Learning curve and safety of the implementation of laparoscopic complete mesocolic excision with intracorporeal anastomosis for right-sided colon cancer: results from a propensity score-matched study
Background 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 implement...
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| Veröffentlicht in: | Surgical endoscopy 2024-09, Vol.38 (9), p.5114-5121 |
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| creator | Vela, Javier Riquoir, Christophe Jarry, Cristián Silva, Felipe Besser, Nicolás Urrejola, Gonzalo Molina, María Elena Miguieles, Rodrigo Bellolio, Felipe Larach, José Tomás |
| description | Background
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.
Methods
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).
Results
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).
Conclusion
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. |
| doi_str_mv | 10.1007/s00464-024-11086-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3082628782</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3098423260</sourcerecordid><originalsourceid>FETCH-LOGICAL-c256t-6eaee69b16e777624b8bc9f25dbedfbabb7bb0a9dad65c2dab309c5541c071f53</originalsourceid><addsrcrecordid>eNp9kc2O1DAQhC0EYpeFF-CALHHhYrCdxEm4oRV_0khc4By1nc6MV4kd3A7sPCGvhYdZQOLAyVL3V9UlF2NPlXyppGxfkZS1qYXUtVBKdkaoe-xS1ZUWWqvuPruUfSWFbvv6gj0iupGF71XzkF1UvdRdVTeX7McOIQUf9txt6RtyCCMnmDAfeZx4PiD3yzrjgiFD9jGcpjOskCK5uHrHXTztM_IFKbo4lxHeOk8n9rvPB-5DTuBiWmNCmMsBoByXSJ74FBNPfn_IgvyIY_Gai8pBcJhe84S0zblQKS4c-JriioF8SVZOJxQLZHcoKsrbeHzMHkwwEz65e6_Yl3dvP19_ELtP7z9ev9kJpxuThUFANL1VBtu2Nbq2nXX9pJvR4jhZsLa1VkI_wmgap0ewlexd09TKyVZNTXXFXpx9S5yvG1IeFk8O5xkCxo2GSnba6K7tdEGf_4PexC2Fkq5QfVfrShtZKH2mXPlSSjgNa_ILpOOg5HCqeTjXPJSah181D6qInt1Zb3bB8Y_kd68FqM4AlVXYY_p7-z-2PwHznLnp</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3098423260</pqid></control><display><type>article</type><title>Learning curve and safety of the implementation of laparoscopic complete mesocolic excision with intracorporeal anastomosis for right-sided colon cancer: results from a propensity score-matched study</title><source>MEDLINE</source><source>SpringerLink (Online service)</source><creator>Vela, Javier ; Riquoir, Christophe ; Jarry, Cristián ; Silva, Felipe ; Besser, Nicolás ; Urrejola, Gonzalo ; Molina, María Elena ; Miguieles, Rodrigo ; Bellolio, Felipe ; Larach, José Tomás</creator><creatorcontrib>Vela, Javier ; Riquoir, Christophe ; Jarry, Cristián ; Silva, Felipe ; Besser, Nicolás ; Urrejola, Gonzalo ; Molina, María Elena ; Miguieles, Rodrigo ; Bellolio, Felipe ; Larach, José Tomás</creatorcontrib><description>Background
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.
Methods
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).
Results
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).
Conclusion
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.</description><identifier>ISSN: 0930-2794</identifier><identifier>ISSN: 1432-2218</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-024-11086-1</identifier><identifier>PMID: 39028345</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Aged ; Anastomosis, Surgical - education ; Anastomosis, Surgical - methods ; Colectomy - education ; Colectomy - methods ; Colonic Neoplasms - pathology ; Colonic Neoplasms - surgery ; Colorectal cancer ; Female ; Gastroenterology ; Gynecology ; Hepatology ; Humans ; Laparoscopy ; Laparoscopy - education ; Laparoscopy - methods ; Learning Curve ; Learning curves ; Length of Stay - statistics & numerical data ; Male ; Medicine ; Medicine & Public Health ; Mesocolon - surgery ; Middle Aged ; Operative Time ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Proctology ; Propensity Score ; Retrospective Studies ; Surgery</subject><ispartof>Surgical endoscopy, 2024-09, Vol.38 (9), p.5114-5121</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c256t-6eaee69b16e777624b8bc9f25dbedfbabb7bb0a9dad65c2dab309c5541c071f53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-024-11086-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-024-11086-1$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39028345$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vela, Javier</creatorcontrib><creatorcontrib>Riquoir, Christophe</creatorcontrib><creatorcontrib>Jarry, Cristián</creatorcontrib><creatorcontrib>Silva, Felipe</creatorcontrib><creatorcontrib>Besser, Nicolás</creatorcontrib><creatorcontrib>Urrejola, Gonzalo</creatorcontrib><creatorcontrib>Molina, María Elena</creatorcontrib><creatorcontrib>Miguieles, Rodrigo</creatorcontrib><creatorcontrib>Bellolio, Felipe</creatorcontrib><creatorcontrib>Larach, José Tomás</creatorcontrib><title>Learning curve and safety of the implementation of laparoscopic complete mesocolic excision with intracorporeal anastomosis for right-sided colon cancer: results from a propensity score-matched study</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
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.
Methods
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).
Results
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).
Conclusion
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.</description><subject>Abdominal Surgery</subject><subject>Aged</subject><subject>Anastomosis, Surgical - education</subject><subject>Anastomosis, Surgical - methods</subject><subject>Colectomy - education</subject><subject>Colectomy - methods</subject><subject>Colonic Neoplasms - pathology</subject><subject>Colonic Neoplasms - surgery</subject><subject>Colorectal cancer</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Laparoscopy</subject><subject>Laparoscopy - education</subject><subject>Laparoscopy - methods</subject><subject>Learning Curve</subject><subject>Learning curves</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mesocolon - surgery</subject><subject>Middle Aged</subject><subject>Operative Time</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Proctology</subject><subject>Propensity Score</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><issn>0930-2794</issn><issn>1432-2218</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kc2O1DAQhC0EYpeFF-CALHHhYrCdxEm4oRV_0khc4By1nc6MV4kd3A7sPCGvhYdZQOLAyVL3V9UlF2NPlXyppGxfkZS1qYXUtVBKdkaoe-xS1ZUWWqvuPruUfSWFbvv6gj0iupGF71XzkF1UvdRdVTeX7McOIQUf9txt6RtyCCMnmDAfeZx4PiD3yzrjgiFD9jGcpjOskCK5uHrHXTztM_IFKbo4lxHeOk8n9rvPB-5DTuBiWmNCmMsBoByXSJ74FBNPfn_IgvyIY_Gai8pBcJhe84S0zblQKS4c-JriioF8SVZOJxQLZHcoKsrbeHzMHkwwEz65e6_Yl3dvP19_ELtP7z9ev9kJpxuThUFANL1VBtu2Nbq2nXX9pJvR4jhZsLa1VkI_wmgap0ewlexd09TKyVZNTXXFXpx9S5yvG1IeFk8O5xkCxo2GSnba6K7tdEGf_4PexC2Fkq5QfVfrShtZKH2mXPlSSjgNa_ILpOOg5HCqeTjXPJSah181D6qInt1Zb3bB8Y_kd68FqM4AlVXYY_p7-z-2PwHznLnp</recordid><startdate>20240901</startdate><enddate>20240901</enddate><creator>Vela, Javier</creator><creator>Riquoir, Christophe</creator><creator>Jarry, Cristián</creator><creator>Silva, Felipe</creator><creator>Besser, Nicolás</creator><creator>Urrejola, Gonzalo</creator><creator>Molina, María Elena</creator><creator>Miguieles, Rodrigo</creator><creator>Bellolio, Felipe</creator><creator>Larach, José Tomás</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20240901</creationdate><title>Learning curve and safety of the implementation of laparoscopic complete mesocolic excision with intracorporeal anastomosis for right-sided colon cancer: results from a propensity score-matched study</title><author>Vela, Javier ; Riquoir, Christophe ; Jarry, Cristián ; Silva, Felipe ; Besser, Nicolás ; Urrejola, Gonzalo ; Molina, María Elena ; Miguieles, Rodrigo ; Bellolio, Felipe ; Larach, José Tomás</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c256t-6eaee69b16e777624b8bc9f25dbedfbabb7bb0a9dad65c2dab309c5541c071f53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Abdominal Surgery</topic><topic>Aged</topic><topic>Anastomosis, Surgical - education</topic><topic>Anastomosis, Surgical - methods</topic><topic>Colectomy - education</topic><topic>Colectomy - methods</topic><topic>Colonic Neoplasms - pathology</topic><topic>Colonic Neoplasms - surgery</topic><topic>Colorectal cancer</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Laparoscopy</topic><topic>Laparoscopy - education</topic><topic>Laparoscopy - methods</topic><topic>Learning Curve</topic><topic>Learning curves</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mesocolon - surgery</topic><topic>Middle Aged</topic><topic>Operative Time</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Proctology</topic><topic>Propensity Score</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vela, Javier</creatorcontrib><creatorcontrib>Riquoir, Christophe</creatorcontrib><creatorcontrib>Jarry, Cristián</creatorcontrib><creatorcontrib>Silva, Felipe</creatorcontrib><creatorcontrib>Besser, Nicolás</creatorcontrib><creatorcontrib>Urrejola, Gonzalo</creatorcontrib><creatorcontrib>Molina, María Elena</creatorcontrib><creatorcontrib>Miguieles, Rodrigo</creatorcontrib><creatorcontrib>Bellolio, Felipe</creatorcontrib><creatorcontrib>Larach, José Tomás</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vela, Javier</au><au>Riquoir, Christophe</au><au>Jarry, Cristián</au><au>Silva, Felipe</au><au>Besser, Nicolás</au><au>Urrejola, Gonzalo</au><au>Molina, María Elena</au><au>Miguieles, Rodrigo</au><au>Bellolio, Felipe</au><au>Larach, José Tomás</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Learning curve and safety of the implementation of laparoscopic complete mesocolic excision with intracorporeal anastomosis for right-sided colon cancer: results from a propensity score-matched study</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2024-09-01</date><risdate>2024</risdate><volume>38</volume><issue>9</issue><spage>5114</spage><epage>5121</epage><pages>5114-5121</pages><issn>0930-2794</issn><issn>1432-2218</issn><eissn>1432-2218</eissn><abstract>Background
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.
Methods
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).
Results
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).
Conclusion
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.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>39028345</pmid><doi>10.1007/s00464-024-11086-1</doi><tpages>8</tpages></addata></record> |
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| subjects | Abdominal Surgery Aged Anastomosis, Surgical - education Anastomosis, Surgical - methods Colectomy - education Colectomy - methods Colonic Neoplasms - pathology Colonic Neoplasms - surgery Colorectal cancer Female Gastroenterology Gynecology Hepatology Humans Laparoscopy Laparoscopy - education Laparoscopy - methods Learning Curve Learning curves Length of Stay - statistics & numerical data Male Medicine Medicine & Public Health Mesocolon - surgery Middle Aged Operative Time Postoperative Complications - epidemiology Postoperative Complications - etiology Proctology Propensity Score Retrospective Studies Surgery |
| title | Learning curve and safety of the implementation of laparoscopic complete mesocolic excision with intracorporeal anastomosis for right-sided colon cancer: results from a propensity score-matched study |
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