Minimally invasive esophagectomy learning curves with different types of background experience

Journal of Thoracic Disease

article

Olli Helminen¹  Joonas H. Kauppila¹  Henna Saviaro¹  Fredrik Yannopoulos¹  Sanna Meriläinen¹  Vesa Koivukangas¹  Heikki Huhta¹  Johanna Mrena²  Juha Saarnio¹  Eero Sihvo² 

[1] Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu;Department of Surgery, Central Finland Central Hospital;Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institute, Karolinska University Hospital;Department of Cardiothoracic Surgery, Oulu University Hospital

关键词: Minimally invasive esophagectomy (MIE);    learning curve;    cumulative sum (CUSUM);    surrogate surgery;    esophageal cancer;   

DOI  :  10.21037/jtd-21-1063

学科分类：呼吸医学

来源: Pioneer Bioscience Publishing Company

【 摘 要 】

Background: Minimally invasive esophagectomy (MIE) is a complex procedure with learning associated morbidity. The aim was to evaluate the learning curve for MIE focusing on short-term outcomes in two settings: (I) experienced MIE surgeon in new hospital (Hospital 1); (II) surgeons experienced with open esophagectomy and minimally invasive surrogate surgery (Hospital 2). Methods: In Hospital 1 and Hospital 2, on intent-to-treat basis number of MIEs were 132 and 57, respectively. The primary outcomes were major complications and anastomosis leaks. Secondary outcomes were operative time, blood loss, lymph node yield, hospital stay and 1-year mortality. Length of learning curves were analyzed with risk-adjusted cumulative sum (RA-CUSUM) method. Results: In Hospital 1, major complication and anastomosis leak rates were 9.8% and 4.5%, 22.8% and 12.3% in Hospital 2, respectively. In Hospital 1, complication and leak rates remained stable. In Hospital 2, improvement occurred after 34 cases in major complications and 29 cases in leaks. Of secondary outcomes, improvements were seen in Hospital 1 in operative time after 61, blood loss after 86, lymph node yield after 52, hospital stay after 19 and 1-year mortality after 24 cases. In Hospital 2, improvement occurred in operative time after 30, blood loss after 15, lymph node yield after 45, hospital stay after 50 and 1-year mortality after 15 cases. Conclusions: According to this study, learning phase of the individual surgeon determines the outcomes of MIE, not the institutional learning phase.

【 授权许可】

Unknown