Kazama Keisuke, Numata Masakatsu, Aoyama Toru, Atsumi Yosuke, Tamagawa Hiroshi, Godai Teni, Saeki Hiroyuki, Saigusa Yusuke, Shiozawa Manabu, Yukawa Norio, Masuda Munetaka, Rino Yasushi
Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
Department of Surgery, Fujisawa Shounandai Hospital, Fujisawa, Japan.
World J Surg Oncol. 2021 Feb 19;19(1):53. doi: 10.1186/s12957-021-02155-z.
This study aimed to investigate the short-term and oncological impact of the Endoscopic Surgical Skill Qualification System (ESSQS) by the Japan Society for Endoscopic Surgery on the operator performing laparoscopic surgery for colon cancer.
This retrospective cohort study was based on medical records from a multicentre database. A total of 417 patients diagnosed with stage II/III colon and rectosigmoid cancer treated with curative resection were divided into two groups according to whether they were operated on by qualified surgeons (Q group, n=352) or not (NQ group, n=65). Through strict propensity score matching, 98 cases (49 in each group) were assessed.
Operative time was significantly longer in the NQ group than in the Q group (199 vs. 168 min, p=0.029). The amount of blood loss, post-operative complications, and duration of hospitalisation were similar between both groups. No mortality was observed. One conversion case was seen in the NQ group. The 3-year recurrence-free survival rate was 86.6% in the NQ group and 88.2% in the Q group, which was not statistically significant (log-rank p=0.966).
Direct operation by ESSQS-qualified surgeons contributed to a shortened operation time. Under an organised educational environment, almost equivalent safety and oncological outcomes are expected regardless of the surgeon's qualifications.
本研究旨在调查日本内镜外科学会的内镜手术技能资格系统（ESSQS）对进行结肠癌腹腔镜手术的操作者的短期影响和肿瘤学影响。
本回顾性队列研究基于一个多中心数据库中的医疗记录。共有417例诊断为II/III期结肠癌和直肠乙状结肠癌并接受根治性切除术的患者，根据手术医生是否具备资格分为两组（合格组，n = 352；不合格组，n = 65）。通过严格的倾向评分匹配，评估了98例患者（每组49例）。
不合格组的手术时间显著长于合格组（199分钟对168分钟，p = 0.029）。两组之间的失血量、术后并发症和住院时间相似。未观察到死亡病例。不合格组有1例中转病例。不合格组的3年无复发生存率为86.6%，合格组为88.2%，差异无统计学意义（对数秩检验p = 0.966）。
ESSQS合格的外科医生直接进行手术有助于缩短手术时间。在有组织的教育环境下，无论外科医生的资格如何，预期安全性和肿瘤学结局几乎相当。
