Yang Yan, Yao Yao, Li Xiangyang, Ni Ling, Hang Zhenning, Feng Xiaobo
Department of General Surgery Jinling Hospital of Medical School of Nanjing University Nanjing Jiangsu China.
Health Sci Rep. 2025 Apr 29;8(5):e70759. doi: 10.1002/hsr2.70759. eCollection 2025 May.
Robotic rectal cancer surgery has been introduced to reduce the difficulty and complications of the procedure. This study aims to assess the learning curve for robotic rectal cancer of individual surgeons with extensive laparoscopic rectal cancer surgery through multidimensional analyses.
Data were retrospectively collected on 156 patients who underwent robotic rectal cancer surgery by a single surgeon between January 2018 and December 2023.
The operative time required for LAR can be divided into three distinct phases: an early or learning phase (1-24 cases), an intermediate or proficient phase (25-55 cases), and a late or mastery phase (56-72 cases). The study found that the learning curve for LAR and protective operative time can be divided into three distinct phases: an early or learning phase (1 to 15 cases), an intermediate or proficient phase (16 to 40 cases), and a late or mastery stage (41 to 63 cases). Following the completion of 46 cases of surgery, the next stage of the learning curve for lymph nodes retrieval has been reached. The discrepancy between the mean number of lymph nodes retrieved in each of the three stages was marginal, with an difference of 0.5 between the lowest and highest values observed (14.1 vs. 13.6 vs. 13.7). The length of hospital stay for patients decreases as the surgeon gains more experience, reaching a mean of 10.3 days in 2023.
This study shows that robotic surgery for rectal cancer has a significant learning curve with multiple stages. Robotic surgery can remove more lymph nodes than recommended by guidelines even during the learning phase (recommend that at least 12 lymph nodes should be retrieved). As the learning curve progresses to the mastery phase, the length of postoperative hospital stays gradually decreases to a lower level.
机器人直肠癌手术已被引入以降低手术难度和并发症。本研究旨在通过多维度分析评估具有丰富腹腔镜直肠癌手术经验的个体外科医生进行机器人直肠癌手术的学习曲线。
回顾性收集了2018年1月至2023年12月间由一名外科医生进行机器人直肠癌手术的156例患者的数据。
低位前切除术（LAR）所需的手术时间可分为三个不同阶段：早期或学习阶段（1 - 24例）、中期或熟练阶段（25 - 55例）和后期或精通阶段（56 - 72例）。研究发现，LAR和保护性手术时间的学习曲线可分为三个不同阶段：早期或学习阶段（1至15例）、中期或熟练阶段（16至40例）和后期或精通阶段（41至63例）。在完成46例手术后，淋巴结清扫的学习曲线进入下一阶段。三个阶段中每个阶段平均清扫淋巴结数量的差异很小，最低值和最高值之间相差0.5（14.1对13.6对13.7）。随着外科医生经验的增加，患者的住院时间缩短，2023年平均住院时间达到10.3天。
本研究表明，机器人直肠癌手术有显著的多阶段学习曲线。即使在学习阶段，机器人手术清扫的淋巴结数量也可能超过指南推荐数量（指南建议至少清扫12枚淋巴结）。随着学习曲线进入精通阶段，术后住院时间逐渐降至较低水平。
