Does staged surgical training for minimally invasive esophagectomy have an impact on short-term outcomes?
- PDF / 566,076 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 94 Downloads / 180 Views
and Other Interventional Techniques
Does staged surgical training for minimally invasive esophagectomy have an impact on short‑term outcomes? Koshiro Ishiyama1,2 · Takeo Fujita3 · Hisashi Fujiwara3 · Daisuke Kurita1 · Junya Oguma1 · Hitoshi Katai4 · Hiroyuki Daiko1 Received: 13 July 2020 / Accepted: 21 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background sophageal cancer has a low incidence, and the anatomy is difficult to understand during esophagectomy. This necessitates a precise and lengthy operation. Therefore, the establishment of a training system in esophageal surgery is of critical importance. In this study, we compared the short-term outcomes of minimally invasive esophagectomy (MIE) performed by consultants versus trainees and explored the factors that impacted the thoracic operation time for each group. Methods We have introduced standardized MIE surgical techniques to our trainees in 2016. Our procedure consists of a laparoscopic phase and a thoracoscopic phase and is systematically designed to be learned in a step-by-step manner in each phase. We retrospectively identified 308 patients who underwent MIE from April 2016 to April 2018. The patients were divided into those who underwent MIE by consultants and those who underwent MIE by trainees. The preoperative background factors, operation-related factors, and postoperative complications were compared between the two groups. We also assessed the association between a prolonged thoracic operation time and tumor-and patient-related factors in each of the consults and trainees. Results Significantly more patients had stage ≥ III cancer in the consultant than trainee group. However, the postoperative complications were comparable, specifically pneumonia (11% vs. 18%), anastomotic leakage (11% vs. 13%), and mortality (0.6% vs. 1.3%). There was no significant difference in the lymph node yield (20 vs. 17) or R0 resection rate (94% vs. 91%) between the two groups. However, the trainees had a significantly longer thoracic operation time (143 ± 34 vs. 190 ± 28 min) and significantly greater blood loss (93 vs. 183 ml). Oncological factors were correlated with a prolonged thoracic operation time in the consultants, but not in the trainees. Conclusions Under standardized surgical management using a stepwise educational program, performance of MIE by trainees has no impact on short-term outcomes. Keywords Esophageal cancer · Minimally invasive esophagectomy · Surgical training · Complication
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-020-08125-y) contains supplementary material, which is available to authorized users. * Hiroyuki Daiko [email protected] 1
Division of Esophageal Surgery, National Cancer Center Hospital, 5‑1‑1 Tsukiji, Chuo‑Ku 104‑0045, Japan
2
Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, 2‑1‑1 Hongo, Bunkyo‑ku 113‑8421, Japan
3
Division of Esophageal Surgery, National Can
Data Loading...
