Structured training pathway and proctoring; multicenter results of the implementation of transanal total mesorectal excision (TaTME) in the Netherlands
Structured training pathway and proctoring; multicenter results of the implementation of transanal total mesorectal excision (TaTME) in the Netherlands
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DOI：
10.1007/s00464-019-06750-w
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发表时间：
2020-01-01
影响因子：
3.1
通讯作者：
Tuynman, J. B.
中科院分区：
文献类型：
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作者：
Helbach, M. Veltcamp;van Oostendorp, S. E.;Tuynman, J. B.
背景经肛门全直肠系膜切除术（TaTME）是一种新的复杂技术，有可能提高中低位直肠癌患者的直肠系膜切除质量。这一程序在技术上具有挑战性，而且已经证明与相对较长的学习曲线有关，这可能会妨碍广泛采用。因此，荷兰为TaTME建立了一个国家结构化培训途径，以便安全实施。本研究的目的是监测12个中心培训计划的安全性和有效性。方法在荷兰的12个参与中心，在国家结构化培训途径内，对前10例TaTME手术的短期结局进行评价。在直肠癌根治术期间和之后进行手术的连续性患者纳入研究。主要结局为术中并发症的发生率，次要结局包括术后并发症和病理结局。结果2018年10月，12家医院完成了培训计划，每个中心的前10名患者被纳入评估。术中并发症发生率为4.9%。临床病理学结果报告100%的患者标本完整或接近完整，100%的患者远端切缘阴性，5.0%的患者环周切缘阳性。总体术后并发症发生率为45.0%，Clavien-Dindo ≥ III的发生率为19.2%，吻合口瘘发生率为17.3%。结论：本研究表明，全国性的TaTME结构化培训计划在每个中心的前10个连续病例中，在术中和病理结局方面安全实施了TaTME。然而，即使在结构化的培训途径中，术后发病率也很高，外科医生应该意识到这种新技术的学习曲线。
Background Transanal total mesorectal excision (TaTME) is a new complex technique with potential to improve the quality of surgical mesorectal excision for patients with mid and low rectal cancer. The procedure is technically challenging and has shown to be associated with a relative long learning curve which might hamper widespread adoption. Therefore, a national structured training pathway for TaTME has been set up in the Netherlands to allow safe implementation. The aim of this study was to monitor safety and efficacy of the training program with 12 centers. Methods Short-term outcomes of the first ten TaTME procedures were evaluated in 12 participating centers in the Netherlands within the national structured training pathway. Consecutive patients operated during and after the proctoring program for rectal carcinoma with curative intent were included. Primary outcome was the incidence of intraoperative complications, secondary outcomes included postoperative complications and pathological outcomes. Results In October 2018, 12 hospitals completed the training program and from each center the first 10 patients were included for evaluation. Intraoperative complications occurred in 4.9% of the cases. The clinicopathological outcome reported 100% for complete or nearly complete specimen, 100% negative distal resection margin, and the circumferential resection margin was positive in 5.0% of patients. Overall postoperative complication rate was 45.0%, with 19.2% Clavien-Dindo >= III and an anastomotic leak rate of 17.3%. Conclusions This study shows that the nationwide structured training program for TaTME delivers safe implementation of TaTME in terms of intraoperative and pathology outcomes within the first ten consecutive cases in each center. However, postoperative morbidity is substantial even within a structured training pathway and surgeons should be aware of the learning curve of this new technique.