Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.
Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
Surg Endosc. 2024 May;38(5):2454-2464. doi: 10.1007/s00464-024-10740-y. Epub 2024 Mar 8.
Conversion to laparotomy is among the serious intraoperative complications and carries an increased risk of postoperative complications. In this cohort study, we investigated whether or not the Endoscopic Surgical Skill Qualification System (ESSQS) affects the conversion rate among patients undergoing laparoscopic surgery for rectal cancer.
We performed a retrospective secondary analysis of data collected from patients undergoing laparoscopic surgery for cStage II and III rectal cancer from 2014 to 2016 across 56 institutions affiliated with the Japan Society of Laparoscopic Colorectal Surgery. Data from the original EnSSURE study were analyzed to investigate risk factors for conversion to laparotomy by performing univariate and multivariate analyses based on the reason for conversion.
Data were collected for 3,168 cases, including 65 (2.1%) involving conversion to laparotomy. Indicated conversion accounted for 27 cases (0.9%), while technical conversion accounted for 35 cases (1.1%). The multivariate analysis identified the following independent risk factors for indicated conversion to laparotomy: tumor diameter [mm] (odds ratio [OR] 1.01, 95% confidence interval [CI] 1.01-1.05, p = 0.0002), combined resection of adjacent organs [+/-] (OR 7.92, 95% CI 3.14-19.97, p < 0.0001), and surgical participation of an ESSQS-certified physician [-/+] (OR 4.46, 95% CI 2.01-9.90, p = 0.0002). The multivariate analysis identified the following risk factors for technical conversion to laparotomy: registered case number of institution (OR 0.99, 95% CI 0.99-1.00, p = 0.0029), institution type [non-university/university hospital] (OR 3.52, 95% CI 1.54-8.04, p = 0.0028), combined resection of adjacent organs [+/-] (OR 5.96, 95% CI 2.15-16.53, p = 0.0006), and surgical participation of an ESSQS-certified physician [-/+] (OR 6.26, 95% CI 3.01-13.05, p < 0.0001).
Participation of ESSQS-certified physicians may reduce the risk of both indicated and technical conversion. Referral to specialized institutions, such as high-volume centers and university hospitals, especially for patients exhibiting relevant background risk factors, may reduce the risk of conversion to laparotomy and lead to better outcomes for patients.
This study was registered with the Japanese Clinical Trials Registry as UMIN000040645.
中转开腹是术中严重并发症之一，会增加术后并发症的风险。在这项队列研究中，我们调查了内镜手术技能资格认证系统（ESSQS）是否会影响接受腹腔镜直肠癌手术患者的中转率。
我们对 2014 年至 2016 年间，日本腹腔镜结直肠外科学会下属 56 家机构中接受腹腔镜 cT2-3 期直肠癌手术的患者进行了数据回顾性二次分析。对原始 EnSSURE 研究的数据进行分析，根据中转原因进行单因素和多因素分析，以探讨中转开腹的危险因素。
共纳入 3168 例患者，其中 65 例（2.1%）中转开腹。指征性中转占 27 例（0.9%），技术性中转占 35 例（1.1%）。多因素分析确定了指征性中转开腹的独立危险因素：肿瘤直径[mm]（比值比[OR] 1.01，95%置信区间[CI] 1.01-1.05，p=0.0002）、合并相邻器官切除[+/-]（OR 7.92，95% CI 3.14-19.97，p<0.0001）和手术医生 ESSQS 认证[+/-]（OR 4.46，95% CI 2.01-9.90，p=0.0002）。多因素分析确定了技术性中转开腹的危险因素：机构登记病例数（OR 0.99，95% CI 0.99-1.00，p=0.0029）、机构类型[非大学/大学医院]（OR 3.52，95% CI 1.54-8.04，p=0.0028）、合并相邻器官切除[+/-]（OR 5.96，95% CI 2.15-16.53，p=0.0006）和手术医生 ESSQS 认证[+/-]（OR 6.26，95% CI 3.01-13.05，p<0.0001）。
ESSQS 认证医生的参与可能降低指征性和技术性中转的风险。将患者转至专科机构，如高容量中心和大学医院，特别是对于存在相关背景风险因素的患者，可能降低中转开腹的风险，从而改善患者结局。
本研究在日本临床试验注册中心注册，注册号为 UMIN000040645。
