日本内镜外科技能资质对直肠癌腹腔镜切除术的影响：EnSSURE研究
Impact of Endoscopic Surgical Skill Qualification on Laparoscopic Resections for Rectal Cancer in Japan: The EnSSURE Study.
作者信息
Ichikawa Nobuki, Homma Shigenori, Hida Koya, Akagi Tomonori, Kamada Yasuyuki, Yamaguchi Tomohiro, Ito Masaaki, Ishida Fumio, Watanabe Jun, Yamamoto Daisuke, Iijima Hiroaki, Yamaguchi Shigeki, Inomata Masafumi, Sakai Yoshiharu, Naitoh Takeshi, Taketomi Akinobu
机构信息
From the Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Department of Surgery, Kyoto University Hospital, Kyoto, Japan.
出版信息
Ann Surg Open. 2022 Apr 22;3(2):e160. doi: 10.1097/AS9.0000000000000160. eCollection 2022 Jun.
OBJECTIVE
This cohort study investigated short- and long-term postoperative outcomes of laparoscopic procedures for rectal cancer performed with versus without certified surgeons.
BACKGROUND
In Japan, the Endoscopic Surgical Skill Qualification System (ESSQS) evaluates surgical skills deemed essential for laparoscopic surgery; however, it is unknown whether this certification contributes to procedural safety.
METHODS
Outcomes of laparoscopic rectal resections for cStage II and III rectal cancer performed from 2014 to 2016 at 56 Japanese hospitals were retrospectively reviewed. The impact of having versus not having certified surgeons on postoperative complications and other short- and long-term outcomes were assessed. In cases with ESSQS-certified surgeons, surgeons attended surgery in the capacity of an operator, assistant, scope operator, or advisor.
RESULTS
Overall, 3188 procedures were analyzed, with 2644 procedures performed with and 544 without ESSQS-certified surgeons. A multivariate logistic regression model showed that the adjusted odds ratio of postoperative complications after procedures performed with ESSQS-certified surgeons was 0.68 (95% confidence interval, 0.51-0.91; = 0.009). The adjusted odds ratios for conversion and pathological R0 resection rates with ESSQS-certified surgeons were 0.20 ( < 0.001) and 2.10 ( = 0.04), respectively. Multiple linear regression analyses showed significantly shorter surgical duration and more harvested lymph nodes for operations performed with ESSQS-certified surgeons. Multivariate Cox regression showed that the adjusted hazard ratios for poor overall and recurrence-free survival after operations performed with ESSQS-certified surgeons were 0.88 ( = 0.35) and 1.04 ( = 0.71), respectively.
CONCLUSIONS
This study showed the superiority of the short-term postoperative results for laparoscopic rectal procedures performed with ESSQS-certified surgeons.
目的
本队列研究调查了由获得认证的外科医生与未获得认证的外科医生进行的腹腔镜直肠癌手术的短期和长期术后结果。
背景
在日本，内镜外科技能资格认证系统（ESSQS）评估腹腔镜手术所需的基本手术技能；然而，该认证是否有助于手术安全尚不清楚。
方法
回顾性分析了2014年至2016年期间日本56家医院进行的cII期和III期直肠癌腹腔镜切除术的结果。评估了有或没有获得认证的外科医生对术后并发症及其他短期和长期结果的影响。在有ESSQS认证外科医生的病例中，外科医生以术者、助手、内镜操作者或顾问的身份参与手术。
结果
总体而言，共分析了3188例手术，其中2644例由ESSQS认证的外科医生进行，544例没有。多因素逻辑回归模型显示，由ESSQS认证的外科医生进行手术后，术后并发症的调整优势比为0.68（95%置信区间，0.51 - 0.91；P = 0.009）。ESSQS认证的外科医生进行手术的中转率和病理R0切除率的调整优势比分别为0.20（P < 0.001）和2.10（P = 0.04）。多元线性回归分析显示，由ESSQS认证的外科医生进行的手术，手术时间明显更短，切除的淋巴结更多。多因素Cox回归显示，由ESSQS认证的外科医生进行手术后，总体生存不良和无复发生存的调整风险比分别为0.88（P = 0.35）和1.04（P = 0.71）。
结论
本研究表明，由ESSQS认证的外科医生进行腹腔镜直肠手术，术后短期结果更优。
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