Sekkat Hamza, Souadka Amine, Alaoui Leila, Rafik Ali, Belkhadir Zakaria, Amrani Laila, Benkabbou Amine, Mohsine Raouf, Majbar Anass Mohammed
Department of Digestive Surgical Oncology, National Institute of Oncology, IBN Sina University Hospital; Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.
Department of Statistics, Cancer Research Institute, Fez, Morocco.
J Minim Access Surg. 2023 Apr-Jun;19(2):296-304. doi: 10.4103/jmas.jmas_78_22.
This study aimed to analyse the learning curve (LC) in laparoscopic rectal cancer resections of 2 millennial surgeons during the implementation of the first laparoscopic rectal cancer surgery programme in low- and middle-income country (LMIC) cancer centre.
All consecutive patients operated by two millennial surgeons for primary rectal adenocarcinoma between January 2018 and March 2020 were included. The LC was analysed for operative duration and conversion to open surgery using both cumulative sum (CUSUM) and/or variable life-adjusted display (VLAD) charts.
Eighty-four patients were included, 45 (53.6%) men with a mean age of 57.3 years. Abdominoperineal resection was performed in 31 (36.9%) cases and resections were extended to other organs in 20 (23.8%) patients. Thirteen patients (15.5%) had conversion to open surgery. Using CUSUM, Learning curve based on conversion was completed at 12 cases for the first surgeon versus 10 cases for the second. While using VLAD and learning curve-CUSUM (LC-CUSUM), the cases needed were 26 vs 24 respectively. The median operative duration was 314 min with a LC completed at cases (17 vs. 26), and (18 vs. 29) using, respectively, standard and LC-CUSUM.
This study shows a safe and short LC of millennial surgeons during the implementation of a laparoscopic rectal cancer surgery in an LMIC cancer centre, and the valuable use of modern statistical methods in the prospective assessment of LC safety during surgical training.
本研究旨在分析在一个低收入和中等收入国家（LMIC）癌症中心实施首个腹腔镜直肠癌手术项目期间，两位千禧一代外科医生进行腹腔镜直肠癌切除术的学习曲线（LC）。
纳入2018年1月至2020年3月间由两位千禧一代外科医生为原发性直肠腺癌进行手术的所有连续患者。使用累积和（CUSUM）和/或可变寿命调整图（VLAD）分析手术持续时间和转为开放手术的学习曲线。
纳入84例患者，45例（53.6%）为男性，平均年龄57.3岁。31例（36.9%）患者行腹会阴联合切除术，20例（23.8%）患者的手术范围扩大至其他器官。13例患者（15.5%）转为开放手术。使用CUSUM分析，第一位外科医生基于手术转为开放手术的学习曲线在12例时完成，而第二位外科医生在10例时完成。使用VLAD和学习曲线 - CUSUM（LC - CUSUM）分析时，所需病例数分别为26例和24例。中位手术持续时间为314分钟，使用标准方法和LC - CUSUM分析时，学习曲线分别在17例和26例、18例和29例时完成。
本研究表明，在LMIC癌症中心实施腹腔镜直肠癌手术期间，千禧一代外科医生的学习曲线安全且短，并且现代统计方法在手术培训期间对学习曲线安全性的前瞻性评估中具有重要价值。
