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Can better surgical outcomes be obtained in the learning process of robotic rectal cancer surgery? A propensity score-matched comparison between learning phases

Authors
 Jong Min Lee  ;  Seung Yoon Yang  ;  Yoon Dae Han  ;  Min Soo Cho  ;  Hyuk Hur  ;  Byung Soh Min  ;  Kang Young Lee  ;  Nam Kyu Kim 
Citation
 SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol.35(2) : 770-778, 2021-02 
Journal Title
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES
ISSN
 0930-2794 
Issue Date
2021-02
MeSH
Aged ; Female ; Humans ; Laparoscopy / methods ; Learning / physiology* ; Male ; Propensity Score ; Rectal Neoplasms / surgery* ; Robotic Surgical Procedures / methods* ; Treatment Outcome
Keywords
Learning curve ; Rectal cancer ; Robot ; Surgical outcome
Abstract
Background: Although studies of robotic rectal cancer surgery have demonstrated the effects of learning on operation time, comparisons have failed to demonstrate differences in clinicopathological outcomes between unadjusted learning phases. This study aimed to investigate the learning curve of robotic rectal cancer surgery for clinicopathological outcomes and compare surgical outcomes between adjusted learning phases. Study design We enrolled 506 consecutive patients with rectal adenocarcinoma who underwent robotic resection by a single surgeon between 2007 and 2018. Risk-adjusted cumulative sum (RA-CUSUM) for surgical failure was used to analyze the learning curve. Surgical failure was defined as the occurrence of any of the following: conversion to open surgery, severe complications (Clavien-Dindo grade ≥ 3a), insufficient number of harvested lymph nodes (LNs), or R1 resection. Comparisons between learning phases analyzed by RA-CUSUM were performed before and after propensity score matching.

Results: In RA-CUSUM analysis, the learning curve was divided into two learning phases: phase 1 (1st-177th cases, n = 177) and phase 2 (178th-506th cases, n = 329). Before matching, patients in phase 2 had deeper tumor invasion and higher rates of positive LNs on pretreatment images and preoperative chemoradiotherapy. After matching, phase 1 (n = 150) and phase 2 (n = 150) patients exhibited similar clinical characteristics. Phase 2 patients had lower rates of surgical failure overall and these components: conversion to open surgery, severe complications, and insufficient harvested LNs.

Conclusions: For robotic rectal cancer surgery, surgical outcomes improved after the 177th case. Further studies by other robotic surgeons are required to validate our results.
Full Text
https://link.springer.com/article/10.1007%2Fs00464-020-07445-3
DOI
10.1007/s00464-020-07445-3
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Nam Kyu(김남규) ORCID logo https://orcid.org/0000-0003-0639-5632
Min, Byung Soh(민병소) ORCID logo https://orcid.org/0000-0003-0180-8565
Yang, Seung Yoon(양승윤) ORCID logo https://orcid.org/0000-0001-8129-7712
Lee, Kang Young(이강영)
Lee, Jong Min(이종민) ORCID logo https://orcid.org/0000-0003-1654-1533
Cho, Min Soo(조민수)
Han, Yoon Dae(한윤대) ORCID logo https://orcid.org/0000-0002-2136-3578
Hur, Hyuk(허혁) ORCID logo https://orcid.org/0000-0002-9864-7229
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/184174
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