Sawada Naruhiko, Akagi Tomonori, Shimomura Manabu, Todate Yukitoshi, Nagakari Kunihiko, Takeshita Hiroaki, Maruyama Satoshi, Takata Manabu, Ichikawa Nobuki, Hida Koya, Iijima Hiroaki, Yamaguchi Shigeki, Taketomi Akinobu, Naitoh Takeshi
Digestive Disease Center Showa University Northern Yokohama Hospital Yokohama Japan.
Department of Gastroenterological and Pediatric Surgery Oita University Oita Japan.
Ann Gastroenterol Surg. 2023 Dec 14;8(3):464-470. doi: 10.1002/ags3.12763. eCollection 2024 May.
A technical qualification system was developed in 2004 by the Japan Society for Endoscopic Surgery. An analysis of the EnSSURE study on 3188 stage II-III rectal cancer patients, which was performed by including the participation of qualified surgeons as assistants and advisers without restricting their participation as operators, revealed that the participation of technically qualified surgeons in surgery improved the technical and oncological safety of laparoscopic rectal resection.
This secondary retrospective analysis of the EnSSURE study examined the advantage of qualified surgeons participating in laparoscopic low anterior resection (LAR).
The outcomes of low anterior resection were compared between groups with and without the participation of surgeons qualified by the Endoscopic Surgical Skill Qualification System ( and non- groups, respectively). We used propensity score matching to generate paired cohorts at a one-to-one ratio. The postoperative complication rate, short-term results (hemorrhage volume, operative time, number of dissected lymph nodes, open conversion rate, intraoperative complication rate, and R0 resection rate), and long-term results (disease-free survival rate, local recurrence rate, and overall survival rate) were evaluated.
The frequencies of postoperative complications, anastomotic bleeding, and intraperitoneal abscess were significantly lower, the operative time was significantly shorter, the postoperative hospital stay was significantly shorter, and the number of dissected lymph nodes was higher in the group. No significant differences were observed in disease-free survival, local recurrence, or overall survival rate rates between the groups.
The participation of qualified surgeons in LAR is technically advantageous.
日本内镜外科学会于2004年制定了一项技术资格认证体系。对EnSSURE研究中3188例II-III期直肠癌患者进行分析，该研究纳入了具备资质的外科医生作为助手和顾问参与其中，且不限制他们作为术者的参与度，结果显示具备技术资质的外科医生参与手术可提高腹腔镜直肠癌切除术的技术安全性和肿瘤学安全性。
本项对EnSSURE研究的二次回顾性分析探讨了具备资质的外科医生参与腹腔镜低位前切除术（LAR）的优势。
比较了有内镜手术技能资格认证体系认定的合格外科医生参与（分别为 组和非 组）与无此类医生参与的两组低位前切除术的结果。我们使用倾向评分匹配法以1:1的比例生成配对队列。评估术后并发症发生率、短期结果（出血量、手术时间、清扫淋巴结数量、中转开腹率、术中并发症发生率及R0切除率）以及长期结果（无病生存率、局部复发率及总生存率）。
组术后并发症、吻合口出血及腹腔内脓肿的发生率显著更低，手术时间显著更短，术后住院时间显著更短，且清扫淋巴结数量更多。两组之间在无病生存率、局部复发率或总生存率方面未观察到显著差异。
具备资质的外科医生参与LAR在技术上具有优势。
