微创食管切除术的分期手术培训对短期结果有影响吗？

Does staged surgical training for minimally invasive esophagectomy have an impact on short-term outcomes?

作者信息

Ishiyama Koshiro, Fujita Takeo, Fujiwara Hisashi, Kurita Daisuke, Oguma Junya, Katai Hitoshi, Daiko Hiroyuki

机构信息

Division of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, 104-0045, Japan.

Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, 113-8421, Japan.

出版信息

Surg Endosc. 2021 Nov;35(11):6251-6258. doi: 10.1007/s00464-020-08125-y. Epub 2020 Oct 30.

DOI:10.1007/s00464-020-08125-y

PMID:33128077

Abstract

BACKGROUND

sophageal cancer has a low incidence, and the anatomy is difficult to understand during esophagectomy. This necessitates a precise and lengthy operation. Therefore, the establishment of a training system in esophageal surgery is of critical importance. In this study, we compared the short-term outcomes of minimally invasive esophagectomy (MIE) performed by consultants versus trainees and explored the factors that impacted the thoracic operation time for each group.

METHODS

We have introduced standardized MIE surgical techniques to our trainees in 2016. Our procedure consists of a laparoscopic phase and a thoracoscopic phase and is systematically designed to be learned in a step-by-step manner in each phase. We retrospectively identified 308 patients who underwent MIE from April 2016 to April 2018. The patients were divided into those who underwent MIE by consultants and those who underwent MIE by trainees. The preoperative background factors, operation-related factors, and postoperative complications were compared between the two groups. We also assessed the association between a prolonged thoracic operation time and tumor-and patient-related factors in each of the consults and trainees.

RESULTS

Significantly more patients had stage ≥ III cancer in the consultant than trainee group. However, the postoperative complications were comparable, specifically pneumonia (11% vs. 18%), anastomotic leakage (11% vs. 13%), and mortality (0.6% vs. 1.3%). There was no significant difference in the lymph node yield (20 vs. 17) or R0 resection rate (94% vs. 91%) between the two groups. However, the trainees had a significantly longer thoracic operation time (143 ± 34 vs. 190 ± 28 min) and significantly greater blood loss (93 vs. 183 ml). Oncological factors were correlated with a prolonged thoracic operation time in the consultants, but not in the trainees.

CONCLUSIONS

Under standardized surgical management using a stepwise educational program, performance of MIE by trainees has no impact on short-term outcomes.

摘要

背景

食管癌发病率较低，在食管癌切除术中其解剖结构难以理解。这就需要进行精确且耗时较长的手术。因此，建立食管外科培训体系至关重要。在本研究中，我们比较了由顾问医师与受训医师实施的微创食管癌切除术（MIE）的短期结果，并探讨了影响每组胸腔手术时间的因素。

方法

我们于2016年向受训医师介绍了标准化的MIE手术技术。我们的手术包括腹腔镜阶段和胸腔镜阶段，并系统设计为在每个阶段逐步学习。我们回顾性确定了2016年4月至2018年4月期间接受MIE的308例患者。这些患者被分为由顾问医师实施MIE的患者和由受训医师实施MIE的患者。比较了两组患者的术前背景因素、手术相关因素和术后并发症。我们还评估了顾问医师组和受训医师组中胸腔手术时间延长与肿瘤及患者相关因素之间的关联。

结果

顾问医师组中癌症分期≥III期的患者明显多于受训医师组。然而，术后并发症相当，具体为肺炎（11%对18%）、吻合口漏（11%对13%）和死亡率（0.6%对1.3%）。两组之间的淋巴结获取数量（20对17）或R0切除率（94%对91%）无显著差异。然而，受训医师的胸腔手术时间明显更长（143±34对190±28分钟），失血量明显更多（93对183毫升）。肿瘤学因素与顾问医师组胸腔手术时间延长相关，但与受训医师组无关。