From the Département de Chirurgie, Faculté de Médecine, Université Laval, Québec City, Que. (Brind’Amour, Gagné, Poirier); the Département de Chirurgie générale, Centre Hospitalier Universitaire de Québec, Québec City, Que. (Gagné, Poirier); and the Axe Oncologie, Centre de Recherche du Centre Hospitalier Universitaire de Québec, Université Laval, Québec City, Que. (Hogue, Poirier).
Can J Surg. 2021 Mar 2;64(2):E119-E126. doi: 10.1503/cjs.019919.
Two members from an academic tertiary hospital went to the National Cancer Institute in Tokyo, Japan, to learn how to perform an adequate D2 lymphadenectomy and to then introduce this technique in the surgical care of patients undergoing surgery for gastric cancer at a Western hospital. We aimed to compare the perioperative outcomes and long-term survival of Western patients who underwent gastric resection, performed by these 2 surgeons, before and after the surgeons' shortcourse technical training in Japan.
We conducted a retrospective comparative study of all patients (n = 27 before training and n = 79 after training) who underwent gastric resection for cancer by the same 2 surgeons between September 2007 and December 2017 at the Centre Hospitalier Universitaire de Québec - Université Laval (Québec, Canada). We collected data on patient demographic, clinical, surgical, pathological and treatment characteristics, as well as long-term survival and complications.
In the post-training group, the number of sampled lymph nodes was higher (median 33 v. 14, p < 0.0001), but this increase did not result in a higher number of histologically positive lymph nodes (p = 0.35). The rate of complications was lower in the post-training group (15.2% v. 48.2%, p = 0.002). The hospital stay was shorter in the post-training group (11 [standard deviation (SD) 7] v. 23 [SD 45] d, p = 0.03). The median survival was higher in the post-training group (47 v. 29 mo, p = 0.03).
These results suggest that a short-course technical training in D2 lymphadenectomy, completed in Japan, improved lymph node sampling, decreased postoperative complications and improved survival of patients undergoing surgery for gastric cancer in a Western setting.
两名来自学术性三级医院的成员前往日本东京的国立癌症研究所学习如何进行充分的 D2 淋巴结清扫术，然后将该技术引入到西方医院接受胃癌手术的患者的外科治疗中。我们旨在比较这 2 名外科医生在日本接受短期技术培训前后，接受他们手术的西方患者的围手术期结果和长期生存情况。
我们对 2007 年 9 月至 2017 年 12 月期间，同 2 名外科医生在魁北克大学医院-拉瓦尔大学（加拿大魁北克省）为癌症行胃切除术的所有患者（培训前 27 例，培训后 79 例）进行了回顾性比较研究。我们收集了患者人口统计学、临床、手术、病理和治疗特征以及长期生存和并发症的数据。
在培训后组中，取样的淋巴结数量更多（中位数 33 比 14，p < 0.0001），但这并没有导致组织学阳性淋巴结数量的增加（p = 0.35）。培训后组的并发症发生率较低（15.2%比 48.2%，p = 0.002）。培训后组的住院时间较短（11 [标准差（SD）7] 比 23 [SD 45] d，p = 0.03）。培训后组的中位生存期更长（47 比 29 个月，p = 0.03）。
这些结果表明，在日本完成的 D2 淋巴结清扫术短期技术培训提高了淋巴结取样量，降低了术后并发症发生率，并提高了在西方环境下接受胃癌手术患者的生存率。
