Colorectal Surgery Unit, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 4th Floor, Santiago, Chile.
Surg Endosc. 2024 Sep;38(9):5114-5121. doi: 10.1007/s00464-024-11086-1. Epub 2024 Jul 19.
Retrospective studies and randomized controlled trials support the safety of laparoscopic complete mesocolic excision (CME) for the treatment of right-sided colon cancer (RSCC). Few studies, however, examine the learning curve of this operation and its impact on safety during an implementation period. We aim to evaluate the learning curve and safety of the implementation of laparoscopic CME with intracorporeal anastomosis for RSCC.
Consecutive patients undergoing a laparoscopic right colectomy with intracorporeal anastomosis for RSCC between January 2016 and June 2023 were included. Clinical, perioperative, and histopathological variables were collected. Correlation and cumulative sum (CUSUM) analyses between the operating time and case number were performed. Breakpoints of the learning curve were estimated using the broken-line model. CME and conventional laparoscopic right colectomy outcomes were compared after propensity score matching (PSM).
Two hundred and ninety patients underwent laparoscopic right colectomy during study period. One hundred and eight met inclusion criteria. After PSM, 56 non-CME and 28 CME patients were compared. CME group had a non-statistically significant tendency to a longer operating time (201 versus 195 min; p = 0.657) and a shorter hospital stay (3 versus 4 days; p = 0.279). No significant differences were found in total complication rates or their profile. Correlation analysis identified a significant trend toward operating time reduction with increasing case numbers (Pearson correlation coefficient = - 0.624; p = 0.001). According to the CUSUM analysis, an institutional learning curve was deemed completed after 13 cases and the broken-line model identified three phases: learning (1-6 cases), consolidation (7-13 cases), and mastery (after 13 cases).
The learning curve of laparoscopic CME for RSCC can be achieved after 13 cases in centers with experience in advanced laparoscopic surgery and surgeons with familiarity with this technique. Its implementation within this setting seems to be as safe as performing a conventional right colectomy.
回顾性研究和随机对照试验支持腹腔镜完整结肠系膜切除术（CME）治疗右侧结肠癌（RSCC）的安全性。然而，很少有研究检查该手术的学习曲线及其在实施期间对安全性的影响。我们旨在评估腹腔镜 CME 联合腔内吻合术治疗 RSCC 的学习曲线和安全性。
纳入 2016 年 1 月至 2023 年 6 月期间接受腹腔镜右结肠切除术联合 RSCC 腔内吻合术的连续患者。收集临床、围手术期和组织病理学变量。对手术时间和病例数之间进行相关性和累积和（CUSUM）分析。使用折线模型估计学习曲线的断点。在倾向评分匹配（PSM）后比较 CME 和传统腹腔镜右半结肠切除术的结果。
研究期间有 290 例患者接受了腹腔镜右结肠切除术。其中 108 例符合纳入标准。PSM 后，比较了 56 例非 CME 和 28 例 CME 患者。CME 组手术时间有延长的趋势，但无统计学意义（201 分钟比 195 分钟；p=0.657），住院时间缩短（3 天比 4 天；p=0.279）。总并发症发生率及其特征无显著差异。相关性分析显示，手术时间与病例数呈显著负相关（皮尔逊相关系数=-0.624；p=0.001）。根据 CUSUM 分析，在完成 13 例病例后，认为机构学习曲线已经完成，并且折线模型确定了三个阶段：学习（1-6 例）、巩固（7-13 例）和掌握（13 例后）。
在有经验的高级腹腔镜手术中心和熟悉该技术的外科医生中，腹腔镜 CME 治疗 RSCC 的学习曲线可在 13 例病例后达到。在这种情况下实施似乎与进行传统的右半结肠切除术一样安全。
