We have made an analysis about the number of publications, countries, institutions, co-cited references and authors researching surgery in uterine cervical neoplasms research. The results showed that countries worldwide have paid more attention on this topic over the last 17 years. And the United States is the center of this field with the most publications, academic institutions, high-impact journals, and authors.
The analysis of high-frequency keywords and keywords with timeline view showed that the researches’ focus has changed over time. From 2006 to 2008, laparotomy, vaginal hysterectomy, abdominal hysterectomy, positron emission tomography, pelvic lymphadenectomy, and sentinel node have been the research hot spots. Women with Stage 1B disease traditionally require a radical abdominal hysterectomy (RAH) and pelvic lymph node dissection. However, it carries significant morbidity, particularly in terms of large volume blood loss, bladder and bowel dysfunction. The results from a research showed women who diagnosed with early (stage 1 to 2A) cervical cancer underwent laparoscopically assisted radical vaginal hysterectomy (LARVH) have less blood loss compared with those who underwent RAH. And RAH was associated with significantly shorter operation time compared with LARVH (median: 180 minutes with LARVH versus 138 minutes with RAH, P value = 0.05)14. The advances in minimal access surgery have made it possible to perform radical hysterectomy with the use of laparoscopy with the aim of reducing the surgical morbidity and promoting a faster recovery15. Since 2016, the interest in the relationship among prognostic factor, preservation, neoadjuvant chemotherapy, human papilloma virus (HPV) infection and surgery have gradually increased, which means auxiliary methods has been put more emphasis on. HPV infection is closely associated with cervical cancer. Vaccination has shown the potential to reduce the risk of cervical cancer, and ultimately, making a lower cervical cancer patient number. Some researchers believed HPV vaccines, together with a growing arsenal of HPV-based screening tests, have the potential to radically change public health, would substantially impact on the reduction of the world cervical cancer burden16,17. And patients’ quality of life, surgical procedure guideline, and gynecologic surgical procedure have become the hot interests since 2019. Cervical cancer with a five-year survival rate of 60%18, many cervical cancer patients are young, socially and sexually active women whose QoL is at risk of being endangered by surgery treatment. A Romania research took translated standardized questionnaires, namely QLQ-C30 and QLQ-CX24 to assess their QoL after radical hysterectomy19. The questionnaires include functional scales, symptom scales, global health QoL scale and single items assessing symptoms20. The survivors revealed a relatively good global score of QoL (64.6, median), the symptoms scales showed a relatively low level of side effects of cancer treatment. However, the analysis of some symptoms and sexual activity had a low score. This suggests that researchers are increasingly concerned about the quality of life of patients after surgery. How to improve surgical efficacy and reduce surgical trauma are also been more valued. In the era of COVID-19, some articles were major in gynecologic surgical considerations, indicating that it is necessary to have a pre-operative COVID-19 testing, a triage before the gynecologic surgical procedures, and an appropriate using of personal protective equipment (PPE) during the operation21,22.
The USA made the great contribution in this field with 342 publications, followed by People’s Republic of China, Italy, Germany, Japan, France, and South Korea. A large number of studies output from these countries may be attributed to the wide interest within this field in these countries’ researchers and a stable financial investment. The USA and Germany nods had purple trims, which means the United States’ articles and Germany’s had high betweenness centrality. Indicating the US and Germany had a more concentrated research direction. A gradually increased trend in the number of publications was also found, this may be associated with the growing economy of developing country, which lead to more financial support for scholars23. The next step is to increase respect for knowledge, strengthen government functions and increase financial support for scientific research, thereby narrowing the gap between developing and developed countries in this field.
For the institutions analysis, the map contains 316 unique nodes, 516 lines, and 0.0104 density, which means that there is closer cooperation between the various institutions. The top five institutions are all in developed country. Univ Texas MD Anderson Canc Ctr and Mem Sloan Kettering Canc Ctr are famous organizations where locate in US, Charles Univ Prague and Univ Cattolica Sacro Cuore are in Europe and Yonsei Univ in South Korea. Indicating that the developed countries play the most contribution in this field, and the influence of well-known research institutions and centers continues to increase. But the institutions' cooperation is largely confined to the countries where they locate in. It is therefore necessary to strengthen cross-border cooperation among institutions between different countries and to enhance the depth and breadth of communication.
Authors and co-cited authors analysis showed that Scambia G (17 papers), Leblanc E (14 papers), and Bogani G (11 papers) were the authors that published the most articles. Ramirez PT (155 co-citations), Querleu D (126 co-citations), and Dargent D (108 co-citations) were the top three co-cited authors. In one of the studies, Scambia G updated the related technologies, he proposed the application of sentinel lymph node (SLN) mapping with indocyanine green in cervical cancer patients undergoing open radical hysterectomy, indicating that it has high sensitivity and negative predictive value, comparable to minimally invasive SLN biopsy performance24. Leblanc E reported a simple laparoscopic procedure to restore a normal vaginal length after colpohysterectomy for cervical and vaginal neoplasia25. And Bogani G reported that laparoscopic approach resulted in a faster recovery of bladder function in comparison to open surgery for patients. Minimally invasive surgery improved short-term outcomes of nerve-sparing radical hysterectomy in patients with cervical cancer26.
From the perspective of co-cited journals and co-cited references, the top three most co-cited journals are all in developed country. All of them are publications that major in topics relevant to diagnosis, and treatment of gynecologic malignancies. Gynecologic Oncology (715 times) and American Journal of Obstetrics and Gynecology (483 times) are in USA, International Journal of Gynecological Cancer (493 times) is in Europe. The top three most co-cited references are reported by Ramirez PT, Melamed A, and Querleu D, respectively. Ramirez PT focused to describe survival outcomes after laparoscopic or robot-assisted radical hysterectomy. His results showed that minimally invasive radical hysterectomy was associated with lower rates of disease-free survival and overall survival than open abdominal radical hysterectomy among women with early-stage cervical cancer27. And Melamed A’s research was major in survival after minimally invasive radical hysterectomy for early-stage cervical cancer, the results indicated that minimally invasive radical hysterectomy was associated with shorter overall survival than open surgery among women with stage IA2 or IB1 cervical carcinoma28. Querleu D described four types of radical hysterectomy (A-D), A: minimum resection of paracervix, B: transection of paracervix at the ureter, C: transection of paracervix at junction with internal iliac vascular system, D: laterally extended resection29. The research further pointed out that the classification is suitable to fertility-sparing surgery, and can be adapted to other surgery styles like open, vaginal, laparoscopic, or robotic surgery.
The articles enrolled in this study are based on WoSCC database, while some other articles only enrolled in Pubmed, Scopus or any other databases, which may lead to a not comprehensive article enrolled in this study. Another shortcoming is that the results of this paper are finished by machine algorithm, which may have systemic bias in the program.
From 55 in 2006 to 110 in 2021, the number of publications in the field has been growing year by year. The United States and Europe remain the foremost contributors to this field, with well-known research centers, authoritative journals, and prestigious researchers. But the development of emerging countries does not be ignored. More national cooperation is necessary in the future, and more cooperation results are looked forward to.