Learning curve of laparoscopic assisted radical resection for rectal cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WUYunhua ¹ , QIJie ² ,  SUNXuejun ¹ , ZHENGJianbao ¹ , GAOQi ¹ , WEIGuangbing ¹ , WANGWei ¹ , CUIFeibo ¹

1. Department of General Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, P.R. China;
2. Second Department of Cardiovascular Medicine, Shaanxi Provincial People’s Hospital, Xi’an 710068, P.R.China;

Corresponding?author：

SUNXuejun, Email: sunxy@mail.xjtu.edu.cn

Keywords：

aparoscopic surgery; rectal cancer; learning curve; short-term effect

DOI：

10.7507/1007-9424.201605106

Video：

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Objective To investigate the learning curve of laparoscopic assisted rectal cancer radical resection of a surgeon and share the experience of laparoscopic surgery. Methods The date of 119 consecutive patients who were suffered operation by same team during January 2010 to December 2015 were retrospectively analyzed. The learning curve and its stages were obtained by using weighted moving average method, cumulative sum analysis(CUSUM), risk-adjusted CUSUM (RA-CUSUM)and Matlab software. The effects of each stage, such as operative time, intraoperative bold loss, harvested lymph node numbers, distal margin to the edge of tumor, complications after operation, hospital stay days, and the first time take soft food were compared, and the experience of laparoscopic assisted surgery for rectal cancer was summarized. Results Our learning curve was divided into three periods, the cutting point was around 36^th and 80^th cases, respectively. There was no significant difference between the 3 stages in general data, however when comparing the operative time, loss of blood, harvested lymph node numbers, the distal margin to the edge of tumor, hospital stay and total complications, the last period were best and the first stage were worst. Conclusions The learning curve can be divided into three stages, the exploration, mastery and proficient period. Our term, fixed and with rich experience in laparotomy, completed our first exploration period at about 36^th patients and the second stage is around 80^th cases. And the short term effect of each period’s had gradually improved with master of laparoscopic technique.

Citation： WUYunhua, QIJie, SUNXuejun, ZHENGJianbao, GAOQi, WEIGuangbing, WANGWei, CUIFeibo. Learning curve of laparoscopic assisted radical resection for rectal cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(1): 37-42. doi: 10.7507/1007-9424.201605106 Copy

1.	Green BL, Marshall HC, Collinson F,et al. Long-term follow-up of the Medical Research Council CLASICC trial of conventionalversus laparoscopically assisted resection in colorectal cancer. Br J Surg, 2013, 100(1): 75-82.
2.	Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R,et al. Survival after laparoscopic surgeryversus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol, 2009, 10(1): 44-52.
3.	Laurent C, Leblanc F, Wütrich P,et al. Laparoscopicversus open surgery for rectal cancer: long-term oncologic results. Ann Surg, 2009, 250(1): 54-61.
4.	Foo CC, Law WL. The learning curve of robotic-assisted low rectal resection of a novice rectal surgeon. World J Surg, 2016, 40(2): 456-462.
5.	李國新, 閏鴻濤, 余江, 等. 腹腔鏡直腸癌切除術術的學習曲線. 南方醫科大學學報, 2006, 26(4): 535-538.
6.	Li JC, Hon SS, Ng SS,et al. The learning curve for laparoscopic colectomy: experience of a surgical fellow in an university colorectal unit. Surg Endosc, 2009, 23(7): 1603-1608.
7.	Ratti F, Barkhatov LI, Tomassini F,et al. Learning curve of self-taught laparoscopic liver surgeons in left lateral sectionectomy: results from an international multi-institutional analysis on 245 cases. Surg Endosc, 2015, 30(8): 3618-3629.
8.	Tsai KY, Kiu KT, Huang MT,et al. The learning curve for laparoscopic colectomy in colorectal cancer at a new regional hospital. Asian J Surg, 2016, 39(1): 34-40.
9.	池畔, 林惠銘. 腹腔鏡結直腸癌根治術學習曲線. 中華胃腸外科雜志, 2004, 7(5): 372-374.
10.	Park EJ, Kim CW, Cho MS,et al. Multidimensional analyses of the learning curve of robotic low anterior resection for rectal cancer: 3-phase learning process comparison. Surg Endosc, 2014, 28(10): 2821-2831.
11.	孫燕, 鄭樹, 萬德森, 等. 中國結直腸癌診療規范(2015版). 中華消化外科雜志, 2015, 14 (10): 783-799.
12.	Kim CW, Kim WR, Kim HY,et al. Learning curve for single-incision laparoscopic anterior resection for sigmoid colon cancer. J Am Coll Surg, 2015, 221(2): 397-403.
13.	Steiner SH, Cook RJ, Farewell VT,et al. Monitoring surgical performance using risk-adjusted cumulative sum charts. Biostatistics, 2000, 1(4): 441-452.
14.	Cook DA, Duke G, Hart GK,et al. Review of the application of risk-adjusted charts to analyse mortality outcomes in critical care. Crit Care Resusc, 2008, 10(3): 239-251.
15.	Clavien PA, Barkun J, de Oliveira ML,et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
16.	Chen K, Zhang Z, Zuo Y,et al. Comparison of the clinical outcomes of laparoscopic-assistedversus open surgery for colorectal cancer. Oncol Lett, 2014, 7(4): 1213-1218.
17.	Park EJ, Kim MS, Kim G,et al. Long-term oncologic outcomes of laparoscopic right hemicolectomy during the learning curve period: comparative study with cases after the learning curve period. Surg Laparosc Endosc Percutan Tech, 2015, 25(1): 52-58.
18.	Huang C, Shen JC, Zhang J,et al. Clinical comparison of laparoscopyvs open surgery in a radical operation for rectal cancer: A retrospective case-control study. World J Gastroenterol, 2015, 21(48): 13532-13541.
19.	Kim CW, Han YD, Kim HY,et al. Learning curve for single-incision laparoscopic resection of right-sided colon cancer by complete mesocolic excision. Medicine (Baltimore), 2016, 95 (26): e3982.
20.	Heroor A, Panjwani G, Chaskar R. A study of 101 laparoscopic colorectal surgeries: a single surgeon experience. how important is the learning curve. Indian J Surg, 2015, 77(Suppl 3): 1275-1279.
21.	蘭遠志, 曾冬竹, 張超, 等. 達芬奇機器人直腸癌根治術的學習曲線. 中國微創外科雜志, 2014, 14(6): 490-493.
22.	桂林, 蔣鵬程, 管榮祥, 等. 腹腔鏡輔助胃癌D2根治術學習曲線研究. 中國實用外科雜志, 2013, 33(2): 146-149.
23.	譚明華, 朱勁濤, 呂益中, 等. 腹腔鏡輔助Dixon及Miles根治術治療低位直腸癌的療效比較. 嶺南現代臨床外科, 2014, 14(3): 251-255.
24.	Choi YY, Song JH, An JY. Reply: factors favorable to reducing the learning curve of laparoscopic gastrectomy for gastric cancer. J Gastric Cancer, 2016, 16(2): 128-129.
25.	Tan CL, Zhang H, Peng B,et al. Outcome and costs of laparoscopic pancreaticoduodenectomy during the initial learning curvevs laparotomy. World J Gastroenterol, 2015, 21(17): 5311-5319.

1. Green BL, Marshall HC, Collinson F,et al. Long-term follow-up of the Medical Research Council CLASICC trial of conventionalversus laparoscopically assisted resection in colorectal cancer. Br J Surg, 2013, 100(1): 75-82.
2. Colon Cancer Laparoscopic or Open Resection Study Group, Buunen M, Veldkamp R,et al. Survival after laparoscopic surgeryversus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol, 2009, 10(1): 44-52.
3. Laurent C, Leblanc F, Wütrich P,et al. Laparoscopicversus open surgery for rectal cancer: long-term oncologic results. Ann Surg, 2009, 250(1): 54-61.
4. Foo CC, Law WL. The learning curve of robotic-assisted low rectal resection of a novice rectal surgeon. World J Surg, 2016, 40(2): 456-462.
5. 李國新, 閏鴻濤, 余江, 等. 腹腔鏡直腸癌切除術術的學習曲線. 南方醫科大學學報, 2006, 26(4): 535-538.
6. Li JC, Hon SS, Ng SS,et al. The learning curve for laparoscopic colectomy: experience of a surgical fellow in an university colorectal unit. Surg Endosc, 2009, 23(7): 1603-1608.
7. Ratti F, Barkhatov LI, Tomassini F,et al. Learning curve of self-taught laparoscopic liver surgeons in left lateral sectionectomy: results from an international multi-institutional analysis on 245 cases. Surg Endosc, 2015, 30(8): 3618-3629.
8. Tsai KY, Kiu KT, Huang MT,et al. The learning curve for laparoscopic colectomy in colorectal cancer at a new regional hospital. Asian J Surg, 2016, 39(1): 34-40.
9. 池畔, 林惠銘. 腹腔鏡結直腸癌根治術學習曲線. 中華胃腸外科雜志, 2004, 7(5): 372-374.
10. Park EJ, Kim CW, Cho MS,et al. Multidimensional analyses of the learning curve of robotic low anterior resection for rectal cancer: 3-phase learning process comparison. Surg Endosc, 2014, 28(10): 2821-2831.
11. 孫燕, 鄭樹, 萬德森, 等. 中國結直腸癌診療規范(2015版). 中華消化外科雜志, 2015, 14 (10): 783-799.
12. Kim CW, Kim WR, Kim HY,et al. Learning curve for single-incision laparoscopic anterior resection for sigmoid colon cancer. J Am Coll Surg, 2015, 221(2): 397-403.
13. Steiner SH, Cook RJ, Farewell VT,et al. Monitoring surgical performance using risk-adjusted cumulative sum charts. Biostatistics, 2000, 1(4): 441-452.
14. Cook DA, Duke G, Hart GK,et al. Review of the application of risk-adjusted charts to analyse mortality outcomes in critical care. Crit Care Resusc, 2008, 10(3): 239-251.
15. Clavien PA, Barkun J, de Oliveira ML,et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
16. Chen K, Zhang Z, Zuo Y,et al. Comparison of the clinical outcomes of laparoscopic-assistedversus open surgery for colorectal cancer. Oncol Lett, 2014, 7(4): 1213-1218.
17. Park EJ, Kim MS, Kim G,et al. Long-term oncologic outcomes of laparoscopic right hemicolectomy during the learning curve period: comparative study with cases after the learning curve period. Surg Laparosc Endosc Percutan Tech, 2015, 25(1): 52-58.
18. Huang C, Shen JC, Zhang J,et al. Clinical comparison of laparoscopyvs open surgery in a radical operation for rectal cancer: A retrospective case-control study. World J Gastroenterol, 2015, 21(48): 13532-13541.
19. Kim CW, Han YD, Kim HY,et al. Learning curve for single-incision laparoscopic resection of right-sided colon cancer by complete mesocolic excision. Medicine (Baltimore), 2016, 95 (26): e3982.
20. Heroor A, Panjwani G, Chaskar R. A study of 101 laparoscopic colorectal surgeries: a single surgeon experience. how important is the learning curve. Indian J Surg, 2015, 77(Suppl 3): 1275-1279.
21. 蘭遠志, 曾冬竹, 張超, 等. 達芬奇機器人直腸癌根治術的學習曲線. 中國微創外科雜志, 2014, 14(6): 490-493.
22. 桂林, 蔣鵬程, 管榮祥, 等. 腹腔鏡輔助胃癌D2根治術學習曲線研究. 中國實用外科雜志, 2013, 33(2): 146-149.
23. 譚明華, 朱勁濤, 呂益中, 等. 腹腔鏡輔助Dixon及Miles根治術治療低位直腸癌的療效比較. 嶺南現代臨床外科, 2014, 14(3): 251-255.
24. Choi YY, Song JH, An JY. Reply: factors favorable to reducing the learning curve of laparoscopic gastrectomy for gastric cancer. J Gastric Cancer, 2016, 16(2): 128-129.
25. Tan CL, Zhang H, Peng B,et al. Outcome and costs of laparoscopic pancreaticoduodenectomy during the initial learning curvevs laparotomy. World J Gastroenterol, 2015, 21(17): 5311-5319.

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