Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK.
BJS Open. 2020 Feb;4(1):86-90. doi: 10.1002/bjs5.50219. Epub 2019 Nov 6.
This study aimed to determine whether trainee involvement in D2 gastrectomies was associated with adverse outcomes.
Data from a prospectively created database of consecutive patients undergoing open D2 total (TG) or subtotal (STG) gastrectomy with curative intent between January 2009 and January 2014 were reviewed. Short- and long-term clinical outcomes were compared in patients operated on by consultants and those treated by trainees under consultant supervision.
A total of 272 D2 open gastrectomies were performed, 123 (45·2 per cent) by trainees. There was no significant difference between consultants and trainees in median duration of surgery (TG: 240 (range 102-505) versus 240 (170-375) min respectively, P = 0·452; STG: 225 (150-580) versus 212 (125-380) min, P = 0·192), number of resected nodes (TG: 30 (13-101) versus 30 (11-102), P = 0·681; STG: 26 (5-103) versus 25 (1-63), P = 0·171), length of hospital stay (TG: 15 (7-78) versus 15 (8-65) days, P = 0·981; STG: 10 (6-197) versus 14 (7-85) days, P = 0·242), overall morbidity (TG: 44 versus 49 per cent, P = 0·314; STG: 34 versus 25 per cent, P = 0·113) or mortality (TG: 4 versus 2 per cent; P = 0·293). No difference in predicted 5-year overall survival was noted between the two cohorts (TG: 68 per cent for consultants versus 77 per cent for trainees, P = 0·254; STG: 70 versus 75 per cent respectively, P = 0·512). The trainee cohort had lower median blood loss for both TG (360 (range 90-1200) ml versus 600 (70-2350) ml for consultants; P = 0·042) and STG (235 (50-1000) versus 360 (50-3000) ml respectively; P = 0·053).
Clinical outcomes were not compromised by supervised trainee involvement in D2 open gastrectomy.
本研究旨在确定受训者参与 D2 胃切除术是否与不良结局相关。
对 2009 年 1 月至 2014 年 1 月期间接受开放 D2 全胃切除术（TG）或次全胃切除术（STG）根治性治疗的连续患者的前瞻性创建数据库中的数据进行了回顾性分析。比较了顾问和受训者在顾问监督下治疗的患者的短期和长期临床结局。
共进行了 272 例开放 D2 胃切除术，其中 123 例（45.2%）由受训者完成。顾问和受训者之间手术持续时间的中位数无显著差异（TG：240（范围 102-505）与 240（170-375）分钟，P=0.452；STG：225（150-580）与 212（125-380）分钟，P=0.192），切除的淋巴结数量（TG：30（13-101）与 30（11-102），P=0.681；STG：26（5-103）与 25（1-63），P=0.171），住院时间（TG：15（7-78）与 15（8-65）天，P=0.981；STG：10（6-197）与 14（7-85）天，P=0.242），总发病率（TG：44%与 49%，P=0.314；STG：34%与 25%，P=0.113）或死亡率（TG：4%与 2%；P=0.293）。两组之间预测的 5 年总生存率无差异（TG：顾问为 68%，受训者为 77%，P=0.254；STG：顾问为 70%，受训者为 75%，P=0.512）。受训者组 TG 的中位出血量较低（360（范围 90-1200）ml 与顾问组的 600（70-2350）ml；P=0.042）和 STG（235（50-1000）与 360（50-3000）ml，P=0.053）。
在监督受训者参与 D2 开放胃切除术的情况下，临床结局并未受到影响。
