Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakano Asahi Yokohama Kanagawa, Yokohama, Japan.
Department of Surgery, Yokohama City University, Yokohama, Japan.
Surg Endosc. 2020 Jan;34(1):429-435. doi: 10.1007/s00464-019-06786-y. Epub 2019 Apr 9.
Laparoscopic gastrectomy is becoming more commonly performed, but acquisition of its technique remains challenging. We investigated whether laparoscopy-assisted distal gastrectomy (LDG) performed by trainees (TR) supervised by a technically qualified experienced surgeon (QS) is feasible and safe.
The short-term outcomes of LDG were assessed in patients with gastric cancer between 2008 and 2018. We compared patients who underwent LDG performed by qualified experienced surgeons (QS group) with patients who underwent LDG performed by the trainees (TR group).
The operation time was longer in the TR group than in the QS group (median time: 270 min vs. 239 min, p < 0.001). The median duration of the postoperative hospital stay was 9 days in the QS group and 8 days in the TR group (p = 0.003). The incidence of postoperative complications did not differ significantly between the two groups. Grade 2 or higher postoperative complications occurred in 18 patients (12.9%) in the QS group and 47 patients (11.7%) in the TR group (p = 0.763). Grade 3 or higher postoperative complications occurred in 9 patients (6.4%) in the QS group and 17 patients (4.2%) in the TR group (p = 0.357). Multivariate analysis showed that the American Society of Anesthesiologist Physical Status was an independent predictor of grade 2 or higher postoperative complications and that gender was an independent predictor of grade 3 or higher postoperative complications. The main operator (TR/QS) was not an independent predictor of complications.
Laparoscopy-assisted distal gastrectomy performed by trainees supervised by an experienced surgeon is a feasible and safe procedure similar to that performed by experienced surgeons.
腹腔镜胃切除术越来越普遍，但技术的掌握仍然具有挑战性。我们研究了由技术熟练的经验丰富的外科医生（QS）监督的受训者（TR）进行的腹腔镜辅助远端胃切除术（LDG）是否可行和安全。
评估了 2008 年至 2018 年期间接受胃癌腹腔镜辅助远端胃切除术（LDG）的患者的短期结果。我们将接受有经验的合格外科医生（QS 组）进行 LDG 的患者与接受受训者（TR 组）进行 LDG 的患者进行比较。
TR 组的手术时间长于 QS 组（中位数时间：270 分钟比 239 分钟，p < 0.001）。QS 组的术后住院时间中位数为 9 天，TR 组为 8 天（p = 0.003）。两组术后并发症发生率无显著差异。QS 组有 18 例（12.9%）和 TR 组有 47 例（11.7%）发生 2 级或以上术后并发症（p = 0.763）。QS 组有 9 例（6.4%）和 TR 组有 17 例（4.2%）发生 3 级或以上术后并发症（p = 0.357）。多因素分析显示，美国麻醉医师协会身体状况是 2 级或以上术后并发症的独立预测因素，性别是 3 级或以上术后并发症的独立预测因素。主要手术者（TR/QS）不是并发症的独立预测因素。
由经验丰富的外科医生监督的受训者进行的腹腔镜辅助远端胃切除术是一种可行且安全的手术，与经验丰富的外科医生进行的手术相似。
