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Surgeon Quality Control and Standardization of D2 Lymphadenectomy for Gastric Cancer: A Prospective Multicenter Observational Study (KLASS-02-QC)

 Sang-Uk Han  ;  Hoon Hur  ;  Hyuk-Joon Lee  ;  Gyu Seok Cho  ;  Min-Chan Kim  ;  Young Kyu Park  ;  Wook Kim  ;  Woo Jin Hyung 
 ANNALS OF SURGERY, Vol.273(2) : 315-324, 2021-02 
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Adult ; Aged ; Clinical Competence* ; Female ; Gastrectomy / standards* ; Humans ; Laparoscopy / standards* ; Lymph Node Excision / standards* ; Male ; Middle Aged ; Prospective Studies ; Quality Control* ; Randomized Controlled Trials as Topic ; Stomach Neoplasms / pathology ; Stomach Neoplasms / surgery* ; Treatment Outcome
Objective: To qualify surgeons to participate in a randomized trial comparing laparoscopic and open distal D2 gastrectomy for advanced gastric cancer. Summary of background data: No studies have sought to qualify surgeons for a randomized trial comparing laparoscopic and open D2 gastrectomy for advanced gastric cancer. Methods: We conducted a multicenter prospective observational study evaluating unedited videos of laparoscopic and open D2 gastrectomy performed by 27 surgeons. Surgeons performed 3 of each laparoscopic and open distal gastrectomies with D2 lymphadenectomy for gastric cancer. Five peers reviewed each unedited video using a video assessment form. Based on experts' review of videos, a separate review committee decided surgeons as "Qualified" or "Not-qualified." Results: Twelve surgeons (44.4%) were qualified on initial evaluation whereas the other 15 surgeons were not. Another 9 surgeons were finally qualified after re-evaluation. The median score for Qualified was significantly higher than Not-qualified (P < 0.001).Significant differences between Qualified and Not-qualified were noted both in operation type and in all evaluation area of surgical skill, perigastric, and extra-perigastric lymphadenectomy, although the inter-rater variability of the assessment score was low (kappa = 0.285). However, Not-qualified surgeons' scores improved upon re-evaluation of resubmitted videos.When compared laparoscopy with open surgery, median scores were similar between the 2 groups (P = 0.680). However, open gastrectomy scores for surgical skills were significantly higher than for laparoscopic surgery (P = 0.016). Conclusions: Our surgeon quality control study for gastrectomy represents a milestone in surgical standardization for surgical clinical trials. Our methods could also serve as a system for educating surgeons and assessing surgical proficiency.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Hyung, Woo Jin(형우진) ORCID logo https://orcid.org/0000-0002-8593-9214
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