Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Surg Endosc. 2011 May;25(5):1409-14. doi: 10.1007/s00464-010-1404-4. Epub 2010 Oct 17.
Laparoscopic resection for colorectal cancer is increasingly being performed worldwide. Although learning standardized procedures under the supervision of an experienced surgeon may be effective, there is currently no information on the learning curve under such circumstances. This single-center study aimed to evaluate the learning curve for laparoscopic resection for colorectal cancer of one surgical fellow with no previous experience with laparoscopic colectomy.
Data were analyzed for 108 consecutive patients who underwent laparoscopic resection for colorectal cancer between July 2007 and October 2009. Surgery was performed by a single fellow with no prior experience with laparoscopic colorectal resection. The learning effect was evaluated by dividing the patients into two groups: group 1 consisted of the first 50 patients and group 2 included the last 58 patients. Short-term outcomes were compared between groups.
More complex procedures were performed more frequently in group 2 than in group 1 (p=0.0086). A significantly greater percentage of cases was completed by the trainee in group 2 than in group 1 (91% vs. 68%; p=0.0030) and were performed independent of the supervisor (81% vs. 38%; p<0.0001). All procedures after the 65th case were completed by the trainee. Mean number of lymph nodes harvested (15 vs. 16), conversion to open surgery (0% vs. 2%), and postoperative complications (4% vs. 12%) did not differ significantly between groups. There were no intraoperative complications or mortality. Operating time for sigmoidectomy/high anterior resection reached a steady state after 35 cases.
The present study shows that training in laparoscopic surgery for colorectal cancer under the supervision of an experienced surgeon can be performed safely without jeopardizing the short-term outcomes. More complex procedures were performed successfully by the trainee during the later period, even though he was more independent of the supervisor.
腹腔镜结直肠癌切除术在全球范围内的应用日益增多。虽然在经验丰富的外科医生的监督下学习标准化的操作程序可能是有效的，但目前还没有关于这种情况下学习曲线的信息。本单中心研究旨在评估一位没有腹腔镜结肠切除术经验的外科医生对 108 例连续腹腔镜结直肠癌患者的学习曲线。
对 2007 年 7 月至 2009 年 10 月期间接受腹腔镜结直肠癌切除术的 108 例连续患者的数据进行了分析。手术由一位没有腹腔镜结直肠切除术经验的外科医生完成。通过将患者分为两组来评估学习效果：第 1 组包括前 50 例患者，第 2 组包括后 58 例患者。比较两组之间的短期结果。
第 2 组中更复杂的手术比第 1 组更频繁地进行（p=0.0086）。第 2 组中由受训者完成的病例比例明显高于第 1 组（91%比 68%；p=0.0030），并且在没有监督的情况下独立完成（81%比 38%；p<0.0001）。第 65 例后的所有手术均由受训者完成。两组间淋巴结清扫数目（15 枚比 16 枚）、中转开腹率（0%比 2%）和术后并发症发生率（4%比 12%）无显著差异。无术中并发症或死亡。乙状结肠切除术/高位前切除术的手术时间在 35 例后达到稳定状态。
本研究表明，在经验丰富的外科医生的监督下，腹腔镜结直肠癌手术的培训可以安全地进行，而不会影响短期结果。受训者在后期可以成功地完成更复杂的手术，即使他更加独立于监督者。
