228 8.6 176 6.1 Hospital function General hospital 3451 71.3 2893 58.9 641 13.4 <0.001 1998 75.7 2097 79.5 1526 53.2 <0.001 Cancer center 1088 22.5 1626 33.1 4145 86.6 450 17.0 386 14.6 1223 42.6 W&C center 298 6.2 394 8.0 0 0.0 194 7.3 154 5.8 120 4.2 Region North 724 15.0 1292 26.3 2784 58.2 <0.001 589 22.3 220 8.3 605 21.1 <0.001 South 1380 28.5 1095 22.3 531 11.1 688 26.1 427 16.2 120 4.2 Central 618 12.8 410 8.3 1169 24.4 350 13.2 700 26.5 231 8.1 East 1490 30.8 1013 20.6 302 6.3 752 28.5 396 15.0 0 0.0 Southwest 307 6.3 335 6.8 0 0.0 91 3.4 507 19.2 1808 63.0 Northwest 158 3.3 668 13.6 0 0.0 161 6.1 323 12.2 105 3.7 Northeast 160 3.3 100 2.0 0 0.0 11 0.4 64 2.4 0 0.0 City scale First-tier 773 16.0 745 15.2 529 11.1 <0.001 560 21.2 299 11.3% 0 0.0 <0.001 Second-tier 2458 50.8 2885 58.7 3986 83.3 1471 55.7 1916 72.7% 2362 82.3 Third-tier 1606 33.2 1283 26.1 271 5.7 611 23.1 422 16.0% 507 17.7 Mode of delivery No delivery 49 1.0 57 1.2 22 0.5 <0.001 23 0.9 23 0.9 36 1.3 <0.001 Vaginal delivery 3684 76.2 4026 81.9 4059 84.8 2114 80.0 2157 81.8 2541 88.6 Cesarean delivery 253 5.2 291 5.9 221 4.6 194 7.3 243 9.2 261 9.1 Unknown 851 17.6 539 11.0 484 10.1 311 11.8 214 8.1 31 1.1 Comorbidity No 4526 93.6 4592 93.5 4242 88.6 <0.001 2425 91.8 2436 92.4 2611 91.0 0.18 Yes 311 6.4 321 6.5 544 11.4 217 8.2 201 7.6 258 9.0 FIGO stage IA1+IA2 133 2.7 76 1.5 30 0.6 <0.001 70 2.7 49 1.9 45 1.6 <0.001 IB1 2288 47.3 2117 43.1 2282 47.7 1554 58.8 1323 50.2 1318 45.9 IB2 656 13.6 690 14.0 531 11.1 289 10.9 295 11.2 328 11.4 IIA1 679 14.0 680 13.8 1278 26.7 350 13.2 329 12.5 586 20.4 IIA2 297 6.1 324 6.6 478 10.0 123 4.7 176 6.7 270 9.4 IIB 784 16.2 1026 20.9 187 3.9 256 9.7 465 17.6 322 11.2 Gross type Exophytic 2585 53.4 2854 58.1 2058 43.0 <0.001 1287 48.7 1357 51.5 1540 53.7 <0.001 Endophytic 276 5.7 316 6.4 1528 31.9 128 4.8 73 2.8 185 6.4 Ulcerated 900 18.6 790 16.1 550 11.5 461 17.4 467 17.7 699 24.4 Endocervical 105 2.2 64 1.3 29 0.6 45 1.7 39 1.5 44 1.5 After conization 132 2.7 106 2.2 74 1.5 80 3.0 97 3.7 102 3.6 Preclinical carcinoma 342 7.1 414 8.4 178 3.7 298 11.3 256 9.7 140 4.9 Unknown 497 10.3 369 7.5 369 7.7 343 13.0 348 13.2 159 5.5 Histological types Squamous cell 4178 86.4 4326 88.1 4301 89.9 <0.001 2252 85.2 2223 84.3 2481 86.5 0.008 Adenocarcinoma 450 9.3 397 8.1 294 6.1 262 9.9 293 11.1 272 9.5 Adenosquamous 113 2.3 92 1.9 94 2.0 45 1.7 54 2.0 49 1.7 Other subtypes 81 1.7 90 1.8 89 1.9 48 1.8 43 1.6 56 2.0 Unknown 15 0.3 8 0.2 8 0.2 35 1.3 24 0.9 11 0.4 Preoperative treatment No received 3457 71.5 3565 72.6 3911 81.7 <0.001 2038 77.1 2098 79.6 2164 75.4 <0.001 Neoadjuvant chemotherapy 1243 25.7 970 19.7 594 12.4 557 21.1 449 17.0 667 23.2 Preoperative radiotherapy 137 2.8 378 7.7 281 5.9 47 1.8 90 3.4% 38 1.3 Lymph node dissection PLA 4651 96.2 4604 93.7 4735 98.9 <0.001 2269 85.9 2028 76.9 1905 66.4 <0.001 PLA+PALA 186 3.8 309 6.3 51 1.1 373 14.1 609 23.1 964 33.6 Hysterectomy types Type B 2852 59.0 2140 43.6 3340 69.8 <0.001 1047 39.6 592 22.4 242 8.4 <0.001 Type C2 1962 40.6 2719 55.3 1424 29.7 1558 59.0 1991 75.5 2616 91.2 Type C1 23 0.5 54 1.1 22 0.5 37 1.4 54 2.0 11 0.4 Operation time 232.8±64.8 205.0±55.4 164.7±52.8 <0.001 259.6±77.1 234.4±70.8 209.6±64.6 <0.001 Blood loss 499.2±363.1 470.3±375.14 241.0±211.6 <0.001 216.2±305.7 193.0±188.6 185.1±170.1 <0.001 Abbreviations: PLA, pelvic lymphadenectomy; PALA, para-aortic lymphadenectomy. Table 3. Predictors of the high and intermediate volume surgeons. Abdominal cohort Laparoscopic cohort OR (95% CI) P value OR (95% CI) P value Age at surgery, years 0.16 0.002 ≥ 60 Ref Ref < 60 0.16 ( 0.79-1.04) 0.16 0.74 (0.61-0.90) 0.002 Year of diagnosis <0.001 0.02 2004-2009 Ref Ref 2010-2016 1.55 ( 1.41-1.69) <0.001 1.46 (1.06-2.01) 0.02 Urban-rural distribution < 0.001 0.08 Rural Ref Ref Urban 0.87 ( 0.80-0.96) 0.005 1.11 (0.97-1.27) 0.13 Unknown 0.51 ( 0.45-0.58) < 0.001 0.87 (0.72-1.08) 0.20 Hospital function < 0.001 <0.001 General hospital Ref Ref Cancer center 3.43 ( 3.06-3.86) < 0.001 1.82 (1.49-2.23) <0.001 W&C center 1.55 ( 1.27-1.89) < 0.001 0.26 (0.20 -0.35) <0.001 Region < 0.001 <0.001 North Ref Ref South 0.46 ( 0.39-0.54) < 0.001 4.90 (3.65-6.57) <0.001 Central 0.91 ( 0.78-1.06) 0.24 2.10 (1.67-2.66) <0.001 East 0.37 ( 0.32-0.42) < 0.001 0.35 (0.28-0.45) <0.001 Southwest 1.06 ( 0.84-1.32) 0.64 82.85 (57.46-116.60) <0.001 Northwest 3.30 ( 2.55-4.25) < 0.001 1.28 (0.88-1.87) 0.19 Northeast 0.22 ( 0.16-0.29) < 0.001 3.34 (1.70-6.57) <0.001 City scale < 0.001 <0.001 First-tier Ref Ref Second-tier 0.71 ( 0.59-0.85) < 0.001 8.75 (6.32-12.12) <0.001 Third-tier 0.37 ( 0.31-0.43) < 0.001 1.18 (0.89-1.56) 0.25 Mode of delivery < 0.001 0.004 No delivery 1.01 ( 0.68-1.49) 0.97 1.06 (0.57-1.98) 0.84 Vaginal delivery Ref Ref Cesarean delivery 1.06 ( 0.89-1.27) 0.51 1.36 (1.10-1.68) 0.005 Unknown 0.66 ( 0.59-0.74) < 0.001 1.33 (1.07-1.67) 0.01 Comorbidity 0.40 0.44 No Ref Ref Yes 0.93 ( 0.79-1.10) 0.40 1.09 (0.88-1.35) 0.44 FIGO stage < 0.001 <0.001 IA1+IA2 Ref Ref IB1 1.44 ( 1.08-1.94) 0.015 1.16 (0.77-1.76) 0.48 IB2 1.54 ( 1.12-2.11) 0.008 1.46 (0.93-2.31) 0.10 IIA1 1.83 ( 1.34-2.49) < 0.001 1.42 (0.91-2.22) 0.12 IIA2 1.83 ( 1.31-2.56) < 0.001 2.62 (1.60-4.29) <0.001 IIB 1.07 ( 0.77-1.48) 0.71 1.85 (1.13-3.03) 0.02 Gross type < 0.001 0.008 Exophytic Ref Ref Endophytic 2.09 ( 1.78-2.45) < 0.001 0.64 (0.48-0.86) 0.003 Ulcerated 0.87 ( 0.78-0.98) 0.018 1.16 (0.98-1.38) 0.08 Endocervical 0.55 ( 0.40-0.77) < 0.001 0.89 (0.56-1.42) 0.63 After conization 0.92 ( 0.70-1.19) 0.52 1.21 (0.85-1.70) 0.29 Preclinical carcinoma 1.41 ( 1.20-1.65) < 0.001 0.88 (0.72-1.08) 0.22 Unknown 0.73 ( 0.64-0.85) < 0.001 1.05 (0.87-1.28) 0.61 Histological types 0.021 0.97 Squamous cell Ref Ref Adenocarcinoma 0.89 ( 0.77-1.02) 0.10 1.06 (0.87-1.28) 0.56 Adenosquamous 0.81 ( 0.62-1.07) 0.14 1.00 (0.65-1.55) 0.98 Other subtypes 0.66 ( 0.49-0.90) 0.008 0.98 (0.64-1.48) 0.90 Unknown 0.75 ( 0.33-1.72) 0.50 0.89 (0.50-1.57) 0.68 Preoperative treatment < 0.001 < 0.001 No received Ref Ref Neoadjuvant chemotherapy 0.81 ( 0.72-0.91) < 0.001 0.69 (0.57-0.82) < 0.001 Preoperative radiotherapy 1.91 ( 1.53-2.39) < 0.001 0.85 (0.58-1.26) 0.42 Lymph node dissection 0.99 0.04 PLA Ref Ref PLA+PALA 0.99 ( 0.81-1.23) 0.99 1.19 (1.01-1.40) 0.04 Hysterectomy types < 0.001 < 0.001 Type B Ref Ref Type C2 1.74 ( 1.59-1.92) < 0.001 2.33 (1.98-2.74) < 0.001 Type C1 2.78 ( 1.63-4.73) < 0.001 3.59 (2.26-5.70) < 0.001 Abbreviations: PLA, pelvic lymphadenectomy; PALA, para-aortic lymphadenectomy. Table 4. Unadjusted complications associated with radical hysterectomy for cervical cancer stratified by surgeon volume. Outcome Abdominal surgeon volume P value Laparoscopic surgeon volume P value Low Intermediate High Low Intermediate High N % N % N % N % N % N % Any 1 complication 148 3.06 a 168 3.42 a 96 2.01 b <0.001 137 5.19 150 5.69 148 5.16 0.62 Intraoperative complication 27 0.56 32 0.65 16 0.33 0.08 39 1.48 24 0.91 44 1.53 0.09 Ureteral injury 15 0.31 ab 22 0.45 a 8 0.16 b 0.045 28 1.06 14 0.53 24 0.84 0.10 Bladder injury 3 0.06 4 0.08 1 0.02 0.55 3 0.11 4 0.15 8 0.28 0.34 Bowel injury 0 0 2 0.04 0 0 0.33 1 0.04 1 0.04 4 0.14 0.38 Vascular injury 9 0.18 2 0.04 5 0.10 0.10 4 0.15 4 0.15 7 0.24 0.69 Obturator nerve injury 0 0 2 0.04 2 0.04 0.48 5 0.19 1 0.04 2 0.07 0.24 Stomach 0 0 0 0 0 —— —— 1 0.04 0 0 0 0 0.65 Postoperative complication 122 2.52 a 141 2.87 a 81 1.69 b <0.001 102 3.86 127 4.81 110 3.83 0.12 Bowel obstruction 46 0.95 ab 63 1.28 a 29 0.61 b 0.003 18 0.68 18 0.68 21 0.73 0.97 Pelvic hematoma 1 0.02 1 0.02 0 0 0.99 0 0 2 0.08 0 0 0.11 Hemorrhage 3 0.06 3 0.06 1 0.02 0.71 5 0.19 3 0.11 5 0.17 0.83 Vesicovaginal fistula 8 0.16 9 0.18 6 0.13 0.81 19 0.72 17 0.64 24 0.84 0.71 Ureterovaginal fistula 9 0.19 ab 21 0.43 a 6 0.13 b 0.006 27 1.02 a 47 1.78 b 31 1.08 a 0.02 Rectovaginal fistula 1 0.02 2 0.04 1 0.02 0.99 3 0.11 3 0.11 3 0.10 0.99 Ureteral 3 0.06 3 0.06 1 0.02 0.71 4 0.15 2 0.08 2 0.07 0.67 Venous thromboembolism 51 1.05 43 0.88 37 0.77 0.34 28 1.06 38 1.44 24 0.84 0.10 Chylous leakage 1 0.02 0 0 0 0 0.66 3 0.11 5 0.19 3 0.10 0.69 Other Death 0 0 0 0 2 0.04 0.11 0 0 1 0.04 1 0.03 0.77 Different letters on the shoulder mark indicate significant differences (P < 0.05), and the same letter or no letter indicates that the difference is not significant (P ≥ 0.05). Table 5. Multivariable analysis of factors associated with complications. Abdominal surgeon volume Laparoscopic surgeon volume Low Intermediate High P value Low intermediate High P value Any 1 complication 3.06% 3.42% 2.01% 0.10 5.19% 5.69% 5.16% 0.26 1.20 0.87-1.66 0.27 1.14 0.82-1.58 0.43 1.39 1.02-1.89 0.04 1.26 0.95-1.67 0.11 Intraoperative complication 0.56% 0.65% 0.33% 0.21 1.48% 0.91% 1.53% 0.46 0.46 0.19-1.09 0.08 1.23 0.67-2.26 0.51 0.58 0.25-1.38 0.22 0.86 0.48-1.54 0.61 Postoperative complication 2.52% 2.87% 1.69% 0.04 3.86% 4.81% 3.83% 0.13 1.38 0.97-1.96 0.07 1.09 0.75-1.58 0.65 1.55 1.11-2.15 0.01 1.34 0.98-1.83 0.07 The middle row for each complication class was adjusted for clinical and demographic factors, including age, year of diagnosis, urban-rural distribution, hospital function, region, city scale, mode of delivery, comorbidity, FIGO stage, gross type, histological type, preoperative treatment, lymph node dissection, and hysterectomy type reported, with the odds ratio (95% CI) of low vs. high volume. The bottom row for each complication class is adjusted for the factors mentioned above, with the odds ratio (95% CI) of intermediate vs. high volume. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2139253","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":142313303,"identity":"133baf38-0af0-4d8d-81ef-e701428d5fb2","order_by":0,"name":"Cong Liang","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Cong","middleName":"","lastName":"Liang","suffix":""},{"id":142314715,"identity":"50547041-3891-40e2-8432-280c9eaf7133","order_by":1,"name":"Weili Li","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Weili","middleName":"","lastName":"Li","suffix":""},{"id":142314716,"identity":"cc574247-b28a-4860-bf99-4ee7abe286bd","order_by":2,"name":"Xiaoyun Liu","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiaoyun","middleName":"","lastName":"Liu","suffix":""},{"id":142314717,"identity":"7a0aa3d5-3d0e-4a11-996c-e5487e221bb5","order_by":3,"name":"Hongwei Zhao","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hongwei","middleName":"","lastName":"Zhao","suffix":""},{"id":142314718,"identity":"7dbba33a-1228-4db2-8533-4247d823db9e","order_by":4,"name":"Lu Yin","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Lu","middleName":"","lastName":"Yin","suffix":""},{"id":142314719,"identity":"7d0a7b1a-00d2-4c79-8122-0ef2c85baea6","order_by":5,"name":"Mingwei Li","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mingwei","middleName":"","lastName":"Li","suffix":""},{"id":142314720,"identity":"4f6fbbe8-d357-415c-8345-cf4c523e94eb","order_by":6,"name":"Yu Guo","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yu","middleName":"","lastName":"Guo","suffix":""},{"id":142314721,"identity":"cd9ae4b2-16a2-4877-987f-b2545083dc5f","order_by":7,"name":"Jinghe Lang","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jinghe","middleName":"","lastName":"Lang","suffix":""},{"id":142314722,"identity":"9776cd38-e5a6-4335-93cc-80b3f19c8d94","order_by":8,"name":"Xiaonong Bin","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiaonong","middleName":"","lastName":"Bin","suffix":""},{"id":142314723,"identity":"aacaadbf-7908-4f33-8826-0a25e6361f40","order_by":9,"name":"Ping Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAp0lEQVRIiWNgGAWjYBACPgbmgw8gzAQitbAxsCUbkKqFx0yCRC3SDWaVP3MOM/Cz5xgw/NxBjBaZA2m3ebcdZpDseWPA2HuGGC0SCcduMwK1GNzIMWBmbCNKS2Jb4U+gFnsStCSzMYAcZiBBtBaZY8zSvNvSeSTOPCs42EuMFn7p/o8ff26zluNvT9744CcxWhigkcIDIg4QowGuZRSMglEwCkYBbgAAl44vyvOtmtUAAAAASUVORK5CYII=","orcid":"","institution":"","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Ping","middleName":"","lastName":"Liu","suffix":""},{"id":142314724,"identity":"dc7b42bb-9ccc-4a85-bbfa-21675485792d","order_by":10,"name":"Chunlin Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAoklEQVRIiWNgGAWjYFAC5oYDHyAsA2K1MDYenEGqlubDPCRp4W8/2HDY5s+2xAb25m0SDDV3CGuROJPYcDi37XZiA8+xMgmGY88IazGQYARqaQBqkcgxA7GJ1GLxB6hF/g0pWhjYQLbwEKkF5JeDvW23jdt40ootEo4RoYW//fDhDz/+3JbtZz+88caHGiK0wAEbiEggQcMoGAWjYBSMAjwAALyGPFiYtwX1AAAAAElFTkSuQmCC","orcid":"","institution":"","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Chunlin","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2022-10-06 15:23:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2139253/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2139253/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":27482471,"identity":"0a5f6c63-fa01-4aeb-8b73-368da5070114","added_by":"auto","created_at":"2022-10-07 17:43:47","extension":"tif","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":417817,"visible":true,"origin":"","legend":"\u003cp\u003eNumbers of patients and surgeons by year in abdominal surgery cohort (A); Numbers of patients and surgeons by year in laparoscopic surgery cohort (B).\u003c/p\u003e","description":"","filename":"FIGURE1.tif","url":"https://assets-eu.researchsquare.com/files/rs-2139253/v1/f0d00f2d104bf9828c5512bb.tif"},{"id":27482472,"identity":"601ac1a4-3e08-47b1-a120-b4db3d9b0eb2","added_by":"auto","created_at":"2022-10-07 17:43:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":820199,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2139253/v1/a87049d4-a0de-46cc-b46e-6f866c39db1c.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003e\u003cstrong\u003eEffect of surgeon case volume on major surgical complications for abdominal and laparoscopic radical hysterectomy for cervical cancer in China, 2004-2016: A retrospective cohort study\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCervical cancer ranks as the fourth most frequently diagnosed cancer in women (570,000 cases) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Radical hysterectomy with bilateral pelvic lymph node dissection is the recommended surgical treatment for women with early-stage disease [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Major complications during radical hysterectomy (RH) depend on many factors, such as patients characteristics, tumor characteristics, hospital medical resources, surgical approach [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], surgeon volume, and hospital volume [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Among these, the surgeon\u0026rsquo;s volume has increasingly received attention [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccumulative evidence to date has suggested that higher surgeon volume leads to improved perioperative outcomes for oncologic surgery, such as surgery for esophageal cancer [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], brain tumors [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], pancreatic cancer [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], bladder cancer [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], endometrial cancer [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], rectal cancer [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and lung cancer [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, some scholars argue that surgeon volume is not associated with complications [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Recognition of the volume-outcomes paradigm in high-risk cancer procedures has led to changes in practice. Consequently, some health systems are instituting a minimum surgeon volume standard for high-risk surgery, such as esophagectomy and lung resection [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Wright et al. demonstrated that women treated by high-volume surgeons had fewer postoperative medical complications and lower transfusion requirements after abdominal radical hysterectomy (ARH) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. To date, there are few studies that have investigated the association between surgeon volume and outcomes of laparoscopic radical hysterectomy (LRH) based on large population cohort, although there is a proportionate increase in LRH [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In addition, there is a paucity of data about surgeon volume in Asian populations.\u003c/p\u003e \u003cp\u003eThe first objective of this population-based analysis is to explore the association between surgeon volume and complications after ARH and LRH. The second objective is to examine changes in the number of surgeons, mean surgeon case volume and the total number of cases of cervical cancer over time.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData source\u003c/h2\u003e \u003cp\u003eData from the Major Surgical Complications of Cervical Cancer in China (MSCCCC) project database were utilized. The MSCCCC database is a multicenter retrospective database established to measure surgical quality. Approximately 97.5% of cases from the database could be matched to the cases in Chinese Clinical Cervical Cancer (FOUR-C) project (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.chictr.org.cn/index.aspx\u003c/span\u003e\u003cspan address=\"http://www.chictr.org.cn/index.aspx\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e, ChiCTR1800017778). The MSCCCC database gathers hospitalization information for 36,543 patients from 42 hospitals in 14 provinces of China from 2004\u0026ndash;2016 (updated of June 2020). The 42 hospitals consist of 32 general hospitals, 4 cancer centers and 6 women and children\u0026rsquo;s hospitals (W\u0026amp;C hospitals) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUsing the discharge diagnosis of \u0026ldquo;cervical cancer\u0026rdquo; as the keyword or the International Classification of Diseases Tenth Revision code C53.9 for computerized search, specially-trained gynecologists abstracted data from medical records and the hospital information system. The documentation used for data extraction on complications included inpatient medical records for surgical treatment, postoperative adjuvant therapy records within 6 months, outpatient records, and readmission to the other department for complication treatment within 2 years [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The MSCCCC database collects data on patient demographics, clinical characteristics, and hospital factors. After completion of double data entry, data checking were carried out by two independent gynecologists to eliminate input errors and logic errors. Data masking was used to protect patient privacy. Ethical approval was obtained from Institutional Ethics Committee of Southern Medical University Nanfang Hospital (NFEC-2017-135).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eCohort identification\u003c/h2\u003e \u003cp\u003eWomen who underwent RH for cervical cancer between 2004 and 2016 were analyzed. The inclusion criteria were as follows: 1) the patient had been diagnosed stage IA1 with LVSI (lymphovascular space invasion) to stage IIB, according to the 2009 International Federation of Gynecology and Obstetrics (FIGO) staging system; 2) the patient underwent type B or C RH (Querleu and Morrow classification) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u0026thinsp;+\u0026thinsp;pelvic lymphadenectomy (PLN) \u0026plusmn; para-aortic lymphadenectomy (PALA); and 3) the patient underwent ARH or LRH. The exclusion criteria were as follows: 1) the patient was diagnosed with cervical cancer during pregnancy, was diagnosed with incidental cervical cancer after extrafascial hysterectomy or had a prior history of other malignancies; 2) the patient had an unknown lymphadenectomy status or did not undergo lymphadenectomy; 3) the patient underwent laparoscopic-assisted radical vaginal hysterectomy or robot-assisted RH; or 4) the patient had missing surgeon data or a missing date of operation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eClinical and demographic characteristics\u003c/h2\u003e \u003cp\u003eThe demographic characteristics included age, year of surgery, urban-rural distribution, mode of delivery, and comorbidities. Clinical characteristics that were analyzed included FIGO stage, gross type of tumor, histological type, preoperative anticancer treatment, hysterectomy type and lymph node dissection. Other operation details include operative time and estimated blood loss.\u003c/p\u003e \u003cp\u003eThe hospitals where patients were treated were characterized based on hospital function (general hospital, cancer center, or W\u0026amp;C hospital), region of the country (north, south, central, east, southwest, northwest or northeast), and city scale (first-tier, second-tier, and third-tier or below). The levels of urban economic development were as follows: first-tier cities \u0026gt; second-tier cities \u0026gt; third-tier cities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSurgeon volume\u003c/h2\u003e \u003cp\u003eWe calculated the total volume of each surgeon. For each surgeon, annualized surgeon volumes were calculated as the total number of procedures that the surgeon performed divided by the number of years in which an individual surgeon contributed to at least one RH [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Patients were stratified into two cohorts based on the hysterectomy approach: ARH group or LRH group. Surgeon volume cutoff points were then selected to divide patients into approximately equal tertiles. Abdominal surgeon cutoff points were: low volume (\u0026le;\u0026thinsp;8.1 procedures per year), intermediate volume (8.2\u0026ndash;16.9 procedures per year), and high volume (\u0026gt;16.9 procedures per year). Laparoscopic surgeon cutoff points were: low volume (\u0026le;\u0026thinsp;11.0 procedures per year), intermediate volume (11.1\u0026ndash;20.0 procedures per year), and high volume (\u0026gt;20.0 procedures per year).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eOutcomes\u003c/h2\u003e \u003cp\u003eComplications were divided into intraoperative complications and postoperative complications. The intraoperative complications, which included ureteral injury, bladder injury, bowel injury, vascular injury, obturator nerve injury, and stomach injury, were recorded. Postoperative complications included bowel obstruction, pelvic hematoma, hemorrhage, vesicovaginal fistula, ureterovaginal fistula, ureteral fistula, rectovaginal fistula, venous thromboembolism and chylous leakage. We also recorded deaths from surgical complications.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe relationship between the number of surgeons and year was assessed by a non-parametric Spearman correlation test. Due to discontinuous data, one of the hospitals was not including in the graphs. Frequency distributions between categorical variables were compared using χ2 or the Fisher\u0026rsquo;s exact test, and continuous variables were compared using a one-way analysis of variance. The median and interquartile range (IQR) of surgeon volume were also reported for each tertile. Binary logistic regression models were used to determine predictors of treatment by the intermediate and high volume (highest 2/3 volume) surgeons. Demographic, clinical, and hospital characteristics constituted independent variables. To examine the association between surgeon volume and outcome, we built binary logistic regression models including surgeon volume while adjusting for the other variables described above. The results are reported as odds ratios (ORs) and 95% confidence intervals (CIs). A value of \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05 was considered statistically significant. All analyses were performed with the SPSS 23.0 statistical software package (SPSS, Inc., Chicago, IL, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eTrends in the number of surgeons and patients\u003c/h2\u003e \u003cp\u003eWe identified a total of 22,684 patients, including 14536 (64.1%) patients who underwent ARH and 8148 (35.9%) patients who underwent LRH (Table\u0026nbsp;1). The number of surgeons performing ARH each year increased from 89 surgeons who operated on 313 patients in 2004 to 187 surgeons who operated on 1,294 patients in 2012 (P\u0026lt;0.01, r\u0026thinsp;=\u0026thinsp;0.99). However, the number of abdominal surgeons decreased to 122 surgeons with 594 patients in 2016 (P\u0026thinsp;=\u0026thinsp;0.20, r=-0.80). The mean surgeon case volume increased from 3.5 cases in 2004 to 8.7 cases in 2013 and then decreased to 4.9 cases in 2016 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). The number of surgeons performing LRH increased from 1 surgeon with 1 patient in 2004 to 183 surgeons who operated on 2,206 patients in 2016 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01, r\u0026thinsp;=\u0026thinsp;0.99). The mean number of surgeons performing LRH increased from 1 to 12.1 cases between 2004 and 2016 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of the cohort\u003c/h2\u003e \u003cp\u003eIn the ARH cohort, the median volume of surgeons in the low-volume group was two (IQR 1.0-3.5) per year and rose to 30.9 (IQR 21.9\u0026ndash;42.1) in the high volume group. Similarly, in the LRH cohort, the median volume of surgeons in the low-volume group was 2.3 (IQR 1.0\u0026ndash;5.0) and increased to 27.8 (IQR 21.6\u0026ndash;30.1) in the high-volume group (Table\u0026nbsp;2). In both the ARH and LRH cohorts, the operation time and bleeding loss for patients in the high-volume surgeon group were significantly lower than those for patients in the intermediate-volume and low-volume groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;2).\u003c/p\u003e \u003cp\u003eIn the multivariable model of the ARH cohort, patients diagnosed in later years, patients living in rural areas, patients with a higher tumor stage (except stage IIB), patients with the endophytic or preclinical gross type, patients with preoperative radiotherapy, patients undergoing type C1 or C2 hysterectomy, patients undergoing surgery in a W\u0026amp;C hospital or cancer center, and patients undergoing surgery in a hospital of a first-tier city were more likely to be treated by high-volume or intermediate-volume surgeons (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;3).\u003c/p\u003e \u003cp\u003eSimilarly, in the multivariable model of the LRH cohort, age \u0026gt; 60 years, later year of diagnosis, previous cesarean section, FIGO stage IIA2 and IIB, PLN\u0026thinsp;+\u0026thinsp;PALA, and type C1 and C2 hysterectomy were associated with treatment by a high-volume or an intermediate-volume surgeon (P\u0026lt;0.05). In addition, patients undergoing surgery in the cancer center, patients undergoing surgery in the hospital of a second-tier city, and patients undergoing surgery in the hospital of the southwest area were more likely to be treated by intermediate- or high-volume surgeons (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Patients with the endophytic gross type, patients with neoadjuvant chemotherapy, and patients undergoing surgery in W\u0026amp;C hospitals were associated with treatment by a low-volume laparoscopic surgeon (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table\u0026nbsp;3).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eThe impact of surgeon volume on complications\u003c/h2\u003e \u003cp\u003eIn the univariate analysis of the ARH group, the overall complication rates were 3.06% for women treated by low-volume surgeons, 3.42% for those treated by intermediate-volume surgeons, and 2.01% for those treated by high-volume surgeons (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;4). Compared with patients treated by intermediate-volume surgeons, those operated on by high-volume surgeons had fewer postoperative complications (2.87% vs. 1.69%, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), fewer ureteral injuries (0.45% vs. 0.16%, P\u0026thinsp;=\u0026thinsp;0.045), fewer bowel obstructions (1.28% vs. 0.61%, P\u0026thinsp;=\u0026thinsp;0.003), and fewer ureterovaginal fistulas (0.43% vs. 0.13%, P\u0026thinsp;=\u0026thinsp;0.006). There was no significant difference in the frequencies of other complications (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eIn the univariate analysis of the LRH group, patients treated by intermediate-volume surgeons had the highest ureterovaginal fistula rate (low vs. intermediate vs. high volume\u0026thinsp;=\u0026thinsp;1.02% vs. 1.78% vs. 1.08%, P\u0026thinsp;=\u0026thinsp;0.02). The frequencies of the other complications among laparoscopic surgery cases were similar across the tertiles (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;4).\u003c/p\u003e \u003cp\u003eIn the multivariable analysis of the ARH cohort, patients treated by intermediate-volume surgeons were more likely to experience postoperative complications than those treated by high-volume surgeons (OR\u0026thinsp;=\u0026thinsp;1.55, 95% CI\u0026thinsp;=\u0026thinsp;1.11\u0026ndash;2.15). However, abdominal surgeon volume had no influence on overall complications or intraoperative complications (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In the multivariable analysis of the LRH cohort, surgeon volume had no effect on overall complications, intraoperative complications or postoperative complications (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;5).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur findings suggest that trends in the number of surgeons and mean surgeon case volume over time were different in ARH and LRH. In the ARH cohort, postoperative complication rates were higher among intermediate-volume surgeons, while patients treated by high-volume surgeons had lower postoperative complications. However, in the LRH cohort, surgeon volume had little effect on intraoperative and postoperative complications.\u003c/p\u003e \u003cp\u003eThe trends in the number of surgeons and mean surgeon volume over time were differed between the two surgical approaches. From 2004 to 2016, the number of laparoscopic surgeons and mean surgeon case volume rose annually. This increasing acceptance of laparoscopic technique could be due to the short-term benefits of LRH, including a more cosmetically pleasing incision, less bleeding, less postoperative pain, and faster postoperative recovery. However, the opposite trend was observed in ARH cohort. The number of abdominal surgeons and mean surgeon case volume have been decreasing since 2013. In addition, it is noteworthy that categorical definitions of surgeon volume varied substantially among the different studies. In the study of Wright et al.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], a high-volume surgeon and a low-volume surgeon were defined as a surgeon who performed more than 3.75 and less than 2.25 ARHs per year, respectively; but we defined the same terms as a surgeon who performed greater than 16.9 and less than or equal to 8.1 ARHs per year, respectively. The surgeon volume gap between the two groups was much larger than that of the study by Wright et al.. In addition, our results revealed a positive correlation between the number of surgeons and the number of patients. The increasing number of surgeons could effectively alleviate national disease stress. In patients with endometrial cancer in the United States, although there was a small increase in the overall number of patients per year, the surgical treatment of patients has been limited to a smaller number of surgeons [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. They suggested that the increased complexity of treatment has resulted in fewer general gynecologists treating these women. Referral of women with endometrial cancer to gynecologic oncology subspecialists is recommended [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur data demonstrated that the association between surgeon volume and complications for cervical cancer was complex. In the ARH cohort, the postoperative complication rate was higher for intermediate-volume surgeons than for high-volume surgeons (OR\u0026thinsp;=\u0026thinsp;1.55, 95%=1.11\u0026ndash;2.15). However, the postoperative complication rate was found to be similar in the low-volume surgeon group and high-volume surgeon group (OR\u0026thinsp;=\u0026thinsp;1.38, 95%=0.97\u0026ndash;1.96). This observation resembles that of Wright et al.\u003csup\u003e16\u003c/sup\u003e. Their results showed that the perioperative complication rate was highest in the intermediate-volume surgeon group compared with the low-volume and high-volume surgeon groups (low vs. intermediate vs. high\u0026thinsp;=\u0026thinsp;2.9% vs. 6.7% vs. 1.8%, P\u0026lt;0.001). However, no direct comparisons between intermediate-volume surgeons group and other groups were performed in their study. We suppose that surgeon volume had an inverted U-shaped relationship with postoperative complications, rather than a simple linear relationship. Low-volume surgeons with limited experience and limited surgical opportunities performed surgery with utmost caution to prevent complications. The majority of high-volume surgeons benefited from the effect of sufficient learning curve and close cooperation with an experienced surgical team, which translates into a lower complication rate. One possible reason for highest postoperative complications in the intermediate-volume surgeon group could be that they were more lenient in their selection of patients. Patients treated by intermediate-volume surgeons had a higher frequency of FIGO stage IIB, more preoperative radiotherapy, and a higher frequency of PLA +PALA and type C2 hysterectomy. In the Laparoscopic Approach to Cervical Cancer (LACC) trial, ARH was associated with higher rates of disease-free survival and overall survival than minimally invasive radical hysterectomy among women with early-stage cervical cancer [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. ARH therefore has re-emerged as a mainstream treatment for cervical cancer. We may need to pay more attention to the impact of the abdominal surgeon volume on complications.\u003c/p\u003e \u003cp\u003eIn our laparoscopy surgery cohort, surgeon volume had no significant effects on intraoperative complications or postoperative complications. It appears that the effects of surgeon volume on radical hysterectomy complications of different surgical routes are different. Similar results have been reported in endometrial cancer. Among patients who underwent abdominal hysterectomy for endometrial cancer, increased surgical volume was associated with reductions in perioperative surgical complications and medical complications [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, during laparoscopic hysterectomy, the surgeon volume appear to have little effect on perioperative morbidity for endometrial cancer [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. A retrospective analysis of 1016 laparoscopic hysterectomies for benign gynecologic problems found that increasing the surgical volume could not reduce the rate of serious complications [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In addition, surgeon volumes in terms of different surgical procedures differentially affects surgical complication outcomes. This population-based study by Sheetz et al. demonstrated that the comparative safety of laparoscopic and open colectomy was influenced by surgeon volume, but the relationship was stronger for laparoscopy [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNumerous factors affects surgical experience. First, surgical experience was assessed and quantified by different metrics, such as annual surgeon volume (frequency), technique-specific volume, surgeon cumulative volume, and years of experience [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Yasunaga et al.[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] defined surgeon volume as the number of radical hysterectomies that each gynecologist had performed as an operating surgeon over his or her professional career. Their study showed that higher surgeon volume (greater than 200 procedures) was associated with a reduced incidence of postoperative urinary disorders. However, they did not mention the surgical route of radical hysterectomy. Second, surgical educators recognize that skill sets may transfer between operations [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Modrall et al [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. defined the aggregate annual volume per surgeon of upper gastrointestinal operations as the \u0026ldquo;surrogate volume\u0026rdquo;, including excision of esophageal diverticulum, gastrectomy, gastroduodenectomy, and repair of diaphragmatic hernia. Among surgeons with a low-volume esophagectomy experience, increasing the volume of surrogate operations improved the outcomes observed for esophagectomy. However, there has been little discussion about \u0026ldquo;surrogate surgery\u0026rdquo; in gynecological cancer surgery. It was uncertain whether surrogate operative experiences, such as experiences of extrafascial hysterectomy in benign disease and cytoreductive surgery in ovarian cancer, yield improvements in outcomes for radical hysterectomy. Third, the characteristics of the surgeons may have an effect on surgical experience, such as the age of the surgeon. Surgeon age\u0026thinsp;\u0026le;\u0026thinsp;51 and \u0026ge; 56 years may increase short- and long-term mortality after esophagectomy for cancer, and the highest surgical competence is achieved between 52 and 56 years of surgeon age [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The reason for the decreasing performance among older surgeons might be related to mental fatigue, poorer compliance with evidence-based medicine, and higher administrative positions leading to reduced surgical frequency\u003csup\u003e31\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis population-based study is the first to examine changes in the number of surgeons and annual surgeon volume for cervical cancer over time, and to explore the association between surgeon volume and complications after ARH and LRH in China. First, a strength of our study is its large sample size. We reviewed 22,684 cases treated at 42 hospitals over a 13-year period so that data on the rare adverse events could be collected. Second, we also included clinical characteristics, such as FIGO stage, histology, preoperative treatment, hysterectomy type, and lymph node dissection type that may influence treatment outcome\u003csup\u003e17\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWe also recognize several limitations to our findings. First, this study was a retrospective study in which the data were obtained from inpatient medical records or through readmission. Data on complications that may have occurred after discharge and have been treated by other hospitals, could not be obtained. Second, we divided the patients into tertiles based on annualized surgeon volumes, but the results of the present study could not translate into clinically meaning cutoff points. Third, although we considered a wide range of clinical characteristics and tumor characteristics, there might be other unmeasured confounding factors affecting complications, such as assistant surgeons [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], uterine size, downstream care, surgical instruments and management of complications. In addition, skill transference between LRH and ARH remains unclear. Fourth, our study only included patients from only 42 hospitals and the findings may not be representative of other areas in China.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, patients treated by intermediate-volume surgeons may have more postoperative complications after ARH, while patients treated by high-volume surgeons had fewer postoperative complications. In the LRH cohort, surgeon volume appeared to have no significant predictive value for complications.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful to Min Hao (Department of Obstetrics and Gynecology, The Second Hospital of ShanXi Medical University), Wuliang Wang (Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zhengzhou University), Ying Yang (Department of Obstetrics and Gynecology, Xinqiao Hospital, Third Military Medical University), Shan Kang (Department of Obstetrics and Gynecology, The Forth Hospital of Hebei Medical University \u0026amp; The Tumor Hospital of Hebei Province), Bin Ling (Department of Obstetrics and Gynecology, China-Japan Friendship Hospital), Xinli Sun and Hongwei Zhao (Department of Gynecology, Shanxi Provincial Cancer Hospital), Yu Guo and Lihong Lin (Department of Gynecology, Anyang Tumor Hospital), Li Wang (Department of Gynecology, The Affiliated Tumor Hospital of Zhengzhou University), Weidong Zhao (Department of Gynecology and Oncology, Anhui Provincial Cancer Hospital), Yan Ni (Department of Obstetrics and Gynecology, The Yuncheng Central Hospital of Shanxi province), Donglin Li and Wentong Liang (Department of Obstetrics and Gynecology, Guizhou Provincial People`s Hospital), Jianxin Guo (Department of Obstetrics and Gynecology, Daping Hospital, The Third Military Medical University), Xuemei Zhan and Mingwei Li (Department of Gynecology, Jiangmen Central Hospital), Weifeng Zhang (Department of Obstetrics and Gynecology, Ningbo Women \u0026amp; Children\u0026apos;s Hospital), Peiyan Du (Department of Gynecological Oncology, Cancer Center of Guangzhou Medical University), Ziyu Fang (Department of Obstetrics and Gynecology, Liuzhou Workers\u0026apos; Hospital), Long Chen (Department of Obstetrics and Gynecology, Qingdao Municipal Hospital), Encheng Dai and Ruilei Liu (Department of Obstetrics and Gynecology, Linyi People\u0026apos;s Hospital), Mubiao Liu and Yuanli He (Department of Obstetrics and Gynecology, Zhujiang Hospital, Southern Medical University), Jilong Yao and Zhihua Liu (Department of Obstetrics and Gynecology, Shenzhen Maternity \u0026amp; Child Healthcare Hospital), Xueqin Wang (Department of Obstetrics and Gynecology, The Fifth Affiliated Hospital of Southern Medical University), Yan Xu (Department of Obstetrics and Gynecology, Guangzhou Panyu Central Hospital), Ben Ma (Department of Obstetrics and Gynecology, Guangzhou First People\u0026apos;s Hospital), Zhonghai Wang (Department of Obstetrics and Gynecology, Shenzhen Nanshan People\u0026apos;s Hospital), Lin Zhu (Department of Gynecology, The Second Hospital of Shandong University), Hongxin Pan (Department of Obstetrics and Gynecology, the 3rd Affiliated Hospital of Shenzhen University, Luohu People\u0026apos;s Hospital), Qianyong Zhu (Department of Obstetrics and Gynecology, No.153. Center Hospital of Liberation Army, Hospital No.988 of the Chinese People\u0026apos;s Liberation Army Joint Support Force), Xiaohong Wang (Department of Obstetrics and Gynecology, Jinan City People\u0026apos;s Hospital, Former Laiwu People\u0026apos;s Hospital), Dingyuan Zeng and Zhong Lin (Department of Obstetrics and Gynecology, Maternal and Child Health Care Hospital of Liuzhou), Shaoguang Wang (Department of Obstetrics and Gynecology, Yantai Yuhuangding Hospital), Bin Zhu (Department of Obstetrics and Gynecology, Yiwu Maternal and Child Health Hospital), Anwei Lu (Department of Obstetrics and Gynecology, Maternal and Child Health Care Hospital of Guizhou Province), Mei Ji (Department of Obstetrics and Gynecology, the First Affiliated Hospital of Zhengzhou University), Qianqing Wang (Department of Obstetrics and Gynecology, Central Hospital Affiliated to Xinxiang Medical University),\u0026nbsp;Zhumei Cui (Department of Gynecology, The Affiliated Hospital of Qingdao University Medical College), Biliang Chen (Department of Gynecology, Xijing Hospital of Air Force Medical University), Qinghuang Xie (Department of Gynecology, Foshan Women and Children Hospital), Qiubo Lv (Department of Gynecology, Beijing Hospital), Chang Liu (Department of Gynecology, the First Hospital of Lanzhou University), and Yi Zhang (Department of Gynecology, the First Hospital of China Medical University) for providing medical records.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCL and WL: Major contributor in writing the manuscript and analyzed the participant data; XL, HZ, LY, ML,YG, and JL: Contribute to data collection; XB: Contribute to data analysis; CC: Funding recipient and major contributor in study design. All authors gave final approval of the content of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe National Science and Technology Support Program of China (2014BAI05B03);\u003c/p\u003e\n\u003cp\u003eThe Natural Science Fund of Guangdong Province (2015A030311024);\u003c/p\u003e\n\u003cp\u003eThe Science and Technology Plan of Guangzhou (158100075).\u003c/p\u003e\n\u003cp\u003eThey provided financial assistance that played an important role in the collection of data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset generated and/or analysed during the current study are not publicly available due to promises of participant anonymity and confidentiality but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from Institutional Ethics Committee of Southern Medical University Nanfang Hospital (NFEC-2017-135).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) declared no potential conficts of interest for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China. \u003csup\u003e2\u003c/sup\u003e Department of Gynecology, The Third Affiliated Hospital of Zunyi Medical College, Zunyi, China. \u003csup\u003e3\u0026nbsp;\u003c/sup\u003eDepartment of Gynecology, Shanxi Provincial Cancer Hospital, Taiyuan, China. \u003csup\u003e4\u003c/sup\u003e Department of Obstetrics and Gynecology, the Jiangmen Central Hospital of SUN YAT-SEN University, Jiangmen, China. \u003csup\u003e5\u003c/sup\u003e Department of Gynecology, Anyang Tumor Hospital, Anyang, China. \u003csup\u003e6\u003c/sup\u003e Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College \u0026amp; Chinese Academy of Medical Science, Beijing, China. \u003csup\u003e7\u003c/sup\u003e Department of Epidemiology, College of Public Health, Guangzhou Medical University, Guangzhou, China.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. 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Effect of laparoscopic versus abdominal radical hysterectomy on major surgical complications in women with stage IA-IIB cervical cancer in China, 2004\u0026ndash;2015. Gynecol Oncol. 2020;156(1):115\u0026ndash;123.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu P, Liang C, Lu A, et al. Risk factors and long-term impact of urologic complications during radical hysterectomy for cervical cancer in China, 2004\u0026ndash;2016. Gynecol Oncol. 2020;158(2):294\u0026ndash;302.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQuerleu D, Morrow CP. Classification of radical hysterectomy. Lancet Oncol. 2008;9(3):297\u0026ndash;303.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWright JD, Wright JD, Hershman DL, et al. Influence of Surgical Volume on Outcome for Laparoscopic Hysterectomy for Endometrial Cancer. Ann Surg Oncol. 2012;19(3):948\u0026ndash;958.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePractice Bulletin No. 149: Endometrial cancer. Obstet Gynecol. 2015;125(4):1006\u0026ndash;1026.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRamirez PT, Frumovitz M, Pareja R, et al. Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer. N Engl J Med. 2018;379(20):1895\u0026ndash;1904.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWright JD, Lewin SN, Deutsch I, Burke WM, Sun X, Herzog TJ. Effect of surgical volume on morbidity and mortality of abdominal hysterectomy for endometrial cancer. Obstetrics and gynecology (New York. 1953). 2011;117(5):1051\u0026ndash;1059.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTunitsky E, Citil A, Ayaz R, Esin S, Knee A, Harmanli O. Does surgical volume influence short-term outcomes of laparoscopic hysterectomy? Am J Obstet Gynecol. 2010;203(1):21\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSheetz KH, Norton EC, Birkmeyer JD, Dimick JB. Provider Experience and the Comparative Safety of Laparoscopic and Open Colectomy. Health Serv Res. 2017;52(1):56\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaruthappu M, Gilbert BJ, El-Harasis MA, et al. The Influence of Volume and Experience on Individual Surgical Performance. Ann Surg. 2015;261(4):642\u0026ndash;647.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCusimano MC, Baxter NN, Gien LT, et al. Impact of surgical approach on oncologic outcomes in women undergoing radical hysterectomy for cervical cancer. Am J Obstet Gynecol. 2019;221(6):611\u0026ndash;619.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYasunaga H, Nishii O, Hirai Y, Ochiai K, Matsuyama Y, Ohe K. Impact of surgeon and hospital volumes on short-term postoperative complications after radical hysterectomy for cervical cancer. J Obstet Gynaecol Re. 2009;35(4):699\u0026ndash;705.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eModrall JG, Chung J, Kirkwood ML, et al. Low rates of complications for carotid artery stenting are associated with a high clinician volume of carotid artery stenting and aortic endografting but not with a high volume of percutaneous coronary interventions. J Vasc Surg. 2014;60(1):70\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eModrall JG, Minter RM, Minhajuddin A, et al. The Surgeon Volume-outcome Relationship. Ann Surg. 2018;267(5):863\u0026ndash;867.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarkar SR, Mackenzie H, Lagergren P, Lagergren J. Surgeon Age in Relation to Prognosis After Esophageal Cancer Resection. Ann Surg. 2018;268(1):100\u0026ndash;105.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeery SE, O'Donnell TFX, Zettervall SL, et al. Use of an Assistant Surgeon Does not Mitigate the Effect of Lead Surgeon Volume on Outcomes Following Open Repair of Intact Abdominal Aortic Aneurysms. Eur J Vasc Endovasc. 2018;55(5):714\u0026ndash;719.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:center;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eTable 1. Schema of patient selection.\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable style=\"width:418.2pt;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 311.85pt;border-color: windowtext currentcolor;border-style: solid none;border-width: 1.5pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eVariable\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.35pt;border-color: windowtext currentcolor;border-style: solid none;border-width: 1.5pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003eNo. of patients\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 311.85pt;border: medium none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e1.All patients diagnosed with cervical cancers, 2004-2016\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.35pt;border: medium none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e36,543\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 311.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e2. Type B or C radical hysterectomy\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.35pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e31,581\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 311.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e3. Pelvic lymphadenectomy\u0026nbsp;\u003c/span\u003e\u003cspan style=\"font-size:13px;font-family:Symbol;\"\u003e\u0026plusmn;\u003c/span\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;para-aortic lymphadenectomy\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.35pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e30,641\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 311.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e4. 2009 FIGO stage IA1 with LVSI to IIB\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.35pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e24,447\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 311.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e5. No pregnancy, incidental cervical cancer or previous malignant disease\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.35pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e24,350\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 311.85pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e6. Abdominal surgery or total laparoscopic surgery\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.35pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e23,409\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 311.85pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e7. Missing information of surgeon or date of surgery\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106.35pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:13px;font-family:\"Times New Roman\",serif;'\u003e22,684\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cspan style=\"font-size:14px;font-family:DengXian;\"\u003e\u003cbr\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:center;line-height:150%;\"\u003e\u003cstrong\u003e\u003cspan style='line-height:150%;font-family:\"Times New Roman\",serif;'\u003eTable 2. Demographic and clinical characteristics of the abdominal and laparoscopic cohorts stratified by surgeon volume.\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable style=\"width:100.0%;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 18.08%;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1.5pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 28.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:center;line-height:150%;\"\u003e\u003cspan style='font-size:12px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eCharacteristic\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" style=\"width: 34.46%;border-color: windowtext currentcolor;border-style: solid none;border-width: 1.5pt medium;padding: 0in 5.4pt;height: 28.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:center;line-height:150%;\"\u003e\u003cspan style='font-size:12px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eAbdominal surgeon volume\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 6.16%;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1.5pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 28.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;line-height:150%;\"\u003e\u003cem\u003e\u003cspan style='font-size:12px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eP\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:12px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003evalue\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" style=\"width: 35.12%;border-color: windowtext currentcolor;border-style: solid none;border-width: 1.5pt medium;padding: 0in 5.4pt;height: 28.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:center;line-height:150%;\"\u003e\u003cspan style='font-size:12px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eLaparoscopic surgeon volume\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 6.16%;border-color: windowtext currentcolor;border-style: solid none;border-width: 1.5pt medium;padding: 0in 5.4pt;height: 28.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;line-height:150%;\"\u003e\u003cem\u003e\u003cspan style='font-size:12px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eP\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:12px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003evalue\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 10.44%;border: medium none;padding: 0in 5.4pt;height: 28.75pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:center;line-height:150%;\"\u003e\u003cspan style='font-size:12px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eLow\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.78%;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1.5pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 28.75pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:center;line-height:150%;\"\u003e\u003cspan style='font-size:12px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eIntermediate\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 12.26%;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1.5pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 28.75pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:center;line-height:150%;\"\u003e\u003cspan style='font-size:12px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eHigh\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10.42%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 28.75pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:center;line-height:150%;\"\u003e\u003cspan style='font-size:12px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eLow\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 12.42%;border-color: windowtext currentcolor;border-style: solid none;border-width: 1.5pt medium;padding: 0in 5.4pt;height: 28.75pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:center;line-height:150%;\"\u003e\u003cspan style='font-size:12px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eIntermediate\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 12.28%;border-color: windowtext currentcolor;border-style: solid none;border-width: 1.5pt medium;padding: 0in 5.4pt;height: 28.75pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:center;line-height:150%;\"\u003e\u003cspan style='font-size:12px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eHigh\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18.08%;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1.5pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003ePatients\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.44%;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1.5pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e4837\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.98%;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1.5pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e33.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.16%;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1.5pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e4913\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.62%;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1.5pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e33.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.4%;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1.5pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e4786\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.86%;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1.5pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e32.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.16%;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1.5pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.44%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e2642\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.98%;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1.5pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e32.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.66%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e2637\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.76%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e32.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.4%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e2869\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.88%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e35.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.16%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18.08%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eSurgeons\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.44%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e362\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.98%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.16%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e44\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.62%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.4%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e22\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.86%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.16%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.44%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e212\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.98%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.66%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e33\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.76%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.4%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e18\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.88%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.16%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18.08%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eAnnualized hospital volume\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10.44%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e2.0\u003c/span\u003e \u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e(1.0-3.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.78%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e10.8 (9.1-12.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 12.26%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e30.9 (21.9-42.1)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.16%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10.42%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e2.3 (1.0-5.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 12.42%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e13.5(12.3-16.9)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 12.28%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e27.8(21.6-30.1)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.16%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18.08%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eAge at surgery, years\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.44%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.98%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.16%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.62%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.4%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.86%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.16%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.44%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.98%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.66%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New 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style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e331\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.98%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e12.5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.66%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New 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style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e6.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.16%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18.08%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New 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style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.98%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.66%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New 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style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.16%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18.08%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New 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style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e2893\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.62%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e58.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.4%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New 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style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1998\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.98%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e75.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.66%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New 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style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e970\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.62%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e19.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.4%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New 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style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e557\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.98%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e21.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.66%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New 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style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e23.2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.16%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18.08%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003ePreoperative radiotherapy\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.44%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e137\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.98%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e2.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.16%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e378\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.62%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e7.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.4%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e281\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.86%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e5.9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.16%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.44%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e47\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.98%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.66%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e90\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.76%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e3.4%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.4%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e38\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.88%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1.3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.16%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18.08%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eLymph node dissection\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.44%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.98%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.16%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.62%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.4%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.86%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.16%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.44%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.98%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.66%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.76%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.4%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.88%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp 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style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e37\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.98%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.66%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e54\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.76%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e2.0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.4%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e11\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.88%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.16%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18.08%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eOperation time\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10.44%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e232.8\u0026plusmn;64.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.78%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e205.0\u0026plusmn;55.4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 12.26%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e164.7\u0026plusmn;52.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.16%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10.42%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e259.6\u0026plusmn;77.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 12.42%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e234.4\u0026plusmn;70.8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 12.28%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e209.6\u0026plusmn;64.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.16%;border: medium none;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 18.08%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eBlood loss\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10.44%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e499.2\u0026plusmn;363.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.78%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e470.3\u0026plusmn;375.14\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 12.26%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e241.0\u0026plusmn;211.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.16%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10.42%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e216.2\u0026plusmn;305.7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 12.42%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e193.0\u0026plusmn;188.6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 12.28%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e185.1\u0026plusmn;170.1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.16%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eAbbreviations: PLA, pelvic lymphadenectomy; PALA, para-aortic lymphadenectomy.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size:14px;font-family:DengXian;\"\u003e\u003cbr\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:center;line-height:150%;\"\u003e\u003cstrong\u003e\u003cspan style='line-height:150%;font-family:\"Times New Roman\",serif;'\u003eTable 3. Predictors of the high and intermediate volume surgeons.\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable style=\"border-collapse: collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1.5pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 278.95pt;border-color: windowtext currentcolor;border-style: solid none;border-width: 1.5pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eAbdominal cohort\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 279pt;border-color: windowtext currentcolor;border-style: solid none;border-width: 1.5pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eLaparoscopic cohort\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eOR (95% CI)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;border-color: windowtext currentcolor;border-style: solid none;border-width: 1.5pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eP value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eOR (95% CI)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eP value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;border: medium none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eAge at surgery, years\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;border: medium none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;border: medium none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.16\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;border: medium none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;border: medium none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.002\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026ge; 60\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan 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style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e2010-2016\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e1.55\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e(\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e1.41-1.69)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1.46 (1.06-2.01)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 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style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.87 (0.72-1.08)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.20\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eHospital function\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: 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style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eGeneral hospital\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp 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139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eCancer center\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New 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style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1.82 (1.49-2.23)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eW\u0026amp;C center\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp 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top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e8.75 (6.32-12.12)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eThird-tier\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.37\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e(\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.31-0.43)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1.18 (0.89-1.56)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.25\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eMode of delivery\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.004\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eNo delivery\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e1.01\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e(\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.68-1.49)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.97\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1.06 (0.57-1.98)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.84\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eVaginal delivery\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eCesarean delivery\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e1.06\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e(\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.89-1.27)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.51\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1.36 (1.10-1.68)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.005\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eUnknown\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.66\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e(\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.59-0.74)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1.33 (1.07-1.67)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.01\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eComorbidity\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp 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style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e(\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.77-1.48)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.71\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1.85 (1.13-3.03)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.02\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eGross type\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New 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style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.008\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eExophytic\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eEndophytic\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e2.09\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e(\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e1.78-2.45)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.64 (0.48-0.86)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.003\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eUlcerated\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.87\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e(\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.78-0.98)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.018\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1.16 (0.98-1.38)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.08\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eEndocervical\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.55\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e(\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.40-0.77)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.89 (0.56-1.42)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.63\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eAfter conization\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.92\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e(\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.70-1.19)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.52\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1.21 (0.85-1.70)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.29\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003ePreclinical carcinoma\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e1.41\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e(\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e1.20-1.65)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.88 (0.72-1.08)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.22\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eUnknown\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.73\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e(\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.64-0.85)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1.05 (0.87-1.28)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.61\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eHistological types\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.021\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.97\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eSquamous cell\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eAdenocarcinoma\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.89\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e(\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.77-1.02)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.10\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1.06 (0.87-1.28)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.56\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eAdenosquamous\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.81\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e(\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.62-1.07)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n 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\u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eOther subtypes\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.66\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e(\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.49-0.90)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.008\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.98 (0.64-1.48)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.90\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eUnknown\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.75\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e(\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.33-1.72)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.50\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.89 (0.50-1.57)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.68\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003ePreoperative treatment\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eNo received\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eNeoadjuvant chemotherapy\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.81\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e(\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.72-0.91)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.69 (0.57-0.82)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003ePreoperative radiotherapy\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e1.91\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e(\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e1.53-2.39)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.85 (0.58-1.26)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.42\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eLymph node dissection\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.99\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.04\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003ePLA\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003ePLA+PALA\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.99\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e(\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.81-1.23)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.99\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1.19 (1.01-1.40)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.04\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eHysterectomy types\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eType B\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eRef\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eType C2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e1.74\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e(\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e1.59-1.92)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e2.33 (1.98-2.74)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 139.45pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eType C1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.45pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e2.78\u0026nbsp;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e(\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e1.63-4.73)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e3.59 (2.26-5.70)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 139.5pt;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;\u003c/span\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eAbbreviations: PLA, pelvic lymphadenectomy; PALA, para-aortic lymphadenectomy.\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-size:14px;font-family:DengXian;\"\u003e\u003cbr\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:center;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eTable 4. Unadjusted complications associated with radical hysterectomy for cervical cancer stratified by surgeon volume.\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable style=\"width:100.0%;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 22.7%;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1.5pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 20.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:center;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eOutcome\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" style=\"width: 32.38%;border-color: windowtext currentcolor;border-style: solid none;border-width: 1.5pt medium;padding: 0in 5.4pt;height: 20.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eAbdominal surgeon volume\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 7.88%;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1.5pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 20.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:center;\"\u003e\u003cem\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eP\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:12px;font-family: \"Times New Roman\",serif;'\u003evalue\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" style=\"width: 30.96%;border-color: windowtext currentcolor;border-style: solid none;border-width: 1.5pt medium;padding: 0in 5.4pt;height: 20.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eLaparoscopic surgeon volume\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 6.08%;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1.5pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 20.3pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:center;\"\u003e\u003cem\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eP\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:12px;font-family: \"Times New Roman\",serif;'\u003evalue\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 11.42%;border: medium none;padding: 0in 5.4pt;height: 19.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eLow\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10.96%;padding: 0in 5.4pt;height: 19.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eIntermediate\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10%;padding: 0in 5.4pt;height: 19.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eHigh\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10%;border: medium none;padding: 0in 5.4pt;height: 19.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eLow\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10.96%;padding: 0in 5.4pt;height: 19.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eIntermediate\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 10%;padding: 0in 5.4pt;height: 19.25pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eHigh\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.7%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.78%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eN\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.64%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.9%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eN\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.06%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.9%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eN\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.1%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.88%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;background:yellow;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.78%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eN\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.22%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.24%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eN\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.72%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.78%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eN\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.22%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.08%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New 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style=\"width: 5.72%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.53\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.78%;padding: 0in 5.4pt;height: 1pt;vertical-align: bottom;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e24\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.22%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New 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style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.64%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.06\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.9%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.06%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.08\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.9%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.1%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New 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style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.11\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.24%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.72%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.15\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.78%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.22%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.28\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.08%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New 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style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.9%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.06%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.04\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.9%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.1%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.88%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New 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style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.72%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.04\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.78%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.22%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.14\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.08%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.38\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.7%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times 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style=\"width: 6.08%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.83\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22.7%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eVesicovaginal fistula\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.78%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.64%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.16\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.9%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.06%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.18\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3.9%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.1%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.13\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.88%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.81\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.78%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e19\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.22%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New 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style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e24\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.22%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.84\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.08%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.71\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n 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1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.1%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.13\u003c/span\u003e\u003csup\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003eb\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.88%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.006\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.78%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e27\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.22%;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1.02\u003csup\u003ea\u003c/sup\u003e\u003c/span\u003e\u003c/p\u003e\n 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stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.1%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.04\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.88%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.11\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.78%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.22%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.24%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.72%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.04\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 4.78%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5.22%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.03\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.08%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;height: 1pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.77\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;line-height:150%;\"\u003e\u003cspan style='font-size:13px;line-height:150%;font-family:\"Times New Roman\",serif;'\u003eDifferent letters on the shoulder mark indicate significant differences (P \u0026lt; 0.05), and the same letter or no letter indicates that the difference is not significant (P \u0026ge; 0.05).\u003c/span\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;line-height:150%;\"\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:center;\"\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003eTable 5. Multivariable analysis of factors associated with complications.\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable style=\"width:100.0%;border-collapse:collapse;border:none;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.82%;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1.5pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 31.94%;border-color: windowtext currentcolor;border-style: solid none;border-width: 1.5pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eAbdominal surgeon volume\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.16%;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1.5pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 31.94%;border-color: windowtext currentcolor;border-style: solid none;border-width: 1.5pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eLaparoscopic surgeon volume\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.16%;border-color: windowtext currentcolor currentcolor;border-style: solid none none;border-width: 1.5pt medium medium;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.82%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.42%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eLow\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.54%;border-color: windowtext currentcolor;border-style: solid none;border-width: 1.5pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eIntermediate\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.42%;border-color: windowtext currentcolor;border-style: solid none;border-width: 1.5pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eHigh\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.56%;border-color: windowtext currentcolor;border-style: solid none;border-width: 1.5pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.16%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cem\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eP\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003evalue\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.42%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eLow\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.54%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eintermediate\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.42%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eHigh\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.56%;border-color: windowtext currentcolor;border-style: solid none;border-width: 1.5pt medium;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.16%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cem\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eP\u0026nbsp;\u003c/span\u003e\u003c/em\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003evalue\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.82%;border: medium none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003eAny 1 complication\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.42%;border: medium none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e3.06%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.54%;border: medium none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e3.42%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.42%;border: medium none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e2.01%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.56%;border: medium none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.16%;border: medium none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.10\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.42%;border: medium none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e5.19%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.54%;border: medium none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e5.69%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.42%;border: medium none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e5.16%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.56%;border: medium none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.16%;border: medium none;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.26\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.82%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.42%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.54%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.42%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp 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7.16%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.22\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.42%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.54%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.42%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.86\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.56%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.48-1.54\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.16%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.61\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.82%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cstrong\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;'\u003ePostoperative complication\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.42%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e2.52%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.54%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e2.87%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.42%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1.69%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.56%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.16%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.04\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.42%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e3.86%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.54%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e4.81%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.42%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e3.83%\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.56%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.16%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.13\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.82%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.42%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.54%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.42%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1.38\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.56%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.97-1.96\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.16%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.07\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.42%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.54%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.42%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1.09\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.56%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.75-1.58\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.16%;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.65\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.82%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.42%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.54%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.42%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1.55\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.56%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1.11-2.15\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.16%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.01\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.42%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10.54%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6.42%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e1.34\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8.56%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.98-1.83\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.16%;border-color: currentcolor currentcolor windowtext;border-style: none none solid;border-width: medium medium 1.5pt;border-image: none 100% / 1 / 0 stretch;padding: 0in 5.4pt;vertical-align: top;\"\u003e\n \u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:justify;\"\u003e\u003cspan style='font-size:12px;font-family:\"Times New Roman\",serif;color:black;'\u003e0.07\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp style=\"margin-right:0in;margin-left:0in;font-size:14px;font-family:DengXian;margin:0in;text-align:left;line-height:150%;\"\u003e\u003cspan style='line-height:150%;font-family:\"Times New Roman\",serif;'\u003eThe middle row for each complication class was adjusted for clinical and demographic factors, including age, year of diagnosis, urban-rural distribution, hospital function, region, city scale, mode of delivery, comorbidity, FIGO stage, gross type, histological type, preoperative treatment, lymph node dissection, and hysterectomy type reported, with the odds ratio (95% CI) of low vs. high volume. The bottom row for each complication class is adjusted for the factors mentioned above, with the odds ratio (95% CI) of intermediate vs. high volume.\u003c/span\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"The National Science and Technology Support Program of China","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"cervical cancer, radical hysterectomy, cervical cancer, major complications","lastPublishedDoi":"10.21203/rs.3.rs-2139253/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2139253/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTo date, there are few studies that have investigated the association between surgeon volume and outcomes of radical hysterectomy. To examine changes in surgeon volume over time and evaluate the influence of surgeon volume on complications of abdominal and laparoscopic radical hysterectomy for cervical cancer.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a population-based retrospective study using the Major Surgical Complications of Cervical Cancer in China (MSCCCC) database to collect the data of patients who underwent radical hysterectomy from 2004\u0026ndash;2016 at 42 hospitals. Patients were stratified into tertiles according to annualized surgeon volume. The influence of the surgeon volume of abdominal and laparoscopic radical hysterectomy on surgical complications was examined using multivariable logistic regression models.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 22,684 patients who underwent radical hysterectomy were identified. In the abdominal surgery cohort, the mean surgeon case volume increased from 3.5 cases in 2004 to 8.7 cases in 2013 and then decreased to 4.9 cases in 2016. The number of surgeons performing laparoscopic radical hysterectomy increased from 1 surgeon with 1 patient (mean cases\u0026thinsp;=\u0026thinsp;1) in 2004 to 183 surgeons who operated on 2,206 patients in 2016 (mean cases\u0026thinsp;=\u0026thinsp;12.1) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). In the abdominal surgery cohort, patients treated by intermediate-volume surgeons had more postoperative complications (OR\u0026thinsp;=\u0026thinsp;1.55, 95% CI\u0026thinsp;=\u0026thinsp;1.11\u0026ndash;2.15). In the laparoscopic surgery cohort, surgeon volume had no independent effect on intraoperative or postoperative complications (P\u0026thinsp;=\u0026thinsp;0.46; P\u0026thinsp;=\u0026thinsp;0.13).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe performance of ARH by intermediate-volume surgeons is associated with an increased risk of postoperative complications. However, surgeon volume may have little effect on intraoperative or postoperative complications after LRH.\u003c/p\u003e","manuscriptTitle":"Effect of surgeon case volume on major surgical complications for abdominal and laparoscopic radical hysterectomy for cervical cancer in China, 2004-2016: A retrospective cohort study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-10-07 17:43:45","doi":"10.21203/rs.3.rs-2139253/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b9a49db0-19d9-4fbd-aad1-8910ee1b89ce","owner":[],"postedDate":"October 7th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":16050859,"name":"Oncology"},{"id":16050860,"name":"Obstetrics \u0026 Gynecology"}],"tags":[],"updatedAt":"2022-10-07T17:43:46+00:00","versionOfRecord":[],"versionCreatedAt":"2022-10-07 17:43:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2139253","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2139253","identity":"rs-2139253","version":["v1"]},"buildId":"ApUGefWb6u5IBVtyqm6d5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}