Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy.
Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy.
Eur J Surg Oncol. 2024 Nov;50(11):108612. doi: 10.1016/j.ejso.2024.108612. Epub 2024 Aug 20.
Retroperitoneal sarcoma (RPS) surgery poses unique challenges. This retrospective study aimed to analyze the learning curve (LC) in RPS surgery, assessing the relationship between surgical experience and outcomes.
Cumulative sum (CUSUM) analysis was used to analyze 62 RPS surgeries performed by a single surgeon between 2016 and 2022 at our center.
The number of cases where the surgeon acted as first operator increased from 3 in 2016 to 13 in 2022. The surgeon operated with his mentor in 66.7 % of cases in 2016, whereas in 7.7 % of cases in 2022. LC consisted of 3 phases. Phase 1 (16 cases), with a negative slope, represented shorter operative time (OT) and fewer number of resected organs (RO). Phase 2 (30 cases) was the plateau phase. Phase 3 (16 cases), with a positive slope, indicated longer OT and more RO. Statistically significant differences were observed in terms of size (p = 0.003), presentation (p = 0.048), number of resected organs (p = 0.046), pattern of resection (p = 0.033), OT (p = 0.006), and length of stay (p = 0.026) between the three phases.
This study focused on the critical role of LC in RPS surgery, emphasizing its influence on outcomes. We identified three phases, highlighting the surgeon's evolution. This offers a framework for educating sarcoma surgeons and ensuring exposure to increasing surgical complexity. In discussions on sarcoma referral centers and the correlation between case volume and outcomes, this study underlines the importance of evaluating LC to distinguish surgeons qualified to manage sarcoma cases within a referral center.
腹膜后肉瘤（RPS）手术具有独特的挑战。本回顾性研究旨在分析 RPS 手术中的学习曲线（LC），评估手术经验与结果之间的关系。
采用累积和（CUSUM）分析，对 2016 年至 2022 年间我院一位外科医生完成的 62 例 RPS 手术进行了分析。
术者作为第一助手的手术例数从 2016 年的 3 例增加到 2022 年的 13 例。2016 年，术者与导师共同手术的比例为 66.7%，而 2022 年则为 7.7%。LC 分为 3 个阶段。第 1 阶段（16 例）斜率为负，代表手术时间（OT）更短，切除的器官（RO）数量更少。第 2 阶段（30 例）为平台期。第 3 阶段（16 例）斜率为正，表明 OT 延长，RO 增多。在大小（p=0.003）、表现（p=0.048）、切除器官数量（p=0.046）、切除模式（p=0.033）、OT（p=0.006）和住院时间（p=0.026）方面，三个阶段间差异有统计学意义。
本研究重点关注了 LC 在 RPS 手术中的关键作用，强调了其对结果的影响。我们确定了三个阶段，突出了术者的演变。这为肉瘤外科医生的教育和确保接触到不断增加的手术复杂性提供了一个框架。在肉瘤转诊中心的讨论和病例量与结果之间的相关性中，本研究强调了评估 LC 的重要性，以区分有资格在转诊中心管理肉瘤病例的外科医生。
