Division of Minimally-invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Bicocca Bioinformatics Biostatistics and Bioimaging Centre - B4, School of Medicine and Surgery, University of Milan - Bicocca, Monza, Italy.
Colorectal Dis. 2022 May;24(5):577-586. doi: 10.1111/codi.16075. Epub 2022 Feb 8.
Despite the suggested potential benefit of complete mesocolic excision (CME) for right-sided colon cancer (RCC) for patient survival, concerns about its safety and feasibility have contributed to delayed acceptance of the procedure, especially when performed by a minimally invasive approach. Thus, the aim of this work was to evaluate the actual learning curve (LC) of laparoscopic CME for experienced colorectal surgeons.
Prospectively collected data for consecutive patients undergoing laparoscopic CME for RCC between October 2015 and January 2021 at our institution, operated on by experienced surgeons, were analysed. A multidimensional assessment of the LC was performed through cumulative sum (CUSUM) and risk-adjusted (RA) CUSUM analysis.
Two hundred and two patients operated by on by three surgeons were considered. The CUSUM graphs based on operating time showed one peak of the curve between 17 and 27 cases. The CUSUM graphs based on surgical failure showed one peak of the curve between 20 and 24 cases The RA-CUSUM curve also showed one preeminent peak at 24-33 cases. Based on the CUSUM and RA-CUSUM analyses all the surgeons reached proficiency in 24-33 cases.
Our study showed that an experienced minimally invasive colorectal surgeon acquires proficiency in laparoscopic CME for RCC after performing 24-33 cases.
尽管完整结肠系膜切除术（CME）对右侧结肠癌（RCC）患者的生存有潜在益处，但对其安全性和可行性的担忧导致该手术方法的接受速度较慢，尤其是采用微创方法时。因此，本研究旨在评估有经验的结直肠外科医生进行腹腔镜 CME 的实际学习曲线（LC）。
对 2015 年 10 月至 2021 年 1 月期间在我院接受腹腔镜 CME 治疗的连续 RCC 患者的前瞻性收集数据进行了分析，这些患者由经验丰富的外科医生进行手术。通过累积和（CUSUM）和风险调整（RA）CUSUM 分析对 LC 进行了多维评估。
考虑了由三位外科医生对 202 例患者进行的手术。基于手术时间的 CUSUM 图显示，在 17 至 27 例之间出现一个曲线高峰。基于手术失败的 CUSUM 图显示，在 20 至 24 例之间出现一个曲线高峰。RA-CUSUM 曲线也在 24-33 例之间显示出一个突出的高峰。基于 CUSUM 和 RA-CUSUM 分析，所有外科医生在 24-33 例之间达到熟练程度。
我们的研究表明，经验丰富的微创结直肠外科医生在完成 24-33 例腹腔镜 CME 治疗 RCC 后，能够熟练掌握该技术。
