Matsuda Takeru, Sawada Ryuichiro, Hasegawa Hiroshi, Yamashita Kimihiro, Harada Hitoshi, Urakawa Naoki, Goto Hironobu, Kanaji Shingo, Oshikiri Taro, Kakeji Yoshihiro
From the Division of Gastrointestinal Surgery (Matsuda, Sawada, Hasegawa, Yamashita, Harada, Urakawa, Goto, Kanaji, Oshikiri, Kakeji).
Division of Minimally Invasive Surgery (Matsuda), Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
J Am Coll Surg. 2023 May 1;236(5):1054-1063. doi: 10.1097/XCS.0000000000000608. Epub 2023 Feb 3.
Although transanal total mesorectal excision (TaTME) is a promising treatment for low rectal cancer, it is considered technically demanding, and the number of cases required to become proficient in TaTME remains unknown. The purpose of this study was to assess the TaTME learning curve based on the total mesorectal excision completion time.
This retrospective analysis comprised 128 individuals who received TaTME between September 2016 and December 2021. The cumulative sum method was used to generate the learning curve. The duration of the procedure from the beginning to the end of the circumferential rendezvous was used to define the total mesorectal excision completion time.
The learning curve consists of 3 phases: phase I (learning phase: cases 1 to 38), phase II (consolidation phase: cases 39 to 70), and phase III (maturing phase: cases 71 to 128). As the phases varied, both the overall operative time and total mesorectal excision completion time decreased considerably. Through the 3 phases of TaTME, intraoperative adverse events decreased, and in phase III, none occurred. Only 1 instance of local recurrence occurred during phase III, and none occurred during phase I or II.
After 70 operations, the surgeon could join the mastery phase of TaTME based on the total mesorectal excision completion time. After the mastering phase began, there were no intraoperative negative occurrences. From the beginning, the oncological safety could be guaranteed.
尽管经肛门全直肠系膜切除术（TaTME）是治疗低位直肠癌的一种有前景的方法，但它在技术上被认为具有挑战性，且达到熟练掌握TaTME所需的病例数量仍不明确。本研究的目的是基于全直肠系膜切除完成时间评估TaTME的学习曲线。
这项回顾性分析纳入了2016年9月至2021年12月期间接受TaTME的128例患者。采用累积和法生成学习曲线。从开始到环周会师结束的手术持续时间被用来定义全直肠系膜切除完成时间。
学习曲线包括3个阶段：第一阶段（学习阶段：第1至38例）、第二阶段（巩固阶段：第39至70例）和第三阶段（成熟阶段：第71至128例）。随着阶段的变化，总体手术时间和全直肠系膜切除完成时间均显著下降。在TaTME的3个阶段中，术中不良事件减少，在第三阶段未发生不良事件。在第三阶段仅发生1例局部复发，在第一阶段和第二阶段未发生局部复发。
基于全直肠系膜切除完成时间，在进行70例手术后，外科医生可进入TaTME的熟练掌握阶段。在熟练掌握阶段开始后，术中无不良事件发生。从一开始，肿瘤学安全性就能得到保证。
